More Evidence to Support Shift in Standard Glaucoma Care

Glaucoma is a lifelong eye disease that requires regular treatment. For many, it can be controlled by a daily eye drop regimen, but the treatment is not perfect. The preservatives in the drops can cause painful side effects, it’s hard for most patients to use their medication as prescribed, and daily treatment is costly. Previous studies have shown that a laser treatment called selective laser trabeculoplasty is as effective as eye drops, but without the drawbacks of eye drops.

A new study presented today at AAO 2024, the 128th annual meeting of the American Academy of Ophthalmology, shows that laser treatment has an additional advantage: Glaucoma progressed 29 percent slower in patients treated with laser compared with eye drops.

“Selective laser trabeculoplasty should not only be considered an effective and safe alternative to medications as a first-line treatment for primary open-angle glaucoma but can also offer an advantage in reducing vision loss,” said lead researcher Giovanni Montesano, MD, PhD, of Moorfields Eye Hospital in London.

Glaucoma is a leading cause of blindness for people over 60 years old. But blindness from glaucoma can often be prevented with early treatment. Selective laser trabeculoplasty reduces eye pressure by stimulating the trabecular meshwork, the eye’s natural drainage system. Laser treatment is effective for most people and its effects can last a few years or more.

Dr. Montesano and his colleagues conducted a new analysis of a randomized trial called the Laser in Glaucoma and Ocular Hypertension (LiGHT) trial. The trial ,run by chief investigator Prof Gus Gazzard, compared selective laser trabeculoplasty and glaucoma eye drops as first-line treatment in patients recently diagnosed with open-angle glaucoma or ocular hypertension.

Six-year results showed that patients treated with laser experienced a statistically significant lower rate of disease progression and reduced need for glaucoma surgery. Dr. Montesano revisited the visual field outcomes from the LiGHT trial using a more detailed and sensitive statistical approach.

“Since the first study, we developed an improved statistical technique to calculate the rate of progression of the Mean Deviation,” Dr. Montesano said. “This improved methodology, together with the longer follow-up, prompted us to test again the previously observed differences between the SLT-1st and the Medication-1st arms of the LiGHT trial.”

Using this improved methodology, the data show a 29 percent reduction in the rate of mean deviation progression in the better eligible eye of patients treated with laser first over six years of follow-up. This translated to an estimated proportion of eyes with fast progression (faster than -0.5 dB/year) of 14 percent in the laser group and 25 percent for the eye drop group.

Why would laser treatment provide better vision protection? Previous studies suggest that treatments that are more likely to provide continuous pressure control, and do not rely on patient compliance with medication, tend to be more effective in controlling glaucoma.

The American Academy of Ophthalmology recently published an Opthalmic Technology Assessment of selective laser trabeculoplasty. The assessment concluded that laser treatment can be used as either a primary intervention, a replacement for medication, or an additional therapy with glaucoma medications.

About the American Academy of Ophthalmology

The American Academy of Ophthalmology is the world’s largest association of eye physicians and surgeons. A global community of 32,000 medical doctors, we protect sight and empower lives by setting the standards for ophthalmic education and advocating for our patients and the public. We innovate and support research to advance our profession and to ensure the delivery of the highest-quality eye care. Our EyeSmart® program provides the public with the most trusted information about eye health. For more information, visit aao.org.