Researchers in London have determined that primary selective laser trabeculoplasty (SLT) is a valuable and safe option for open-angle glaucoma (OAG) and ocular hypertension (OHT) patients that haven’t received topical medication therapy. Primary SLT achieved comparable early intraocular pressure (IOP)-lowering in both groups. About 75% of eyes met target IOP without disease progression or need for topical IOP-lowering medication, which researched called drop-free disease control.

The Laser in Glaucoma and Ocular Hypertension (LiGHT) trial compared 611 eyes (195 OHT, 416 OAG) that received SLT and 622 eyes (185 OHT, 437 OAG) that received topical medication at baseline to find out whether initial treatment with SLT was superior to initial treatment with medication for treatment-naïve OAG or OHT patients at 36 months. No difference was noted in early absolute IOP-lowering between topical medication and primary SLT.

At 36 months, 536 eyes (87.7% of the 611 OHT and OAG eyes) were available for analysis. In this group, 74.6% treated with primary SLT achieved drop-free disease control at 36 months, with 58.2% achieving it following initial, single SLT. The study found that drop-free disease control was achieved in a higher percentage of OHT and mild OAG eyes compared with moderate and severe OAG eyes. Total SLT power and two-month IOP were predictors of drop-free disease control at 36 months following single SLT.

The researchers believe that SLT has a good safety profile and avoids the potential adherence issues associated with topical medication.

Garg A, Vickerstaff V, Nathwani N, et al. Primary selective laser trabeculoplasty for open angle glaucoma and ocular hypertension: clinical outcomes, predictors of success and safety from the Laser in Glaucoma and Ocular Hypertension (LiGHT) Trial. Ophthalmology. April 25, 2019. [Epub ahead of print].