The landmark LiGHT (Laser in Glaucoma and Ocular Hypertension Trial) study – that ultimately recommended selective laser trabeculoplasty (SLT) as a first-line glaucoma intervention – has published six-year results demonstrating the longer term clinical effectiveness of the laser treatment.
“After six years of treatment and monitoring, SLT safely offers IOP control without the need for medical or surgical treatment in more than 70% of eyes with ocular hypertension (OHT) and open-angle glaucoma (OAG), while also demonstrating reduced progression rates and a reduced need for glaucoma and cataract surgery,” the study, recently published in Ophthalmology, said.
The original LiGHT study, published in The Lancet in 2019, was a multicentre randomised controlled trial comparing initial treatment with SLT with initial treatment with IOP-lowering eye drops for treatment-naïve patients with OAG or OHT.
It reported that initial treatment of OHT or OAG with SLT is more cost-effective than initial treatment with contemporary IOP-lowering eye drops after three years, while also providing eye drop freedom to 74.2% of patients, a reduced number of glaucoma surgeries, and very low rates of adverse events.
The results prompted changes to international guidelines for glaucoma, with the European Glaucoma Society and the American Academy of Ophthalmology now listing SLT as an initial treatment for OAG and OHT alongside medications, and the UK’s National Institute for Health and Care Excellence (NICE) recommending SLT as a first-line treatment.
The latest six-year results – retaining 82% of the original 692 LiGHT participants – demonstrated SLT is a safe treatment for OAG and OHT, providing better long-term disease control than initial drop therapy, with reduced need for incisional glaucoma and cataract surgery over six years.
The study aimed to to provide longer-term, pragmatic treatment outcome data.
Patients within five UK settings who were treated initially with IOP-lowering eye drops switched to SLT to reduce medication load, to avoid increasing medication load, or to delay surgery.
Meanwhile, patients initially treated with SLT underwent a third and final SLT before escalating to IOP-lowering eye drops.
“Data after six years of treatment indicate statistically significant lower rates of disease progression and reduced need for glaucoma and cataract surgery for eyes initially treated with SLT,” the researchers stated.
“Drop-free IOP control and safety of SLT as a first-line treatment for OHT and OAG are confirmed after six years of careful, protocolised monitoring and treatment.
“SLT allowed successful drop-free IOP control in nearly 70% of the eyes after six years of treatment. This is reduced only slightly from 78% of eyes not needing topical therapy at three years and is an important outcome for long-term glaucoma and OHT management.”
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