Best Initial Glaucoma treatment for open angle that is narrowed by a cateract

[KnowItAll7]

The doctor wants Alphagen P as initial treatment, then remove cataract. After questioning why SLT laszer
couldnt be used first, was told the angle was just a little too narrow to do that and is pushing drops as the
only possible first treatment. I have read that SLT is not as effective if used after drops and much better to use first.
What would be the best solution? My pressure was 22. She said the pressure would be probably lowered by removing the
cataract but Ive read not by that much. Why couldnt SLT laser be used first in this case?

[John C Hagan III, MD, FACS, FAAO]

For the reason your ophthalmologist told you, the SLT laser has to be put in a precise place and often a cataract pushes the iris too far forward to do it.  SLT is NOT less effective after eye drops.  However if SLT is used after a number of drops have failed the success will be less than in cases where it is used first. That is because multidrop failure is a sign of severe glaucoma