Nearly 70% of glaucoma patients reduced eye drop use after SLT
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Key takeaways:
- Average IOP reductions were 23.04% at 6 months and 25.74% at 12 months.
- Most patients (68.19%) reported a reduction in the number of eye drops used.
Selective laser trabeculoplasty effectively reduced IOP, as well as the quantity of eye drops used after treatment, among patients with open-angle glaucoma, according to research conducted in Brazil and published in the Journal of Glaucoma.
“We aimed to determine whether [selective laser trabeculoplasty (SLT)] could replace hypotensive eye drops in patients with open-angle glaucoma at a Brazilian public service,” Leopoldo Ernesto Oiticica Barbosa, MD, of the faculty of medicine at the University of Sao Paulo, and colleagues wrote. “The eye drops are part of a high-cost list distributed free of charge by the government, so by reducing the amount of medication, we can relieve resources for the health system.”
In a prospective, nonrandomized, single-arm interventional study of 92 eyes — 70 with mild glaucoma and 22 with moderate glaucoma — from 46 patients with open-angle glaucoma in the Brazilian Public Health System, researchers compared IOP measurements with eye drop use at baseline and 12 months after SLT. All participants underwent a washout of antiglaucoma medications before the baseline measurement.
Participants (mean age, 66 years; 67.4% women) were evaluated at 7, 30, 90, 180, 270 and 360 days after SLT, with IOP measurements taken via Goldman applanation tonometer. The mean number of eye drops used at baseline was 2.26, and the post-washout IOP was 21.1 mm Hg.
Of 29 eyes that achieved absolute success and did not need eye drops, 14 (48.26%) were previously using a single medication, while the rest were on multiple medications. In those achieving relative success, 31.81% continued to use their initially prescribed quantity of eyedrops, and of those, 53.57% transitioned from prostaglandin analogue to timolol maleate, 42.86% reverted to using timolol maleate and 3.57% reintroduced prostaglandin analogue.
Further, researchers reported no statistically significant difference in change in IOP between mild and moderate glaucoma groups, with mean IOP values at 12 months similar to those reported before the washout. Average IOP reductions were 23.04% at 6 months and 25.74% at 12 months.
While most participants returned to eyedrops after SLT (median time, 10.4 months), 68.19% of patients reported a reduction in the quantity of eye drops used. At the end of 12 months, the average number of eye drops used decreased to 1.03 in the mild glaucoma group and 1 in the moderate glaucoma group.
“Our study shows that SLT can be an effective treatment to replace eye drops in the Brazilian Public Health System, leading to a cost reduction,” Barbosa and colleagues wrote.
Perspective
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I recently began glaucoma care for a patient with a combination of skepticism for pharmaceuticals and unique lifestyle factors that made topical medications undesirable. I referred him for SLT and he received the procedure without incident from a trusted glaucoma specialist.
While this procedure was not offered with cost concerns in mind, I think it highlights that we must often consider a patient-centric approach. I could very well see this patient being told that treatment with medications was the preferred option, resulting in increased office visits, cost and frustration for him.
Fortunately, SLT as initial therapy is growing in acceptance due to the growing body of evidence that shows it is an effective alternative to topical medications. Although I have discussed SLT with my patients for some time, it is only within the past few years that I have been met with less resistance to its use as an initial treatment.
In some cases, past referrals have returned only to report that the physician recommended medications over treatment or chose to delay the procedure. Such impediments to care are less than ideal and deprive the patients of effective patient-centric glaucoma care.
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Barbosa LEO, et al. J Glaucoma. 2024:doi:10.1097/IJG.0000000000002343.
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