Primary SLT provides a safe and effective option for IOP control

This study assessed the clinical efficacy and safety of primary selective laser trabeculoplasty (SLT) for open-angle glaucoma (OAG) and ocular hypertension.

Study design

In this post hoc analysis of the Laser in Glaucoma and Ocular Hypertension (LiGHT) trial, researchers examined the clinical efficacy, predictors of success and safety of primary SLT relative to topical medications. Treatment-naïve OAG and ocular hypertension eyes were randomized to receive SLT (n=355) or topical medication (n=362) at baseline. Outcome measures included early (2 month) IOP lowering, frequency and predictors of drop-free disease control at 36 months and frequency of SLT-related complications.

Outcomes

Early absolute IOP-lowering was not significantly different between OAG and hypertension or primary SLT and topical medication. Higher baseline IOP was a predictor of early IOP reduction with SLT. At 36 months, 75% of SLT-treated eyes achieved drop-free disease control, 58% of which needed only a single treatment. Two-month IOP and total SLT power were predictors of drop-free disease control. Primary SLT was well tolerated, with 6 eyes experiencing an immediate post-laser IOP spike; only 1 of these patients required treatment.

Limitations

This was a post hoc analysis of the LiGHT study that had a sample size based on a power calculation to determine the primary outcome of health-related quality of life, not for the IOP-lowering parameters considered in the current report.

Clinical significance

Selective laser trabeculoplasty is a relatively safe procedure but prior topical treatments can render subsequent SLT less effective. These findings suggest that SLT is a viable option to manage IOP in treatment-naïve patients with ocular hypertension and OAG, especially mild cases. This may be especially relevant for patients with adherence issues that are often associated with topical treatments.