SLT compared to drugs as first-line glaucoma therapy

NEW ORLEANS — A randomized trial to compare selective laser trabeculoplasty to medical management as initial therapy for open-angle glaucoma has begun enrolling patients, according to a speaker here.

Selective laser trabeculoplasty (SLT) has previously been shown to be as effective as argon laser trabeculoplasty (ALT) in lowering IOP in patients with open-angle glaucoma, said Joel Schuman, MD. Logically then, he said, SLT should prove equally effective when compared with medical therapies, he said. The SLT-Med study will be undertaken to confirm that theory.

The SLT-Med clinical study will include 60 eyes, randomized “by patient, not by eye,” Dr. Shuman told attendees here at the American Academy of Ophthalmology meeting. Enrollment has begun at 16 sites across the United States and Canada. “It’s an 18 month study with a 1-year follow-up,” he said.

Both eyes of each patient will be treated within 2 weeks of enrollment. Patients undergoing SLT will receive 100 pulses around up to 360° of the trabecular meshwork, Dr. Schuman said. Those randomized to medical therapy will be treated first with prostaglandins, with the addition of beta-blockers and alpha agonists if they are nonresponsive, he said.

Other studies have shown no difference in IOP between ALT and medical therapy with follow-up of 3 years, Dr. Shuman said. “The first 5-year studies are showing similar survival rates,” he added.

The Glaucoma Laser Trial, in which 271 patients with primary open-angle glaucoma were randomized to medical therapy or ALT, “suggested ALT is effective as a first-line treatment in glaucoma management,” Dr. Schuman said. After 7 years, 203 patients who had undergone the laser procedure had lower IOPs than those randomized to medical therapy, Dr. Schuman said.

He said he believes the SLT-Med study will show similar results.