Key takeaways:
- Eyes that switched from eye drops to SLT had a major discount within the common variety of drugs.
- Eyes with uncontrolled IOP benefited from SLT, however some nonetheless wanted trabeculectomy.
For open-angle glaucoma or ocular hypertension nicely managed by eye drops, secondary selective laser trabeculoplasty lowered remedy load, in response to a examine revealed in JAMA Ophthalmology.
In medically uncontrolled eyes, secondary SLT lowered IOP, though some eyes nonetheless required trabeculectomy.
For open-angle glaucoma or ocular hypertension nicely managed by eye drops, secondary selective laser trabeculoplasty lowered remedy load. Picture: Adobe Inventory
“Selective laser trabeculoplasty is an outpatient process used to decrease intraocular strain by growing aqueous outflow by way of the trabecular meshwork,” Evgenia Konstantakopoulou, PhD, of the NIHR Biomedical Analysis Centre at Moorfields Eye Hospital, London, and colleagues wrote. “The efficacy, security and cost-effectiveness of main SLT are nicely confirmed, however there are not any clear pointers on using SLT as a secondary therapy, ie, after prior use of ocular hypotensive eye drops.”
Konstantakopoulou and colleagues carried out a publish hoc exploratory evaluation of the LiGHT trial by which sufferers with open-angle glaucoma or ocular hypertension had been randomly assigned to obtain both SLT or hypotensive eye drops as main therapy for 3 years. As a part of a 3-year extension, sufferers on eye drops might both change to SLT to cut back their remedy load or escalate to SLT if glaucoma or hypertension was not beneath management.
The extension targeted on 633 sufferers, of which 320 obtained main eye drops. Of those, 112 sufferers, comprising 176 eyes, selected SLT after eye drops.
Eyes that switched from eye drops to SLT had a major discount within the common variety of drugs. Earlier than SLT, they used a median of 1.38 energetic components, dropping to 0.59 on the finish of the extension (P < .001).
About 3 years after receiving SLT, 60.5% of eyes that originally had good management with eye drops remained freed from drops and had no want for glaucoma surgical procedure. This was the case for less than 9.5% of eyes that escalated to SLT after not gaining management with eye drops.
Eyes that had management with eye drops had a median 33.9% IOP discount after SLT, which the examine famous is “probably similar to main laser therapy.” People who escalated to SLT after not gaining management with eye drops had a median IOP discount of 21.8%, correlating to 4.6 mm Hg.
Thirty eyes (62.5%) within the escalation group attained their goal IOP by the tip of the extension and didn’t require surgical procedure, whereas 9 eyes (18.7%) required a trabeculectomy.
“The findings of this publish hoc secondary evaluation of a randomized scientific trial recommend that SLT in steady, medically handled eyes was related to eye drop-free IOP and illness management for not less than 3 years with a single therapy in most eyes with primarily delicate illness and lowered remedy depth in lots of extra,” Konstantakopoulou and colleagues wrote. “In eyes with uncontrolled IOP, this evaluation helps the chance that adjunctive SLT might take the place of extra remedy, however for eyes with progressive glaucoma or superior illness, SLT won’t forestall the necessity for definitive surgical strain decreasing.”
Perspective
We beforehand reserved selective laser trabeculoplasty for sufferers who had been noncompliant with topical remedy, had restricted prescription protection or skilled negative effects from eye drops. Nevertheless, the landmark LiGHT trial shifted this paradigm by demonstrating that SLT will not be solely efficient but additionally a viable first-line therapy choice for sufferers with ocular hypertension and open-angle glaucoma. The trial confirmed that SLT achieved comparable IOP management to topical drops with fewer negative effects, higher adherence and larger cost-effectiveness. Most notably, roughly 75% of sufferers handled with SLT required no extra drops for not less than 3 years.
Constructing on these findings, the LiGHT trial extension by Konstantakopoulou and colleagues explored SLT as an adjunctive remedy in sufferers already on topical therapy. Their outcomes confirmed that secondary SLT supplied extra IOP decreasing even in eyes that had been already nicely managed with drops, with outcomes similar to these seen with main SLT therapy.
These findings reinforce SLT’s function as a secure, efficient choice for sufferers with delicate to average glaucoma, providing the potential to cut back or remove the necessity for topical drugs. Nevertheless, for sufferers with superior or extreme glaucoma, SLT alone is often inadequate, and incisional surgical procedure stays the usual method.
Lisa M. Younger, OD, FAAO
Chicago Glaucoma Consultants
Glenview, Illinois
Member, Optometric Glaucoma Society
Disclosures: Younger stories no related monetary disclosures.
Sources/Disclosures
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Disclosures:
Konstantakopoulou stories receiving private charges from AbbVie outdoors this examine. Please see the examine for all different authors’ related monetary disclosures.
