A study recently published in the Journal of Glaucoma investigated the efficacy and safety of selective laser trabeculoplasty (SLT) compared to medical therapy in the treatment of open-angle glaucoma (OAG) or ocular hypertension (OHT).
Give me some background first.
The only proven way to treat primary open-angle glaucoma (POAG) is by the reduction of IOP, which can be done via medical treatment through topical medications.
These are also used to delay or prevent POAG in individuals with ocular hypertension (OHT).
Recently, SLT has been recommended as first-line treatment for POAG by the United Kingdom National Institute for Health and Care Excellence (NICE).
Now, talk about the study.
An alternative to drops, SLT has been associated with similar levels of IOP reduction as topical medications.
Thus: Researchers here conducted a comprehensive review and meta-analysis of existing randomized control trials (RCTs) to fully evaluate the effectiveness of SLT and medical therapy on IOP levels.
Where did the data come from?
The following databases were searched for RCTs:
- PubMed
- Embase
- Cochrane Library
- Web of Science
Data was taken starting from the sites’ respective inceptions until January 4, 2023. See the full search strategy here.
Give me more on these included studies.
After review and exclusion criteria, 14 RCTs were included in the analysis, which amounted to a total of 1,709 patients.
Of these, 936 (54.9%) were randomized to SLT.
Findings?
At the 1-month point, medical therapy displayed higher effectiveness than SLT at reducing IOP (p=0.02).
However, once at 2 months through 12 months, the groups had no significant differences in IOP.
After a follow-up period of ≥5 years, the SLT group exhibited a significantly higher IOP than medical therapy (p<0.01).
Further: Also after the follow-up period, there was also a greater portion of eyes treated with medical therapy that achieved a minimum of 20% IOP reduction (p=0.02).
What about other outcomes?
There were no significant differences between the medical therapy and SLT groups for the following outcome measures:
- IOP mean fluctuation
- Success in reduction of IOP mean fluctuation
- Proportion of eyes at target IOP
- Visual field mean deviation
- Assessment of Quality of Life-7D (AQoL-7D)
- Glaucoma Quality of Life-15 (GQL-15)
Any additional data to know about?
Patients who received SLT treatment were associated with lower medications and glaucoma surgeries (p<0.01).
Plus, the incidence of adverse ocular events was also significantly lower with SLT (p<0.01).
Limitations?
The researchers noted the existence of high levels of heterogeneity in the outcomes analyzed.
Despite this, however, consistent results were reported following sensitivity analysis and tests.
Expert opinion?
The authors also noted: “A reduction in the number of medications positively impacts the long-term success of treatment by mitigating the variable of nonadherence to eye drops. In our meta-analysis, a pooled estimate of 1.09 lessen medications was found in favor of SLT.”
Take home.
Ultimately, this meta-analysis found results displaying that SLT is comparable in efficacy to medical therapy.
The study authors concluded: “Our findings support SLT as an effective and safe treatment for OAG or ocular hypertension, with favorable impacts on critical treatment-related factors.”