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Editors Selection IGR 21-4
Laser treatment: Selective laser trabeculoplasty 3
Comment by Louis Pasquale & Jason Jo 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
See also comment(s) by Eytan Blumenthal •Selective laser trabeculoplasty (SLT) is a laser-based therapy used to lower intraocular pressure (IOP) in ocular hypertension (OHT) and open-angle glaucoma (OAG). In a threeyear continuation of the 2019 'Laser in Glaucoma and Ocular Hypertension Trial' (LiGHT), the authors conclude that SLT remains a safe alternative to IOP-lowering drops in OHT and OAG. Furthermore, the authors conclude that SLT slowed disease progression and reduced rates of additional glaucoma and cataract surgeries compared to drop therapy.
The investigators recruited 633 patients (313 in the SLT group and 320 in the drops group), who had been randomized in the 2019 trial to the three-year extension study. Intention-totreat analysis revealed no significant differences in health-related quality of life and visual field mean deviation between the intervention groups. While IOP was slightly higher in the SLT group at six years, the authors suggest this may be due to more filtration surgeries performed in the drops group. Importantly, the SLT group experienced less disease progression than the drops group. No serious adverse events were attributable to SLT.
The study's strengths were the use of standardized, rigorous criteria for glaucoma definition, IOP target determination, and disease deterioration detection. Of note, however, 69.8% of patients enrolled in the trial extension were White and 22.1% were diagnosed with OHT. Thus, the study's findings may not be entirely generalizable, as first noted by Ang et al.1 regarding the initial trial, particularly given potential ethnicity differences in glaucoma severity and VF progression.2-3
Study's strengths were the use of standardized, rigorous criteria for glaucoma definition, IOP target determination, and disease deterioration detection
Additionally, 29 of the 59 patients who did not participate in the extension trial were from one of the six centers. While these results strongly support SLT as an initial treatment of new-onset OHT and OAG, additional studies evaluating the effect of SLT based on OAG disease severity and ethnicity need to be conducted.
References
- Ang M, Tham CC, Sng CCA. Selective laser trabeculoplasty as the primary treatment for open-angle glaucoma: time for change? Eye. 2020/05/01 2020;34(5):789-791. doi:10.1038/s41433-019-0625-6.
- Halawa OA, Jin Q, Pasquale LR, et al. Race and Ethnicity Differences in Disease Severity and Visual Field Progression Among Glaucoma Patients. Am J Ophthalmol. 2022;242:69-76. doi:10.1016/j.ajo.2022.05.023.
- Kang JH, Wang M, Frueh L, et al. Cohort Study of Race/Ethnicity and Incident Primary Open-Angle Glaucoma Characterized by Autonomously Determined Visual Field Loss Patterns. Transl Vis Sci Technol. 2022;11(7):21. doi: 10.1167/tvst.11.7.21.
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