Selective laser trabeculoplasty superior to drops at preserving VF of OHT/OAG patients

First-line selective laser trabeculoplasty (SLT) demonstrates greater effectiveness than drops in visual field (VF) preservation among patients diagnosed with ocular hypertension (OHT) or open-angle glaucoma (OAG), reports a recent study.

This post hoc analysis of data from the LiGHT trial involved 710 eyes of patients with newly diagnosed OHT/OAG. The better (baseline mean deviation [MD]) eye was selected in each patient, with at least three reliable VFs (false-positive errors <15 percent) over at least 6 months.

Finally, the authors performed secondary analyses to examine the differences in rate across baseline severity groups (OHT, mild OAG, and moderate/severe OAG), the effect of glaucoma surgery and switch to SLT in the drops-first arm by truncating the VF series, and the effect of cataract and cataract surgery by using the mean pattern deviation (MPD) instead of the MD.

Among the eyes analysed, 482 had OAG, and 354 received first-line SLT. Baseline MD was similar between the SLT-first and the drops-first groups (p=0.7). During follow-up, the average intraocular pressure (IOP) was 16.8 in the SLT-first arm and 16.1 in the drops-first arm (p=0.057). The mean MD rates were ‒0.37 and ‒0.26 decibels/year, respectively (p=0.007).

The difference remained significant only in mild OAG (p=0.035, the largest subgroup) when stratified by severity. These results persisted in the secondary analyses. Moreover, the difference in MPD rate was still significantly slower in the SLT-first arm (p<0.001).

“Selective laser trabeculoplasty should be preferred as the first line of treatment in newly diagnosed OHT and OAG eyes,” the authors said.