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Editors Selection IGR 21-1

Surgical Treatment: Selective Laser Trabeculoplasty

Comment by Miriam Kolko on:

84968 Real-World Outcomes of Selective Laser Trabeculoplasty in the United Kingdom, Khawaja AP; Campbell JH; Kirby N et al., Ophthalmology, 2020; 127: 748-757

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In the present study, the authors assessed the efficacy of selective laser trabeculoplasty (SLT) in routine clinical care of patients with glaucoma and ocular hypertension (OHT) in the United Kingdom using real-world data collected by electronic medical records. Moreover, the study aimed to identify factors associated with treatment success. A total of 831 patients were included and underwent SLT treatment. Whereas the recent substantial Laser in Glaucoma and ocular HyperTension (LiGHT) trial compared initial SLT with initial topical medication for treatment-naive patients with primary open-angle glaucoma (POAG) or OHT, the present study assessed the real-world effectiveness of SLT. The authors found that patients had good effect of SLT immediately after treatment, but the effect disappeared in the majority within a year. The effect of SLT was better in patients with higher baseline IOP, but did not differ depending on the degree of glaucoma severity or with concomitant use of IOP-lowering therapy. Failure of SLT in one eye was strongly associated with failure in the fellow eye. Unexpectedly, the study found greater efficacy in patients treated with SLT by trainees compared to SLT treatment performed by more senior ophthalmologists. Although the authors do not conclude that younger ophthalmologists are more successful in performing SLT treatment, the results certainly show that SLT treatment can be performed fully at the same level by less experienced ophthalmologists in training as by experienced senior ophthalmologists. As with all retrospective studies, there is a need to be cautious with conclusions. One of the possible biases affecting the SLT outcome is the lack of knowledge about whether patients have previously had laser trabeculoplasty performed at another center. However, the large sample size in any case makes the study valuable when patients need to be informed about what to expect from SLT treatment. Over all, the authors suggest that SLT is a better treatment option for patients with OHT or high-tension POAG than for patients with normal-tension glaucoma.

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