{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T17:58:35Z","timestamp":1790618315465,"version":"4.1.0"},"reference-count":53,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T00:00:00Z","timestamp":1790467200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Selective laser trabeculoplasty (SLT) has emerged as a primary or adjunctive treatment choice for lowering intraocular pressure (IOP) in open-angle glaucoma (OAG) and ocular hypertension (OHT), addressing limitations of long-term topical therapy such as adherence challenges and cumulative ocular surface burden. This narrative review synthesizes current evidence on the mechanisms, efficacy and durability, safety, re-treatment, and predictors of response for SLT, with additional focus on treatment parameters (180\u00b0 vs. 360\u00b0), emerging laser modalities (automated direct SLT\/DSLT and micropulse laser trabeculoplasty\/MLT), and economic and real-world effectiveness considerations. Mechanistically, SLT is based on selective photothermolysis of pigmented trabecular meshwork cells, aiming to minimize collateral structural damage and thereby support repeatability. Clinical outcomes from high-quality randomized evidence\u2014most prominently the LiGHT program\u2014demonstrate that SLT-first strategies achieve IOP control comparable to initial eye drops, with important patient-centered benefits including greater \u201cdrop-free\u201d persistence, reduced medication burden, and lower need for incisional surgery over extended follow-up. However, durability attenuates over time in both trial and real-world settings, and long-term control may require escalation or re-treatment. The safety profile is characterized mainly by expected transient anterior segment inflammation and early IOP spikes, while rare vision-relevant complications (e.g., cystoid macular edema) have been reported, particularly in higher-risk clinical contexts such as prior intraocular surgery. Evidence supports meaningful repeatability, with a second SLT session showing the strongest support; data beyond later cycles remain more limited. Across studies, baseline IOP is the most consistent predictor of success, while factors such as fellow-eye response and trabecular angle pigmentation may influence both effectiveness and spike risk. Comparative evidence suggests that 360\u00b0 SLT generally provides stronger early IOP reduction than 180\u00b0 SLT, with differences becoming less consistent over longer follow-up. Emerging modalities may improve workflow efficiency (DSLT) and procedural tolerability (MLT), though larger datasets and longer-term durability evidence are still needed. Finally, cost-effectiveness analyses\u2014especially when SLT is used as first-line therapy\u2014support favorable economic outcomes driven by reduced or delayed ongoing medication use. Overall, SLT is well positioned as a cornerstone of modern glaucoma care, with optimal outcomes dependent on appropriate patient selection, parameter choice, risk-adapted follow-up, and safe re-treatment planning.<\/jats:p>","DOI":"10.3390\/jcm15197510","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T16:50:54Z","timestamp":1790614254000},"page":"7510","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Selective Laser Trabeculoplasty in Open-Angle Glaucoma and Ocular Hypertension: A Narrative Review of Current Evidence"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2835-8413","authenticated-orcid":false,"given":"Makedonka Atanasovska","family":"Velkovska","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1016\/S0014-4835(05)80093-4","article-title":"Selective Targeting of Trabecular Meshwork Cells: In Vitro Studies of Pulsed and CW Laser Interactions","volume":"60","author":"Latina","year":"1995","journal-title":"Exp. Eye Res."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Hogarth, G. (2026). SLT (Selective Laser Trabeculoplasty): An Overview. J. Found. Ophthalmol.","DOI":"10.48089\/jfo7689158"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1016\/j.ophtha.2019.10.023","article-title":"Efficacy of Repeat Selective Laser Trabeculoplasty in Medication-Naive Open-Angle Glaucoma and Ocular Hypertension during the LiGHT Trial","volume":"127","author":"Garg","year":"2020","journal-title":"Ophthalmology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.ophtha.2022.09.009","article-title":"Laser in Glaucoma and Ocular Hypertension (LiGHT) Trial: Six-Year Results of Primary Selective Laser Trabeculoplasty versus Eye Drops for the Treatment of Glaucoma and Ocular Hypertension","volume":"130","author":"Gazzard","year":"2023","journal-title":"Ophthalmology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1097\/APO.0000000000000175","article-title":"Selective