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Selective Laser Trabeculoplasty vs. Eye Drops for first line treatment of Ocular Hypertension and Glaucoma: a multicentre randomised controlled trial
Gus Gazzard, Evgenia Konstantakopoulou, David Garway-Heath, Anurag Garg, Victoria Vickerstaff, Rachael Hunter, Gareth Ambler, Catey Bunce, Richard Wormald, Neil Nathwani, Keith Barton, Gary Rubin, Marta Buszewicz; on behalf of the LiGHT Trial Study Group*
Background:
Primary Open Angle Glaucoma and Ocular Hypertension are commonly treated with eye drops that lower eye pressure. SLT (Selective Laser Trabeculoplasty) is a safe alternative but is rarely used as first line treatment. This study compared the two.
Methods:
In this observer masked, randomized controlled trial treatment – naïve patients with open angle glaucoma or ocular hypertension and no ocular comorbidities were recruited between 2012 and 2014 at six UK hospitals.
They were randomly allocated (web-based randomisation) to initial treatment with SLT or to eye drops as first line treatment.
An objective target Intraocular Pressure was set according to the severity of the patient’s glaucoma.
The primary outcome was health-related quality of life (HRQoL) at 3 years (assessed by EQ-5D).
Secondary outcomes were cost and cost effectiveness, disease specific HRQoL, clinical effectiveness and safety.
Findings:
Of 718 patients enrolled, 356 were randomised to the selective laser Trabeculoplasty and 362 to the eye drops group.
652 (91%) returned the primary outcome questionnaire at 36 months. Average EQ-5D score was 0.86 (SD 0.18) in the Selective Laser Trabeculoplasty group versus 0.90 (SD 0.16) in the eye drops group. Therefore there was no significant difference to a patient’s quality of life.
At 36 months 74.2% of patients in the SLT group required no drops to maintain intraocular pressure at target.
Eyes of patients in the Selective Laser Trabeculoplasty group were within target intraocular pressure at more visits (93%) than in the eye drops group (91.3%).
No patients required glaucoma surgery to lower intraocular pressures in the SLT group, while 11 patients from the drops group required further surgical intervention.
Conclusion:
Selective Laser Trabeculoplasty should be offered as first line treatment for open angle glaucoma and ocular hypertension, supporting a change in clinical practice. At the cork eye clinic SLT is now our first line treatment offered to all suitable glaucoma and ocular hypertension patients.
www.thelancet.com Published online March 9, 2019 http://dx.doi.org/10.1016/S0140-6736(18)32213-X
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