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Primary Selective Laser Trabeculoplasty for Open-Angle Glaucoma and Ocular Hypertension
TAKE-HOME MESSAGE
- This study evaluated primary selective laser trabeculoplasty (SLT) for the treatment of ocular hypertension (OHT) and primary open-angle glaucoma (OAG) using post hoc analysis. Results at 36 months showed that the "drop-free" control of IOP was 74.6% in eyes treated with primary SLT.
- A higher percentage of drop-free disease control was achieved in eyes with OHT and mild OAG compared with eyes with moderate or advanced OAG. However, drop-free control of IOP appeared to be less robust in females.
– Kathleen F. Freeman, OD, FAAO
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersPURPOSE
To report clinical efficacy, predictors of success and safety of primary selective laser trabeculoplasty (SLT) used in treatment-naïve open-angle glaucoma (OAG) or ocular hypertension (OHT) patients.
DESIGN
Post-hoc analysis of a multicentre prospective randomized-controlled-trial.
PARTICIPANTS
Treatment-naïve OAG or OHT patients.
METHODS
Patients randomized to SLT or topical medication and treated to pre-defined target IOPs requiring ≥20% IOP reduction from baseline for all disease severity levels.
OUTCOME MEASURES
Initial ("early") absolute IOP-lowering at 2-months. Achievement of "drop-free disease-control": meeting target IOP without disease progression or need for additional topical medication over 36-months following SLT. Predictors of early absolute IOP-lowering and drop-free "disease-control" after single initial SLT. Frequency of laser-related complications.
RESULTS
611 eyes (195 OHT & 416 OAG) of 355 patients received SLT and 622 eyes (185 OHT & 437 OAG) of 362 patients received topical medication at baseline. Early absolute IOP-lowering following SLT was no different between OHT and OAG eyes (adjusted mean difference = -0.05mmHg; 95% confidence interval (CI) -0.6 to 0.5mmHg; p=0.85). No difference was noted in early absolute IOP-lowering between topical medication and primary SLT (adjusted mean difference = -0.1mmHg; 95% CI, -0.6 to 0.4mmHg; p=0.67). Early absolute IOP-lowering with primary SLT was positively associated with baseline IOP (Coefficient 0.59; 95% CI, 0.54 to 0.64; p<0.001) and negatively with female gender (Coefficient -0.63; 95% CI, -1.23 to -0.02; p=0.04). At 36-months, 536 eyes (87.7% of 611 eyes) of 314 patients (88.5% of 355 patients) were available for analysis. 74.6% of eyes (400 eyes) treated with primary SLT achieved drop-free "disease-control" at 36-months; 58.2% (312 eyes) following single SLT. Total SLT power and 2-month IOP were predictors of drop-free "disease-control" at 36-months following single SLT. 6 eyes of 6 patients experienced immediate post-laser IOP spike (>5mmHg from pre-treatment IOP) with 1 eye requiring treatment.
CONCLUSION
Primary SLT achieved comparable early absolute IOP-lowering in OHT vs OAG eyes. Drop-free "disease-control" was achieved in ∼75% eyes at 36-months following 1 or 2 SLTs; the majority of these following single SLT. These analyses are exploratory, but support primary SLT to be effective and safe in treatment-naïve OAG and OHT eyes.
Additional Info
Primary Selective Laser Trabeculoplasty for Open Angle Glaucoma and Ocular Hypertension: Clinical Outcomes, Predictors of Success and Safety From the Laser in Glaucoma and Ocular Hypertension (LiGHT) Trial
Ophthalmology 2019 Apr 24;[EPub Ahead of Print], A Garg, V Vickerstaff, N Nathwani, D Garway-Heath, E Konstantakopoulou, G Ambler, C Bunce, R Wormald, K Barton, G GazzardFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The traditional flow chart for treating open-angle glaucoma commences with the initiation of topical medications and relies on laser trabeculoplasty as second- or third-line treatment. This excellent multicenter, prospective, randomized study by Garg et al showed that initial treatment with selective laser trabeculoplasty (SLT) in patients with ocular hypertension (OHT) and with mild open-angle glaucoma (OAG) is as effective as medical therapy in producing a >20% decrease in intraocular pressure (IOP) from baseline at 3 years.
In patients with moderate or severe OAG, initial SLT is less successful. The 3-year follow-up revealed drop-free disease control in 56.1% of patients with moderate OAG and 42.3% of patients with severe OAG, which is a sharp contrast to the 88.6% of OHT patients and 76.6% of mild OAG patients who had SLT.
This superb study should encourage clinicians to consider SLT as initial treatment in the management of glaucoma. Patients with moderate or severe OAG should be cautioned that further treatment with topical medications might be needed in approximately 50% of cases in order to achieve a 30% decrease in IOP from baseline.
The purpose of this study was to determine the clinical efficacy, predictors of success, and safety of primary selective laser trabeculoplasty (SLT) used in treatment-naïve patients with open-angle glaucoma (OAG) or ocular hypertension (OHT). A total of 611 eyes (195 OHT and 416 OAG) of 355 patients received SLT, and 622 eyes (185 OHT and 437 OAG) of 362 patients received topical medication at baseline.
The authors found that "... primary SLT achieved comparable early absolute IOP-lowering in OHT vs OAG eyes. Drop-free ‘disease-control’ was achieved in ~75% eyes at 36-months following 1 or 2 SLTs; the majority of these following single SLT."
They concluded that the findings, although exploratory, support primary SLT to be effective and safe in treatment-naïve OAG and OHT eyes. As the authors note, the success of this treatment in removing the need for drops in some patients addresses the common problem of compliance in the treatment of elevated IOP.