Selective laser trabeculoplasty versus topical medication as initial glaucoma treatment: the glaucoma initial treatment study randomised clinical trial

Ghee Soon Ang^#¹, Eva K Fenwick^#^{2

3

4}, Marios Constantinou³, Alfred Tau Liang Gan², Ryan Eyn Kidd Man², Robert J Casson⁵, Eric A Finkelstein⁴, Ivan Goldberg⁶, Paul R Healey^{6

7}, Konrad Pesudovs^{8

9}, Sutha Sanmugasundram³, Jing Xie³, Rachel McIntosh³, Jonathan Jackson^{10

11}, Anthony P Wells¹², Andrew White^{6

7

13}, Keith Martin^{1

3

14

15}, Mark J Walland¹, Jonathan G Crowston^{2

3

4

15}, Ecosse Luc Lamoureux^{16

3

4}

Affiliations

¹ Glaucoma Investigation and Research Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.
² Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.
³ Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.
⁴ Duke-NUS Medical School, Singapore.
⁵ Ophthalmology and Visual Sciences, South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia, Australia.
⁶ Discipline of Ophthalmology, The University of Sydney, Sydney, New South Wales, Australia.
⁷ Westmead Institute for Medical Research, Sydney, New South Wales, Australia.
⁸ School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia.
⁹ Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, United Kingdom.
¹⁰ National Vision Research Institute, Australian College of Optometry, Melbourne, Victoria, Australia.
¹¹ Royal Victoria Hospital (BHSCT), Belfast, Northern Ireland.
¹² Capital Eye Specialists, Wellington, New Zealand.
¹³ Cambridge NIHR Biomedical Research Centre, University of Cambridge, Cambridge, UK.
¹⁴ Ophthalmology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
¹⁵ Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.
¹⁶ Singapore Eye Research Institute, Singapore National Eye Centre, Singapore ecosse@unimelb.edu.au.

^# Contributed equally.

PMID: 31488427
DOI: 10.1136/bjophthalmol-2018-313396

Randomized Controlled Trial

Selective laser trabeculoplasty versus topical medication as initial glaucoma treatment: the glaucoma initial treatment study randomised clinical trial

Ghee Soon Ang et al. Br J Ophthalmol. 2020 Jun.

. 2020 Jun;104(6):813-821.

doi: 10.1136/bjophthalmol-2018-313396. Epub 2019 Sep 5.

Authors

Affiliations

¹ Glaucoma Investigation and Research Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.
² Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.
³ Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.
⁴ Duke-NUS Medical School, Singapore.
⁵ Ophthalmology and Visual Sciences, South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia, Australia.
⁶ Discipline of Ophthalmology, The University of Sydney, Sydney, New South Wales, Australia.
⁷ Westmead Institute for Medical Research, Sydney, New South Wales, Australia.
⁸ School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia.
⁹ Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, United Kingdom.
¹⁰ National Vision Research Institute, Australian College of Optometry, Melbourne, Victoria, Australia.
¹¹ Royal Victoria Hospital (BHSCT), Belfast, Northern Ireland.
¹² Capital Eye Specialists, Wellington, New Zealand.
¹³ Cambridge NIHR Biomedical Research Centre, University of Cambridge, Cambridge, UK.
¹⁴ Ophthalmology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
¹⁵ Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.
¹⁶ Singapore Eye Research Institute, Singapore National Eye Centre, Singapore ecosse@unimelb.edu.au.

^# Contributed equally.

PMID: 31488427
DOI: 10.1136/bjophthalmol-2018-313396

Abstract

Background/aims: To determine if selective laser trabeculoplasty (SLT) is superior to topical medication as a first-line treatment for glaucoma on quality of life (QoL) and clinical outcomes.

Methods: In this international, longitudinal, multisite randomised controlled trial, treatment naïve mild-to-moderate primary open angle or exfoliation glaucoma patients were randomised 1:1 to SLT or topical medication. Glaucoma-specific QoL (primary outcome) was measured using the Glaucoma Outcomes Assessment Tool (GOAT; 342 items, 12 domains). Secondary outcomes included rate of successful intraocular pressure (IOP) reduction (>25% reduction from baseline) and presence of ocular surface disease including conjunctival hyperaemia and eyelid erythema. Our intention-to-treat analysis was performed at months 12 and 24.

Results: Of 167 enrolled patients, 83 and 84 were randomised to SLT and topical medication, respectively; and 145 (n=75 SLT, n=70 medication) completed 24-month follow-up. While both treatment arms achieved significant within-group gains in GOAT outcomes at both endpoints, SLT patients reported a greater between-group improvement in 'social well-being' compared with medication patients (mean±SE=0.28±0.13; p=0.034) at 24 months. At month 24, the rate of successful IOP reduction was 18.6% (95% CI 3.0% to 34.3%, p=0.022) higher (absolute difference) in the medication compared with SLT group. More individuals in the medication group had conjunctival hyperaemia and eyelid erythema compared with SLT at 24 months.

Conclusion: Overall, we did not find evidence that SLT was superior to medication in improving glaucoma-specific QoL. While we found superior IOP reduction in the medication arm, eyelid erythema and conjunctival hyperaemia were more prevalent in these patients compared with the SLT group.

Trial registration: ACTRN12611000720910.

Keywords: clinical trial; glaucoma.

PubMed Disclaimer

Conflict of interest statement

Competing interests: IG has the following conflicts of interest to declare: Advisory Board member for Allergan, Novartis, Mundipharma; Speaker Bureau for Allergan, Novartis; Travel support from Pfizer. KM has the following conflicts of interest to declare: Consultant to Allergan, Novartis, Quethera, Sensimed.

Publication types

Actions
Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Substances

Actions
Actions

Associated data

ANZCTR/ACTRN12611000720910

LinkOut - more resources

Full Text Sources
- HighWire
Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Selective laser trabeculoplasty versus topical medication as initial glaucoma treatment: the glaucoma initial treatment study randomised clinical trial

Affiliations

Selective laser trabeculoplasty versus topical medication as initial glaucoma treatment: the glaucoma initial treatment study randomised clinical trial

Authors

Affiliations

Abstract

Conflict of interest statement

Publication types

MeSH terms

Substances

Associated data

LinkOut - more resources

Full Text Sources

Medical