Laser Trabeculoplasty: An Update","volume":"5","author":"Kennedy","year":"2016","journal-title":"Asia-Pac. J. Ophthalmol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"963","DOI":"10.18240\/ijo.2024.05.22","article-title":"Mechanism of Selective Laser Trabeculoplasty: A Systemic Review","volume":"17","author":"Chen","year":"2024","journal-title":"Int. J. Ophthalmol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.1016\/S0140-6736(18)32213-X","article-title":"Selective Laser Trabeculoplasty versus Eye Drops for First-Line Treatment of Ocular Hypertension and Glaucoma (LiGHT): A Multicentre Randomised Controlled Trial","volume":"393","author":"Gazzard","year":"2019","journal-title":"Lancet"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1016\/j.ajo.2006.06.018","article-title":"Selective Laser Trabeculoplasty as Initial and Adjunctive Treatment for Open-Angle Glaucoma","volume":"142","author":"McIlraith","year":"2006","journal-title":"Am. J. Ophthalmol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1413","DOI":"10.1136\/bjo.2004.052795","article-title":"A Randomised, Prospective Study Comparing Selective Laser Trabeculoplasty with Latanoprost for the Control of Intraocular Pressure in Ocular Hypertension and Open Angle Glaucoma","volume":"89","author":"Nagar","year":"2005","journal-title":"Br. J. Ophthalmol."},{"key":"ref_10","first-page":"CD003919","article-title":"Laser Trabeculoplasty for Open-angle Glaucoma and Ocular Hypertension","volume":"8","author":"Paranhos","year":"2022","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Swain, D.L., and Eliassi-Rad, B. (2022). Five-Year Outcomes of Selective Laser Trabeculoplasty: A Retrospective Study. Front Med., 9.","DOI":"10.3389\/fmed.2022.1039195"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"104743","DOI":"10.1016\/j.pdpdt.2025.104743","article-title":"What Is the Long-Term Efficacy and Safety of Selective Laser Trabeculoplasty in the Management of Primary Open-Angle Glaucoma? A Systematic Review and Meta-Analysis","volume":"56","author":"Chen","year":"2025","journal-title":"Photodiagn. Photodyn. Ther."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1016\/j.ophtha.2019.11.017","article-title":"Real-World Outcomes of Selective Laser Trabeculoplasty in the United Kingdom","volume":"127","author":"Khawaja","year":"2020","journal-title":"Ophthalmology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e306","DOI":"10.1111\/j.1755-3768.2010.02029.x","article-title":"Inflammation Assessment after Selective Laser Trabeculoplasty (SLT) Treatment","volume":"89","author":"Ayala","year":"2011","journal-title":"Acta Ophthalmol."},{"key":"ref_15","first-page":"365","article-title":"Early Intraocular Pressure Spikes Observed After Selective Laser Trabeculoplasty Treatment and Risk Factors","volume":"44","year":"2014","journal-title":"Turk. J. Ophthalmol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1957","DOI":"10.1177\/11206721241237305","article-title":"Intraocular Pressure Profile Following Selective Laser Trabeculoplasty in Pigmentary and Primary Open-Angle Glaucoma","volume":"34","author":"Hallaj","year":"2024","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1891","DOI":"10.1007\/s10792-018-1000-5","article-title":"Cystoid Macular Edema Following Selective Laser Trabeculoplasty in a Patient with Ocular Hypertension","volume":"39","year":"2019","journal-title":"Int. Ophthalmol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"137","DOI":"10.2147\/OPTH.S84996","article-title":"Complications of Selective Laser Trabeculoplasty: A Review","volume":"10","author":"Song","year":"2016","journal-title":"Clin. Ophthalmol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.1111\/ceo.13979","article-title":"Selective Laser Trabeculoplasty: A Review","volume":"49","author":"Landers","year":"2021","journal-title":"Clin. Exp. Ophthalmol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1080\/02713683.2025.2485223","article-title":"A Comparison of the 360\u00b0 Versus 180\u00b0 of Selective Laser Trabeculoplasty (SLT) in the Treatment of Open Angle Glaucoma (OAG) and Ocular Hypertension (OHT): A Comprehensive Systematic Review and Meta-Analysis","volume":"50","author":"Amaral","year":"2025","journal-title":"Curr. Eye Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1097\/IJG.0000000000002415","article-title":"180- Versus 360-Degree Selective Laser Trabeculoplasty in Open Angle Glaucoma and Ocular Hypertension: A Systematic Review and Meta-Analysis","volume":"33","author":"Zhu","year":"2024","journal-title":"J. Glaucoma"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1007\/s10792-019-01275-6","article-title":"Comparison of the Effects of 180\u00b0 and 360\u00b0 