LiGHT trial shows more visual field progression with medication vs. laser
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Secondary analysis of the LiGHT trial showed that patients treated first with medications were more likely to undergo rapid visual field progression than those treated first with selective laser trabeculoplasty.
“The LiGHT trial showed that SLT provides better clinical effectiveness and lower treatment intensity among newly diagnosed glaucoma and ocular hypertension patients compared to IOP-lowering eye drops,” David M. Wright, PhD, said at the virtual Association for Research in Vision and Ophthalmology meeting. “As for VF, no difference was found at 3 years between groups, but 3 years is not a long time to detect VF progression in these early stages of glaucoma.”
Because the trial has now achieved 6 years of follow-up, the authors decided to revisit visual field (VF) outcomes using a more detailed and sensitive statistical approach than a simple comparison of means. A total of 1,178 VFs from 688 individuals were included. Hierarchical linear models were used to estimate pointwise VF progression rates, which were then averaged to produce a global progression estimate for each eye. Outcome measures were pointwise, and total deviation and pattern deviation of global progression were measured. The mean rates of progression were estimated for each treatment group, each eye and each location in each eye and then compared between groups.
“There was no evidence of a difference in overall group means, in line with the results at 3 years. However, comparison of the means does not tell us the whole story. If we look closely, we can see that a slightly larger proportion of the medicine first eyes had faster progression, 26.2% vs. 16.9% in the laser first eyes,” Wright said. “Approximately one in four eyes in the medicine first group had moderate or fast progression compared with approximately one in six in the laser first group, giving a risk ratio of 1.55 with strong statistical support. A similar pattern was observed for the location-specific or pointwise rates.”
A possible explanation for the better VF outcomes in the laser first group include avoidance of the low treatment adherence typically observed with eye drops and potentially greater diurnal stability in IOP after laser surgery, he said.
“From a methodological perspective, this type of analysis is likely to be more sensitive than relying on comparison of means alone, and we recommend to consider it when designing trials among early-stage glaucoma patients,” Wright said.
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Wright DM, et al. Visual field outcomes from LiGHT: Laser in Glaucoma and Ocular Hypertension, a multicentre, randomised controlled trial. Presented at: Association for Research in Vision and Ophthalmology annual meeting; June 12, 2020 (virtual meeting).
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