Selective laser trabeculoplasty (SLT) has again proven its long-term value, with new six-year data showing it better preserves vision than eye drops in glaucoma patients.
The latest data from the landmark Laser in Glaucoma and Ocular Hypertension Trial (LiGHT) suggests that SLT is more effective than eye drops in slowing visual field loss in patients with ocular hypertension (OHT) and open-angle glaucoma (OAG).
The post-hoc analysis, led by Giovanni Montesano and colleagues including Professor Gus Gazzard and published in Ophthalmology, compared rates of visual field (VF) progression in 710 eyes from patients newly diagnosed with OHT or OAG. Participants were randomised to receive either SLT or drops as first-line therapy.
Over six years, patients treated with SLT showed slower rates of VF deterioration. The mean rate of progression was -0.26 dB/year in the SLT-first group, compared to -0.37 dB/year in the drops-first group (p=0.007). When broken down by disease severity, the benefit was most pronounced in those with mild glaucoma (p=0.035).
Average intraocular pressure (IOP) was similar in both groups – 16.1 mmHg in the drops-first arm versus 16.8 mmHg in the SLT-first arm (p=0.057) – suggesting that the slower progression with SLT cannot be attributed to IOP differences alone.
This latest evidence strengthens the case for SLT as a standard initial therapy in glaucoma management, with potential implications for reducing long-term vision loss and treatment burden worldwide.
“First-line SLT was more effective than drops at preserving visual fields,” the authors concluded. “SLT should be preferred as the first line of treatment in newly diagnosed OHT and OAG.”
