A Report by the American Academy of Ophthalmology Ophthalmic Technology Assessment Committee Glaucoma Panel: John R. Samples, MD1; Kuldev Singh, MD, MPH2; Shan C. Lin, MD3; Brian A. Francis, MD4; Elizabeth Hodapp, MD, MHS5; Henry D. Jampel, MD, MHS6; Scott D. Smith, MD, MPH7
Ophthalmology, November 2011, Vol 118, 2296-2302 © 2011 by the American Academy of Ophthalmology. Click here for free access to the OTA.
Objective: To provide an evidence-based summary of the outcomes, repeatability, and safety of laser trabeculoplasty for open-angle glaucoma.
Methods: A search of the peer-reviewed literature in the PubMed and the Cochrane Library databases was conducted in June 2008 and was last repeated in March 2010 with no date or language restrictions. The search yielded 637 unique citations, of which 145 were considered to be of possible clinical relevance for further review and were included in the evidence analysis.
Results: Level I evidence indicates an acceptable long-term efficacy of initial argon laser trabeculoplasty for open-angle glaucoma compared with initial medical treatment. Among the remaining studies, level II evidence supports the efficacy of selective laser trabeculoplasty for lowering intraocular pressure for patients with open-angle glaucoma. Level III evidence supports the efficacy of repeat use of laser trabeculoplasty.
Conclusions: Laser trabeculoplasty is successful in lowering intraocular pressure for patients with open-angle glaucoma. At this time, there is no literature establishing the superiority of any particular form of laser trabeculoplasty. The theories of action of laser trabeculoplasty are not elucidated fully. Further research into the differences among the lasers used in trabeculoplasty, the repeatability of the procedure, and techniques of treatment is necessary.
1Department of Ophthalmology, Oregon Health and Sciences University, Portland, Oregon; Department of Surgery, Rocky Vista University, Parker, Colorado; Western Glaucoma Foundation, Portland, Oregon
2 Department of Ophthalmology, Stanford University, Stanford, California
3 Department of Ophthalmology, University of California, San Francisco, San Francisco, California
4 Doheny Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
5 Bascom Palmer Eye Institute, Miami, Florida
6 Glaucoma Division, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
7 Edward S. Harkness Eye Institute, Columbia University, New York, New York