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SLT no more effective than medication in improving QoL
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Investigators found that selective laser trabeculoplasty was not superior to topical medication in maintaining quality of life outcomes when used as first-line therapy for glaucoma.
While SLT resulted in a significantly better social well-being domain, no differences were seen in any of the other quality of life (QoL) domains, in an international, longitudinal, multisite randomized, controlled study published in the British Journal of Ophthalmology.
“We found a lack of evidence overall to support our hypothesis that patients undergoing SLT would report improved QoL at follow-up compared with those in the medication group,” Ghee Soon Ang, MD, researcher at the Singapore Eye Research Institute, Singapore National Eye Centre in Singapore, and colleagues wrote.
Researchers studied 167 glaucoma patients and randomly chose who would receive SLT or topical medication. Glaucoma-specific QoL, IOP reduction and presence of any ocular diseases were evaluated in each patient.
They found that at 24 months, patients who underwent SLTv reported a greater improvement in “social well-being” compared to patients undergoing treatment with medication. The clinical target of 25% IOP reduction was shown to be higher in the medication group. Results found that patients in the medication-treated group had higher risk for conjunctival hyperemia and eyelid erythema compared with the SLT treated group.
“While our results suggest that SLT does not offer any advantages over topical medication from the patient’s perspective, larger [randomized controlled trials] or meta-analyses are needed to verify our results,” Ang and colleagues wrote.
According to the study, medication appears to have a better efficacy to achieve the clinical target reduction in IOP in treatment of mild-to-moderate primary open angle glaucoma and exfoliation glaucoma, but to definitively verify these results a larger patient study is required. – by Erin T. Welsh
Disclosure: Ang reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.
Perspective
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Lisa M. Young, OD, FAAO
Historically, SLT was considered for patients who were noncompliant, had poor prescription coverage or who were intolerant to topical therapy. However, recent data that appears to support the use of SLT as a first-line treatment has broadened its use. Based on the potential side effects and inconvenience of topical therapy, most of us would assume that treatment with SLT would contribute to an improved QoL when compared to those being treated with topical therapy. Perhaps we need to reconsider…
Ang and colleagues, in their international, longitudinal, multisite, randomized controlled trial, did find that SLT as first-line therapy provided improved social well-being, but there was otherwise no difference noted in any other glaucoma-specific QoL domains. Additionally, they found that SLT was inferior to medication in achieving the 25% clinical target IOP reduction at the 24-month mark.
I admit to being surprised by these findings. Perhaps ignorance truly is bliss, and these patients would have thought differently had they used topical therapy prior to SLT, but to me, the take-home point of this powerful study is that their primary findings support the use of topical therapy as the optimal first-line therapy for our patients.
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