SLT effective, safe as long-term treatment option for open-angle glaucoma
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Key takeaways:
- The safety and efficacy of selective laser trabeculoplasty was comparable to argon laser trabeculoplasty.
- Data supports the use of SLT as a primary or supplemental intervention or as replacement for medications.
Selective laser trabeculoplasty can safely and effectively be used as primary intervention for treatment of open-angle glaucoma or as replacement for medications, according to a report by the American Academy of Ophthalmology.
“Level 1 evidence demonstrates that SLT is an effective method with minimal safety concerns for IOP control in patients with ocular hypertension, [primary open-angle glaucoma (POAG)], pigmentary glaucoma, pseudoexfoliation glaucoma and juvenile open-angle glaucoma,” Hana L. Takusagawa, MD, of the Casey Eye Institute at Oregon Health & Science University, and colleagues wrote in Ophthalmology.
They continued, “Level I evidence also indicates that SLT is equivalent to glaucoma medications for IOP control as a first-line treatment for POAG and ocular hypertension, it may be more cost-effective than medications and it may provide better long-term disease control than medications.”
Researchers searched the PubMed database for current published literature on SLT and identified 30 articles that met the inclusion criteria. Of these, 19 received a level 1 rating for randomized controlled trials and 11 received a level 2 rating for case-controlled and cohort studies.
Data from level 1 studies supported the long-term effectiveness of SLT as a primary treatment or as a supplement to medications for open-angle glaucoma, and some level 1 studies found that SLT and argon laser trabeculoplasty (ALT) were comparable in safety and long-term efficacy.
The level 1 studies also indicated that use of perioperative corticosteroid and nonsteroidal anti-inflammatory eye drops do not negatively affect SLT treatment, although their effect on lowering IOP varied across studies.
None of the studies, however, were able to determine ideal power settings for SLT, with most treating 180° or 360° with approximately 50 or 100 spots, respectively.
“Based on level I evidence, SLT is an effective long-term option for the treatment of open-angle glaucoma and is equivalent to ALT,” the researchers wrote. “It can be used as either a primary intervention, a replacement for medication or an additional therapy with glaucoma medications.”
Perspective
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Since its introduction in 2001, SLT has gained traction as a potential first-line treatment for glaucoma. We used to only consider SLT for patients who were noncompliant, had poor prescription coverage or who were intolerant to topical therapy, but recent data is supportive of SLT therapy as an option for first-line treatment.
This report by the American Academy of Ophthalmology serves to review recent literature on the use of SLT for the treatment of glaucoma. It supports SLT as an effective method for IOP control, noting minimal safety concerns and the options for it to be used as primary intervention, replacement therapy for medication or in conjunction with glaucoma medications.
Recent publications undoubtedly support SLT as first-line therapy. While a potentially cost-effective option, we can’t forget that it still may not be the best long-term option, as approximately 80% of patients will achieve a reduction in IOP and that effect may only be of benefit for 3 to 5 years.
It is nice to have all these options when managing glaucoma, and we continue to weigh the pros and cons of each potential therapy.
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