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    Glaucoma

    This randomized controlled trial compared selective laser trabeculoplasty (SLT) vs. topical glaucoma medication as a first-line treatment for open-angle glaucoma and ocular hypertension.

    Study design

    Investigators enrolled 718 treatment-naive glaucoma or ocular hypertension patients who were randomized to SLT or topical medications.

    The primary outcome measure was health-related quality of life, as measured by the EQ-5D questionnaire. Clinical efficacy, cost, cost-effectiveness, disease-specific quality of life and safety were also assessed.

    Outcomes

    There were no significant differences between groups in EQ-5D scores at 36 months, but eyes in the SLT group were within their desired target IOP range more often than the medicated group (93.0% vs 91.3%). Fewer patients in the SLT group required glaucoma surgery (0 vs 11). At 36 months, 74.2% of SLT patients were drop free.

    There were no systemic adverse events associated with SLT, only 1 SLT patient experienced an IOP spike requiring treatment. On average, each SLT patient saved an estimated £451 (approximately USD598) in specialist ophthalmology costs. 

    Limitations

    The EQ-5D questionnaire may not be optimal for assessing glaucoma-related quality of life.

    Clinical significance

    Primary SLT appears to be a cost-effective alternative to drops for IOP control with minimal risks. This intervention can maintain stable pressures for several years, and eliminate some of the challenges relating to medication intolerance or adherence concerns.