A new analysis from the Laser in Glaucoma and Ocular Hypertension trial has examined the efficacy of selective laser trabeculoplasty as a secondary treatment for open-angle glaucoma and ocular hypertension following the use of topical hypotensive medications. Researchers found that selective laser trabeculoplasty was associated with a reduction in medication use for stable eyes and provided additional intraocular pressure control for some patients with medically uncontrolled disease.
This post hoc exploratory analysis used data from the Laser in Glaucoma and Ocular Hypertension (LiGHT) trial—a multicenter randomized clinical trial within the UK National Health Service (NHS). Participants with open-angle glaucoma (OAG) or ocular hypertension (OHT) were initially randomized to either primary selective laser trabeculoplasty (SLT) or topical hypotensive eye drops, the researchers reported in their recent JAMA Ophthalmology article. Patients were followed for 3 years, after which those using eye drops were offered SLT either as a treatment switch to reduce medication burden or as an escalation strategy for additional intraocular pressure (IOP) control.
A total of 633 participants entered the extended study period and 524 (82.8%) completed 72 months of follow-up. Among the 320 participants who initially received medical therapy, 112 (35.0%) opted for SLT. Seventy switched treatments, 29 underwent escalation, and 13 used SLT as both an escalation in one eye and a switch in the other.
Among participants who switched to SLT after 3 years of eye drop use, there was a significant reduction in medication burden. The mean number of active medication ingredients decreased from 1.38 to 0.59 (mean difference = 0.79; 95% confidence interval = 0.66-0.93; P < .001) and by 72 months, 69 eyes (60.5%) required no further medical or surgical treatment.
For participants who had been using only one medication before switching to SLT, 83.8% were able to discontinue all topical therapy. Those previously on two or more medications also showed reductions in medication use, although at lower rates.
For participants who underwent SLT as a treatment escalation due to uncontrolled IOP or disease progression, the procedure resulted in a mean IOP reduction of 4.6 mm Hg (21.8%). At 72 months, 62.5% of eyes treated with SLT in this manner achieved their target IOP without requiring incisional glaucoma surgery. However, 18.7% ultimately required trabeculectomy.
The study reported a low incidence of serious adverse events following SLT. A transient increase in IOP of more than 5 mm Hg within 1 hour following the procedure was observed in a small proportion of patients (3.5%). However, this effect was managed with no long-term consequences. No cases of persistent inflammation, corneal decompensation, or significant visual deterioration related to SLT were recorded.
“Eye drop freedom, treatment burden, and related ocular [adverse events] have been previously identified as important to participants and may have been drivers for participants to alter their therapeutic regimen in this trial,” Evgenia Konstantakopoulou, PhD, of the NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology in London and the Division of Optics and Optometry at the University of West Attica in Athens, Greece, wrote with colleagues. “With the cost of glaucoma prescriptions in England reaching £114.2 million (approximately US $139.7 million) in 2018, switching to SLT may promote more cost-effective services for the NHS and the large numbers of patients still treated medically.”
The researchers concluded, “SLT in stable, medically treated eyes was associated with eye drop–free IOP and disease control for at least 3 years with a single treatment in most eyes with primarily mild disease and reduced medication intensity in many more. In eyes with uncontrolled IOP, this analysis supports the possibility that adjunctive SLT could take the place of additional medication, but for eyes with progressive glaucoma or advanced disease, SLT might not prevent the need for definitive surgical pressure lowering.”
Study limitations included the exploratory nature of the analysis and the number of eyes, particularly advanced or escalating cases.
A full list of disclosures can be found in the published research.
