UK Study: SLT Should Be First-Line Treatment

■ In a study finding that recommends a major change in glaucoma therapy, researchers at Moorfields Eye Hospital in London now prefer quick, one-time selective laser trabeculoplasty (SLT) to daily use of eye drops as first-line glaucoma treatment. Their findings were reported in a recent edition of the journal Lancet.

In the observer-masked, randomized, controlled LiGHT trial, 718 treatment-naive patients with open-angle glaucoma or ocular hypertension and no ocular comorbidities were recruited between 2012 and 2014 at 6 UK hospitals. A target IOP was set according to glaucoma severity. The primary endpoint was health-related quality of life at 3 years, assessed by patient questionnaire. Secondary outcomes were cost and cost-effectiveness, disease-specific quality of life, clinical effectiveness, and safety.

Of the patients enrolled, 356 were randomized to SLT and 362 to the eye drops group, and 652 (91%) returned the primary outcome questionnaire at 36 months. At 36 months, 74.2% of patients in the SLT group required no drops to maintain IOP at target. Eyes of patients in the SLT group were within target IOP at more visits (93.0%) than in the eye drops group (91.3%), with glaucoma surgery to lower IOP required in none vs 11 patients in the eye-drop cohort. Over 36 months, from cost perspective, there was a 97% probability of SLT as first-line treatment being more cost-effective than eye drops. The researchers concluded that SLT should be offered as a first-line treatment for open angle glaucoma and ocular hypertension, supporting a change in clinical practice.