This article is more than 5 years old. Information may no longer be current.
Selective laser trabeculoplasty lowers medication use in glaucoma cases
In patients with mild to moderate glaucoma, selective laser trabeculoplasty is a viable option to stop using daily drops, doctor said.
Click Here to Manage Email Alerts
Selective laser trabeculoplasty reduced glaucoma eye drop usage in 83% of patients at 18 months postoperative, a study found.
Anjali S. Hawkins, MD, PhD, spoke with Ocular Surgery News about a poster she and colleagues presented at the American Glaucoma Society meeting. The study showed that selective laser trabeculoplasty (SLT) helps cut down on glaucoma issues such as patient compliance and the high cost of drugs by reducing dependency on medication.
The retrospective, nonrandomized study looked at 80 eyes of 46 subjects. Patients were offered SLT as an option to reduce the number of glaucoma drugs while maintaining their target IOP. SLT was performed by Dr. Hawkins, who employed 50 spots of varying intensity on 180° of the trabecular meshwork.
Patients were followed for 18 months to determine the stability of their glaucoma as measured by IOP and analysis of optic nerve, visual field and nerve fiber layer.
Patients returned to using their eye drops if a change was found, including if there was a spike in IOP or the visual field worsened, Dr. Hawkins said. Those cases were considered failures.
Dr. Hawkins said the study found that SLT was a viable option for patients with manageable glaucoma to stop using daily drops.
“The most important conclusion of the study is that in mild to moderate glaucoma patients that are well-controlled, SLT is successful in replacing one of their glaucoma medicines, therefore, making patients less dependent on glaucoma drops,” she said.
Results
According to the poster, at 0.13 months, 97.73% of SLT patients had successfully discontinued their medications and were able to remain off of them. At 1.34 months, 95.45% of SLT patients were off their drops; at 6.67 months, 93.13% were off drops; at 7.39 months, 90.80% were off drops; and at 9.1 months, 88.47% were off drops.
The most impressive result, according to Dr. Hawkins, was at 18.69 months. At that time, 83.27% of SLT patients were still off their medications and had stable optic nerves, IOP and visual field measurements.
“I think [SLT is] just as effective as one of our first-line agents. So if it was my eye and I was diagnosed with glaucoma, I would probably choose to have SLT rather than be put on the drop every day,” she said.
The preoperative mean IOP was 15.66 ± 3.66 mm Hg. At 3 months postoperative, it was 16.28 ± 4.24 mm Hg; at 6 months, it was 16.01 ± 3.17 mm Hg; at 1 year, it was 15.69 ± 3.03 mm Hg; and at 18 months, it was 15.2 ± 3.34 mm Hg.
A total of 72 SLT eyes were classified as successes, remaining off drops, while eight were considered failures, according to the poster (see Table).
Practical use
Dr. Hawkins said SLT can easily be applied to physicians’ everyday clinical practice. She said it is an effective means of reducing drops and patients’ dependence on medications and is relatively easy for doctors to perform.
“Some patients always seem to complain about the side effects and/or costs of their glaucoma medicines, and I think they should be informed of the option of SLT – this laser takes a few minutes to do with minimal risks, does not hurt, may work for months to years, can be repeated if needed and in the long run may cost less than drops,” she said.
She said there were limitations to the study. The study design could possibly have a selection bias, and the patient population did not include all types of glaucoma or racial groups. Most of the patients in the study were Caucasian with mild to moderate glaucoma, Dr. Hawkins said, adding that the study is not applicable to all racial groups and should not be applied to advanced glaucoma cases.
For more information:
- Anjali S. Hawkins, MD, PhD, is assistant professor of ophthalmology at Rush Medical Center and in private practice at Geneva Eye Clinic. She can be reached at 302 Randall Road, Suite 10, Geneva, IL 60134; e-mail: eyehawkins@ameritech.net. Dr. Hawkins has no direct financial interest in the products mentioned nor is she a paid consultant for any companies mentioned in this article.
- Erin L. Boyle is an OSN Staff Writer who covers all aspects of ophthalmology.