A deeper analysis of the landmark Laser in Glaucoma and Ocular Hypertension (LiGHT) Trial – that ultimately recommended selective laser trabeculoplasty (SLT) as a first-line glaucoma intervention – has shown the disease progresses 29% slower in patients with this method compared with eye drops.
“Selective laser trabeculoplasty should not only be considered an effective and safe alternative to medications as a first-line treatment for primary open-angle glaucoma but can also offer an advantage in reducing vision loss,” said lead researcher Dr Giovanni Montesano of Moorfields Eye Hospital in London.
The new study was presented on 20 October 2024 at AAO 2024, the 128th annual meeting of the American Academy of Ophthalmology.
Dr Montesano and his colleagues conducted a new analysis of a randomised LiGHT trial, originally run by chief investigator Professor Gus Gazzard in 2019 and published in The Lancet, that compared SLT and glaucoma eye drops as first-line treatments in patients recently diagnosed with open-angle glaucoma (OAG) or ocular hypertension (OHT).
SLT reduces intraocular pressure by stimulating the trabecular meshwork.
The results prompted a shift in international guidelines for glaucoma with official European, US and UK bodies now listing the intervention as an initial treatment for OAG and OHT alongside medications.
Six-year results in 2023 backed the original LiGHT findings, showing patients treated with laser experienced a statistically significant lower rate of disease progression and reduced need for glaucoma surgery.
Dr Montesano revisited the visual field outcomes from the LiGHT trial using a more detailed and sensitive statistical approach.
“Since the first study, we developed an improved statistical technique to calculate the rate of progression of the mean deviation,” he said.
“This improved methodology, together with the longer follow-up, prompted us to test again the previously observed differences between the SLT-1st and the Medication-1st arms of the LiGHT trial.”
Using this improved methodology, the data show a 29% reduction in the rate of mean deviation progression in the better eligible eye of patients treated with laser first over six years of follow-up. This translated to an estimated proportion of eyes with fast progression (faster than -0.5 dB/year) of 14% in the laser group and 25% for the eye drop group, according to a release on the AAO website.
AAO recently published an Opthalmic Technology Assessment of SLT. The assessment concluded that laser treatment can be used as either a primary intervention, a replacement for medication, or an additional therapy with glaucoma medications.
More reading
Glaucoma researchers deliver verdict on SLT versus eye drops in LiGHT study
‘Interventional glaucoma’ and what it means for these Australian ophthalmologists
Keeping the ocular surface healthy in the glaucoma patient
