Using the now well established technique ALT is a safe and effective means of lowering IOP in eyes with POAG, pigmentary glaucoma, and exfoliative glaucoma though the effect diminishes with time. Pressure reduction with ALT is seldom greater than 30% and eyes with an IOP of more than 28 mm Hg are unlikely to be controlled for any length of time without additional treatment. ALT is probably most suitable either for older patients whose glaucoma is not well controlled on medical treatment, or for patients with newly diagnosed open angle glaucoma, but without advanced field loss, as a primary treatment or in combination with a non-miotic topical medication. In many it will defer surgery, in some indefinitely.
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