Repeat SLT ‘promising’ as first choice of treatment escalation in open-angle glaucoma
Click Here to Manage Email Alerts
Key takeaways:
- Both initial and repeat SLT were associated with IOP reduction, but repeat SLT had longer duration of effect.
- IOP reduction from one SLT intervention was not predictive of repeat SLT effectiveness.
Most patients with open-angle glaucoma responded favorably to repeat selective laser trabeculoplasty, regardless of initial response, and experienced a longer duration of effect, according to a study in JAMA Ophthalmology.
“Selective laser trabeculoplasty has been endorsed as the primary treatment option for open-angle glaucoma (OAG), the most prevalent subtype, in the latest editions of guidelines,” Yangfan Yang, MD, PhD, of Zhongshan Ophthalmic Center at Sun Yat-sen University, and colleagues wrote. “Several advantages of SLT have been demonstrated, including comparable efficacy to topical medication, superior cost-effectiveness and minimal tissue damage. However, the potential of OAG to respond favorably to SLT, termed here the responsiveness to SLT, has not been thoroughly explored.”
To do this, Yang and colleagues conducted a post-hoc analysis of the Laser in Glaucoma and Ocular Hypertension Trial in China from March 2015 to April 2023. They included 180 eyes of 105 participants (mean age, 45.6 years; 44.8% women) who were newly diagnosed with OAG or ocular hypertension and underwent initial and repeat SLT. An additional 50 eyes — of patients who were older (mean, 53.8 years) — were given topical medication as opposed to repeat laser due to patient preference.
Of the eyes that underwent single SLT, 13.6% had moderate OAG, and 4.1% had severe OAG compared with 29.4% and 11.7%, respectively, that underwent repeat SLT. There were 73 eyes that required additional treatment escalation beyond repeat SLT, which had more moderate (38.4%) to severe OAG (12.3%) vs. those with no treatment escalation.
According to results, the mean pretreatment IOP was 18.8 mm Hg before repeat SLT and 20.4 mm Hg before initial SLT. Two months after repeat and initial SLT, the mean IOP was 15.8 mm Hg and 16 mm Hg, respectively — associated with reductions of 3.3 mm Hg and 4.5 mm Hg (P < .001). While similar in IOP control, repeat SLT had a longer duration of effect (1,043 days vs. 419 days).
“We demonstrated that IOP reduction observed from only one SLT intervention, especially at an isolated time mark, was not predictive of the effectiveness of repeat SLT,” the researchers wrote.
In addition, of the 15% of participants who were potentially nonresponsive, older age, female sex and lower baseline IOP were identified as distinct characteristics and considered possible risk factors.
“Most OAG and OHT cases had high responsiveness to SLT to achieve considerable IOP reduction,” Yang and colleagues wrote. “Repeat SLT was promising as the first choice of treatment escalation regardless of initial response.”
Perspective
Back to Top
As SLT gains traction as a first-line treatment for glaucoma, addressing the existing knowledge gaps will be crucial in advancing glaucoma care.
This post-hoc analysis of the LiGHT trial in China provides supporting evidence for SLT retreatment in cases of initial treatment failure. If the observations in this paper are applicable to the broader glaucoma population, retreatment should become the standard when encountering initial-SLT treatment failure as opposed to escalation to other forms of treatment. The question of how soon and how best to apply retreatment should continue to be explored so clinicians are better informed.
The analysis also evaluated a subset of patients who showed poor response to both initial and SLT retreatment, with less than 20% IOP reduction with either treatment. Further information on low-responder characteristics could prove invaluable for SLT candidate selection, as it would save valuable time and prevent patient frustration with SLT failure.
However, given that a substantial number of patients exhibited a response greater than 20% only on the second treatment, retreatment should continue to be offered until the characteristics for low response can be further refined.
Collapse
Read more about
Click Here to Manage Email Alerts