New findings from a 3-year extension of the Laser in Glaucoma and Ocular Hypertension (LiGHT) trial provide longer-term data from selective laser trabeculoplasty (SLT) for treating patients with mild to moderate glaucoma.
Let’s start with the original LiGHT trial
Initiated in 2019, the LiGHT trial (NCT03395535) was a 3-year study (718 patients; <18 years of age) that sought to determine whether initial treatment with SLT (356 patients) was superior to initial treatment with topical eye drops (362 patients) for primary open-angle glaucoma (POAG) or ocular hypertension (OHT).
What did they find?
Among the 692 patients who completed the trial, investigators found that SLT provided more robust intraocular pressure (IOP) lowering as well as more effectiveness in improving health-related quality of life (HRQoL) and overall visual outcomes.
There was a 97% probability of SLT as a primary and more cost-effective option in the long term—largely due to the reduced need for eye drops (75% of SLT patients did not require any after 3 years) and hospital visits.
Gotcha. Now talk about this extension.
The prospective, multicenter, and randomized-controlled trial (ISRCTN32038223) continued to assess 91% of patients from the LiGHT trial (633); those in the SLT arm received a third SLT (if necessary), while those in the drops arm received SLT as a treatment switch or escalation.
Patients were followed for an additional 3 years, with the primary outcome being HRQoL measured at 6 years (total) and secondary outcomes of clinical effectiveness and adverse events (AEs).
Findings?
Investigators observed no significant differences in EuroQoL EQ-5D 5 Levels, Glaucoma Utility Index, and Glaucoma Quality of Life-15 (p >0.05 for all).
More of the eye drop-arm patients exhibited disease progression (p= 0.006), while trabeculectomy was also less likely in these patients versus SLT-arm patients (p =0.03).
No serious AEs were reported.
Give me some numbers.
At 6 years, 94.2% of initially-treated SLT eyes met the targeted treatment effectiveness and visual functions (versus 94.7% of initially-treated eye drop eyes).
For target IOP, 92.8% of SLT patients and 93.2% of drop patients were successful.
Expert takeaways?
According to study author Gus Gazzard, MD, MBBChir, MA, MD, FRCOphth, the data shows SLT to be a safe treatment for both OAG and OHT, “providing better long-term disease control than initial drop therapy, with reduced need for incisional glaucoma and cataract surgery over 6 years,” he stated.
What’s next?
A randomized trial is currently in progress that is comparing low-power SLT with ‘treat and repeat’ on an annual basis with the current standard of ‘treat as required,’ according to Dr. Gazzard.
Significance?
To change the landscape of glaucoma laser delivery would be a paradigm shift with a “low-power SLT and a new Direct SLT that uses trans-limbal laser delivery without a contact lens,” he stated.