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SLT shows efficacy as first line, adjunctive therapy in POAG
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Selective laser trabeculoplasty is equally effective at lowering intraocular pressure when used in treatment naïve, newly diagnosed eyes with primary open angle glaucoma (POAG) or as an adjunctive treatment in eyes with medically uncontrolled disease, according to a study.
A first group of 28 eyes of 28 patients, newly diagnosed with POAG with IOP greater than 17 mm Hg, early visual field loss and optic disc changes, received selective laser trabeculoplasty (SLT) as a primary treatment.
A second group of 31 eyes of 31 patients on maximal tolerated medical therapy, uncontrolled IOP greater than17 mm Hg, moderate visual field loss and optic disc changes received SLT as an adjunctive treatment. Patients in both groups were followed for up to 2 years.
SLT was performed with the Selecta 7000 Nd:YAG laser (Coherent), using a 532-nm frequency, a pulse duration of 3 ns, spot size of 400 µ and energy of 0.8 mJ, enlarged or reduced until only intermittent cavitation bubble formation appeared. Fifty adjacent spots were performed in the inferior 180° of the trabecular meshwork.
At all follow-up visits the mean IOP reduction was smaller in the adjunctive SLT group than in the initial SLT group. This difference was statistically significant at 2 years. Success rate at 2 years was comparable in the two groups. As in other published studies, the IOP-reducing effect decreased over time in both groups.
“In conclusion, SLT can be used for the reduction of IOP in patients with OAG or ocular hypertension as an initial treatment option, comparable in efficacy to medication with a prostaglandin analogue, and as adjunctive treatment option in medically controlled and medically uncontrolled glaucoma patients,” the authors wrote.
The Laser in Glaucoma and Ocular Hypertension Trial (LiGHT), a larger prospective, multicenter, randomized, controlled trial including 718 patients, is currently underway in the U.K. The aim of the study is to determine whether initial SLT is more effective than initial treatment with topical medications.
“The LiGHT trial will give important information on the health-related quality of life, clinical efficiency and cost-efficiency of SLT and topical IOP-reducing medications, with the ability to determine the preference of first-line treatment,” the authors wrote. – by Michela Cimberle
Disclosure: The author reported no relevant financial disclosures.
Perspective
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Lisa M. Young, OD, FAAO
Since its introduction in 2001, SLT has gained traction as a potential first-line treatment for glaucoma. For the majority of patients, the benefit of this procedure far outweighs its risk, based on its stellar safety profile and the potential for a 20% to 30% reduction in IOP.
Taking this into consideration, in a small, retrospective review, Gracner and colleagues found that SLT is equally efficacious in reducing IOP as initial or adjunctive treatment for POAG in the initial 2-year period.
While I am not surprised by these results, it’s important to remember that approximately 80% of patients will achieve a reduction in IOP, and that effect may only be of benefit for a 3- to 5-year period. Based on this knowledge, I believe that SLT is a good first-line option for patients who may be noncompliant with medications or have poor prescription coverage, those who are intolerant to topical therapy (often due to preservative sensitivities and ocular surface disease) or those in need of unilateral treatment due to the cosmetic side effects of PGA therapy.
It’s nice to have all these options when managing glaucoma and we continue to weigh the pros and cons of each.
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