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Editors Selection IGR 13-1

Laser Treatment: SLT as First-Line Treatment: Patient and Treater Perspectives

Comment by Rupert Bourne on:

98620 Facilitators and Barriers to Using Selective Laser Trabeculoplasty (SLT) as First-Line Treatment for Glaucoma: Physician and Patient Views Gathered during an Exploratory Descriptive Qualitative Study, Chen Y; Lohfeld L; Song D et al., Ophthalmic Epidemiology, 2022; 0: 1-8

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In this article by Chen et al, 11 Chinese glaucoma specialists and 12 patients were recruited from two tertiary-level municipal hospitals in the cities of Wenzhou and Guangzhou, to participate in recorded interviews. These interviews explored perception of relative advantages and disadvantages of selective laser trabeculoplasty (SLT) versus other intraocular pressure-reducing treatments, factors affecting glaucoma treatment decision-making and barriers to the use of SLT as a first-line treatment for glaucoma in China.

All of the patients were on topical medication, 5 had had SLT and most had received incisional surgery (n=6). The majority had open angle glaucoma (n=10) and the patients were relatively young (median age, 41 years). Eligibility criteria for inclusion in the study are not given, the authors simply explaining that patients were 'selected' by a glaucoma clinic nurse after reviewing patient records. Interviews were assisted by 'interview guides', the transcripts recorded and a thematic framework analysis approach used. The results are a series of anecdotes (with occasional frequencies of anecdote given) from individual participants around each of several themes centering around physician treatment preferences, patient's views on treatment types, and decision-making during the physician-patient encounter, and feasibility of SLT as a first-line therapy.

The rationale for the study was a reportedly lower uptake of SLT in China than in Europe/ USA. Using anecdotal evidence from these limited interviews (questions are in the supplementary material), the authors promote some possible reasons such as willingness to pay, education and patient profile in clinics, yet one has to agree with the authors when they conclude that unfortunately the study design (a very small sample size [e.g. 5 SLT patients] from only 2 hospitals in China) makes it impossible to draw any generalizable conclusions from this study.

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