Applications of Selective Laser Trabeculoplasty on Intraocular Pressure and Cornea","volume":"40","year":"2020","journal-title":"Int. Ophthalmol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1038\/eye.2017.273","article-title":"Selective Laser Trabeculoplasty: Past, Present, and Future","volume":"32","author":"Garg","year":"2018","journal-title":"Eye"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Francis, B.A., Loewen, N., Hong, B., Dustin, L., Kaplowitz, K., Kinast, R., Bacharach, J., Radhakrishnan, S., Iwach, A., and Rudavska, L. (2016). Repeatability of Selective Laser Trabeculoplasty for Open-Angle Glaucoma. BMC Ophthalmol., 16.","DOI":"10.1186\/s12886-016-0299-9"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.ophtha.2023.07.029","article-title":"Selective Laser Trabeculoplasty for the Treatment of Glaucoma: A Report by the American Academy of Ophthalmology","volume":"131","author":"Takusagawa","year":"2024","journal-title":"Ophthalmology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"20","DOI":"10.21037\/aes.2019.05.01","article-title":"Selective Laser Trabeculoplasty: A Review of Repeatability","volume":"4","author":"Guo","year":"2019","journal-title":"Ann. Eye Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"117","DOI":"10.5005\/jp-journals-10078-1302","article-title":"Repeat Selective Laser Trabeculoplasty for Glaucoma Patients: A Systematic Review and Meta-Analysis","volume":"15","author":"Jang","year":"2021","journal-title":"J. Curr. Glaucoma Pract."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"444","DOI":"10.4103\/2008-322X.150814","article-title":"Long Term Efficacy of Repeat Selective Laser Trabeculoplasty","volume":"9","author":"Khouri","year":"2014","journal-title":"J. Ophthalmic Vis. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1016\/j.ogla.2020.12.013","article-title":"Selective Laser Trabeculoplasty: Outcomes of Multiple Repeat Treatments","volume":"4","author":"Wang","year":"2021","journal-title":"Ophthalmol. Glaucoma"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1597","DOI":"10.1007\/s00417-021-05098-z","article-title":"10-Year Outcomes of First-Line Selective Laser Trabeculoplasty (SLT) for Primary Open-Angle Glaucoma (POAG)","volume":"259","author":"Ansari","year":"2021","journal-title":"Graefes Arch. Clin. Exp. Ophthalmol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.ogla.2019.11.010","article-title":"Predictors of Success in Selective Laser Trabeculoplasty","volume":"3","author":"Kuley","year":"2020","journal-title":"Ophthalmol. Glaucoma"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"9428","DOI":"10.1038\/s41598-020-66473-0","article-title":"Predictive Factors for Outcomes of Selective Laser Trabeculoplasty","volume":"10","author":"Hirabayashi","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1097\/IJG.0000000000001534","article-title":"Predictors of Success in Selective Laser Trabeculoplasty: Data from the Lausanne Laser Trabeculoplasty Registry","volume":"29","author":"Elahi","year":"2020","journal-title":"J. Glaucoma"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.ogla.2025.08.008","article-title":"Predictors of Selective Laser Trabeculoplasty Efficacy","volume":"9","author":"Dahlgren","year":"2026","journal-title":"Ophthalmol. Glaucoma"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e236","DOI":"10.1097\/MD.0000000000000236","article-title":"Predictors of Success in Selective Laser Trabeculoplasty for Normal Tension Glaucoma","volume":"93","author":"Lee","year":"2014","journal-title":"Medicine"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1001\/archophthalmol.2011.108","article-title":"Intraocular Pressure Response to Selective Laser Trabeculoplasty in the First Treated Eye vs the Fellow Eye","volume":"129","author":"Shazly","year":"2011","journal-title":"Arch. Ophthalmol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/j.ajo.2020.07.046","article-title":"Laser Trabeculoplasty for Open-Angle Glaucoma: A Systematic Review and Network Meta-Analysis","volume":"229","author":"Zhou","year":"2021","journal-title":"Am. J. Ophthalmol."