Lower-Energy Selective Laser Trabeculoplasty: A Titrated Energy-Pigmentation (TAPE) Approach to Predicting Efficacy and Durability

ObjectiveTo evaluate outcomes of lower-energy selective laser trabeculoplasty (SLT) using a titrated energy-pigmentation (TAPE) construct. MethodsThis retrospective study analyzed de-identified clinical data of 62 eyes undergoing lower-energy SLT as part of routine care. Laser energy was titrated relative to trabecular meshwork (TM) pigmentation grade and quantified as the product of the two (TAPE score). For example, grade 2 pigmentation x 40 mJ total energy yields a TAPE score of 80. The primary outcome was intraocular pressure (IOP) at 2 months, with adjustment for baseline maximum IOP (Tmax) using analysis of covariance (ANCOVA). Durability was assessed using Kaplan-Meier survival analysis and Cox proportional hazards modeling. ResultsAfter adjustment for baseline Tmax, higher TAPE scores ([&ge;]70) were associated with lower 2-month IOP (p < 0.01) and greater likelihood of achieving [&ge;]20% IOP reduction. Over longer follow-up, higher TAPE scores were associated with fewer treatment escalation events and improved survival free of additional therapy. Low-grade anterior chamber inflammation was common, transient, and self-limited. At 3 years, 85% of eyes in the high-TAPE group remained drop-free, accounting for retreatment where applicable. No clinically significant IOP spikes or sight-threatening adverse events were observed. ConclusionsHigher energy-pigmentation (TAPE) scores were associated with improved short-term IOP reduction and greater durability following lower-energy SLT. These findings are hypothesis-generating and suggest that TM pigmentation-adjusted energy delivery may enhance biologic engagement of the trabecular outflow pathway and support prospective evaluation of individualized SLT dosing strategies.