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Editors Selection IGR 23-3

Laser treatment: Selective laser trabeculoplasty 3

Comment by Eytan Blumenthal on:

105797 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, Gazzard G; Konstantakopoulou E; Garway-Heath D et al., Ophthalmology, 2023; 130: 139-151

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This rigorous study is significant because it demonstrates that SLT can be a viable alternative to eye drops as a first-line treatment for glaucoma and ocular hypertension. Eye drops have been the traditional treatment for these conditions, but they can be associated with side effects and issues with compliance. The use of SLT offers a safe and effective option for patients, especially those who have difficulty with eye drop administration, whether due to compliance, side-effects and/or accessibility.

This rigorous study is significant because it demonstrates that SLT can be a viable alternative to eye drops as a first-line treatment for glaucoma and ocular hypertension

Note that at the three-year time-point, patients were given the opportunity to cross-over from the drops to SLT group, based on preference. Hence a subset in each group was treated with both SLT and drops. This, as well as cataract surgeries in different proportions in each group (more in the drops group) complicates data analysis, somewhat reducing the clarity of the results, and perhaps partially masks additional differences between the groups.

Bottom line: If you consider, as a paradigm shift, starting treatment-naive OHT or mild to moderate glaucoma patients with SLT rather than drops, multiple international guidelines as well as data presented in the six-year LiGHT study back this decision.

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