},{"key":"ref_38","first-page":"e54116","article-title":"Identifying Baseline Predictors of Selective Laser Trabeculoplasty Effectiveness: An Alternative Mathematical Approach","volume":"16","author":"Dendumrongsup","year":"2024","journal-title":"Cureus"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e002151","DOI":"10.1136\/bmjophth-2025-002151","article-title":"Real-World Outcomes of Selective Laser Trabeculoplasty and Medical Treatment in Primary Open-Angle Glaucoma and Ocular Hypertension","volume":"10","author":"Fu","year":"2025","journal-title":"BMJ Open Ophthalmol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e001870","DOI":"10.1136\/bmjophth-2024-001870","article-title":"Comparative Outcomes of Selective Laser Trabeculoplasty Delivered by Optometrists Compared with Ophthalmologists: A UK-Based Multicentre Observational Study","volume":"9","author":"Lee","year":"2024","journal-title":"BMJ Open Ophthalmol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2589","DOI":"10.1038\/s41433-024-03086-1","article-title":"Optometrist-Delivered Selective Laser Trabeculoplasty in the HES\u2014A Training Protocol and Early Service Evaluation","volume":"38","author":"Konstantakopoulou","year":"2024","journal-title":"Eye"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2284","DOI":"10.1038\/s41433-025-03857-4","article-title":"The Safety and Effectiveness of Optometrist-Delivered Selective Laser Trabeculoplasty","volume":"39","author":"Swystun","year":"2025","journal-title":"Eye"},{"key":"ref_43","unstructured":"(2026, August 30). Overview|Glaucoma: Diagnosis and Management|Guidance|NICE. Available online: https:\/\/www.nice.org.uk\/guidance\/ng81."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1167\/tvst.10.3.5","article-title":"Automated Direct Selective Laser Trabeculoplasty: First Prospective Clinical Trial","volume":"10","author":"Goldenfeld","year":"2021","journal-title":"Transl. Vis. Sci. Technol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1136\/bjophthalmol-2021-319379","article-title":"Direct Selective Laser Trabeculoplasty in Open Angle Glaucoma Study Design: A Multicentre, Randomised, Controlled, Investigator-Masked Trial (GLAUrious)","volume":"107","author":"Congdon","year":"2023","journal-title":"Br. J. Ophthalmol."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Zollet, P., Macario, F., Healy, R., Manasses, D.T., Sebastian, R.T., and Romano, M.R. (2026). Real World Comparison of Direct Selective Laser Trabeculoplasty Versus Selective Laser Trabeculoplasty: 12-Month Retrospective Study of a Tertiary Center in the UK. Biomedicines, 14.","DOI":"10.3390\/biomedicines14010156"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Confalonieri, F., Casarini, B., Papapicco, A., Stiro, F., Piscopo, R., D\u2019Andrea, L., Petrovski, G., and Verdina, T. (2025). A Systematic Review of Micropulse Laser Trabeculoplasty (MLT) in Primary Open-Angle Glaucoma (POAG) Management: Efficacy, Safety, and Future Perspectives. Biomedicines, 13.","DOI":"10.3390\/biomedicines13010211"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1007\/s10103-025-04450-7","article-title":"Noninferiority of Selective and Micropulse Laser Trabeculoplasties: A Meta-Analysis and Systematic Review","volume":"40","author":"Saleki","year":"2025","journal-title":"Lasers Med. Sci."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1007\/s10103-023-03771-9","article-title":"Selective Laser Trabeculoplasty versus Micropulse Laser Trabeculoplasty for Intraocular Pressure Control in Patients with Primary Open Angle Glaucoma: A 12-Month Retrospective Comparative Study","volume":"38","author":"Pimentel","year":"2023","journal-title":"Lasers Med. Sci."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.1016\/j.jcjo.2026.05.020","article-title":"A Cost-Effectiveness Analysis of Medications Compared with Selective Laser Trabeculoplasty in Patients with Newly Diagnosed Open-Angle Glaucoma","volume":"61","author":"So","year":"2026","journal-title":"Can. J. Ophthalmol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"100650","DOI":"10.1016\/j.clinsp.2025.100650","article-title":"Cost-Effectiveness of Selective Laser Trabeculoplasty as a Replacement for Hypotensive Eye Drops in the Brazilian Public Health System","volume":"80","author":"Barbosa","year":"2025","journal-title":"Clinics"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1001\/archophthalmol.2012.355","article-title":"Cost of Selective Laser Trabeculoplasty vs Topical Medications for Glaucoma","volume":"130","author":"Seider","year":"2012","journal-title":"Arch. Ophthalmol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1271","DOI":"10.1001\/jamaophthalmol.2018.3672","article-title":"A Worldwide Price Comparison of Glaucoma Medications, Laser Trabeculoplasty, and Trabeculectomy Surgery","volume":"136","author":"Zhao","year":"2018","journal-title":"JAMA Ophthalmol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7510\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T17:17:33Z","timestamp":1790615853000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7510"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,27]]},"references-count":53,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["jcm15197510"],"URL":"https:\/\/doi.org\/10.3390\/jcm15197510","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,27]]}}}