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Editors Selection IGR 16-2
Laser Treatment: SLT after drops: what do LiGHT trial data tell us?
Comment by Tony Realini on:
126709 Selective Laser Trabeculoplasty After Medical Treatment for Glaucoma or Ocular Hypertension, Konstantakopoulou E; Gazzard G; Garway-Heath D et al., JAMA ophthalmology, 2025; 143: 295-302
Professor Gus Gazzard and colleagues from the Laser in Glaucoma and Ocular Hypertension (LiGHT) study team have conducted a post hoc analysis to explore the use of selective laser trabeculoplasty (SLT) as a secondary treatment in medically treated eyes. In the LiGHT trial, participants with newly diagnosed open-angle glaucoma or ocular hypertension randomly received primary SLT or primary medical therapy. After the initial 3-year study period, those assigned to medical therapy were offered SLT as a means of reducing/eliminating the medication burden (if controlled) or as a treatment escalation (if uncontrolled). Switching to SLT decreased medication use significantly (from 1.38 to 0.59 mean medications) and allowed 60.5% to attain medication freedom. Those using only a single medication achieved an 83.5% medication freedom rate after 3 years. Those receiving SLT in addition to medications as a treatment escalation saw a mean 4.6 mmHg IOP reduction (21.8% decrease from medication-only baseline), with 62.5% achieving and maintaining target IOP through 3 years post-SLT. While LiGHT was not designed or powered for this analysis, these data are a critical insight into the new glaucoma treatment paradigm. As primary SLT becomes the preferred standard therapy for glaucoma—because it more effectively prevents glaucoma progression and the need for glaucoma surgery compared to medical therapy, and is better tolerated without issues of nonadherence and subsequent disease progression—many patients who did not receive primary SLT will wish to pursue freedom from medical therapy with secondary SLT. These data, from a robustly designed and conducted clinical trial, provide strong support that the majority of such patients will benefit from the switch.
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