Laser Treatment for Glaucoma and Ocular Hypertension: Effectiveness (2020 Clinical Trial Results)

Eye drops that lower eye pressure have long been used as the first-line treatment for glaucoma and ocular hypertension.

However, rather than that,

it is more effective to perform selective laser trabeculoplasty (SLT) first:

The results of a study published in The Lancet in 2019 overturned what had been medical common sense until now¹.

Thus far, IOP-lowering eye drops have been used as a first-line treatment for glaucoma and ocular hypertension (OHT), but a recent report from the Laser in Glaucoma and Ocular Hypertension (LiGHT) trial showed that selective laser trabeculoplasty (SLT), an outpatient laser procedure for the reduction of IOP, provides better clinical effective- ness and lower treatment intensity among newly diagnosed glaucoma and OHT patients compared with IOP-lowering eye drops, and comparable health-related quality of life, while also being cost-effective.²

The LiGHT Study: Comparing Eye Drops and SLT for Glaucoma and Ocular Hypertension

In glaucoma treatment, lowering eye pressure is the only target.
The goal is, as a result, to slow the progression of visual field loss.

Laser Treatment for Glaucoma and Ocular Hypertension: Effectiveness (2020 Clinical Trial Results)

The LiGHT study(Laser in Glaucoma and Ocular Hypertension)

: a multicenter randomized clinical trial comparing eye drop treatment and SLT for glaucoma and ocular hypertension,
has compared and verified the effects of SLT and eye drops.

Many studies have already verified that SLT lowers eye pressure effectively^3-5.

“Compared with eye drop treatment, SLT effectively suppresses the progression of visual field loss.”

These are the results published online in the journal Ophthalmology in April 2020².

What is new this time:
It has become clear that SLT is effective in “slowing the progression of visual field loss”.

Effectiveness of laser treatment for glaucoma and ocular hypertension: a multicenter randomized clinical trial

344 patients (588 eyes): eye drop treatment
344 patients (590 eyes): selective laser trabeculoplasty (SLT)

Visual field analysis was performed over 4 years.

Conclusion:
Among patients diagnosed with glaucoma or ocular hypertension,
visual field loss progressed faster in the group that started with eye drop treatment than in the group that started with SLT.

SLT as the First-Line Treatment for Open-Angle Glaucoma: Time for a Change?

Selective laser trabeculoplasty as the primary treatment for open angle glaucoma: time for change?

This was published in the journal Eye in September 2020.

According to the LiGHT study,
performing SLT first for glaucoma and ocular hypertension is effective:

We have now entered an era in which this has been shown scientifically.

To actually accept this result,

• The experience and views of the ophthalmologist
• Access to facilities that perform laser treatment
• Long-term cost
• Explanation and understanding

There are various points to consider⁶.

I believe we need to calmly keep up with medical common sense, which changes day by day.

(References)

1. Gazzard, G., Konstantakopoulou, E., Garway-Heath, D., Garg, A., Vickerstaff, V., Hunter, R., Ambler, G., Bunce, C., Wormald, R., Nathwani, N., Barton, K., Rubin, G., Buszewicz, M., Ambler, G., Barton, K., Bourne, R., Broadway, D., Bunce, C., Buszewicz, M., Davis, A., Garg, A., Garway-Heath, D., Gazzard, G., Hunter, R., Jayaram, H., Jiang, Y., Konstantakopoulou, E., Lim, S., Liput, J., Manners, T., Morris, S., Nathwani, N., Rubin, G., Strouthidis, N., Vickerstaff, V., Wilson, S., Wormald, R., Zhu, H., 2019. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial. The Lancet 393, 1505–1516. https://doi.org/10.1016/S0140-6736(18)32213-X
2. Wright, D.M., Konstantakopoulou, E., Montesano, G., Nathwani, N., Garg, A., Garway-Heath, D., Crabb, D.P., Gazzard, G., 2020. Visual Field Outcomes from the Multicenter, Randomized Controlled Laser in Glaucoma and Ocular Hypertension Trial (LiGHT). Ophthalmology 127, 1313–1321. https://doi.org/10.1016/j.ophtha.2020.03.029
3. Gazzard, G., Konstantakopoulou, E., Garway-Heath, D., Barton, K., Wormald, R., Morris, S., Hunter, R., Rubin, G., Buszewicz, M., Ambler, G., Bunce, C., 2017. Laser in Glaucoma and Ocular Hypertension (LiGHT) Trial. A multicentre, randomised controlled trial: design and methodology. British Journal of Ophthalmology 102, bjophthalmol-2017. https://doi.org/10.1136/bjophthalmol-2017-310877
4. Konstantakopoulou, E., Gazzard, G., Vickerstaff, V., Jiang, Y., Nathwani, N., Hunter, R., Ambler, G., Bunce, C., 2017. The Laser in Glaucoma and Ocular Hypertension (LiGHT) trial. A multicentre randomised controlled trial: Baseline patient characteristics. British Journal of Ophthalmology 102, bjophthalmol-2017. https://doi.org/10.1136/bjophthalmol-2017-310870
5. Nagar, M., Ogunyomade, A., O’Brart, D.P.S., Howes, F., Marshall, J., 2005. A randomised, prospective study comparing selective laser trabeculoplasty with latanoprost for the control of intraocular pressure in ocular hypertension and open angle glaucoma. Br J Ophthalmol 89, 1413–1417. https://doi.org/10.1136/bjo.2004.052795
6. Ang, M., Tham, C.C., Sng, C.C.A., 2020. Selective laser trabeculoplasty as the primary treatment for open angle glaucoma: time for change? Eye 34, 789–791. https://doi.org/10.1038/s41433-019-0625-6