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Comment
. 2025 Apr 1;143(4):295-302.
doi: 10.1001/jamaophthalmol.2024.6492.

Selective Laser Trabeculoplasty After Medical Treatment for Glaucoma or Ocular Hypertension

Evgenia Konstantakopoulou  1   2 , Gus Gazzard  1 , David Garway-Heath  1 , Mariam Adeleke  3   4 , Gareth Ambler  3 , Victoria Vickerstaff  5   6 , Catey Bunce  7   8 , Neil Nathwani  1 , Keith Barton  1 ; LiGHT Trial Study Group
Collaborators, Affiliations
Comment

Selective Laser Trabeculoplasty After Medical Treatment for Glaucoma or Ocular Hypertension

Evgenia Konstantakopoulou et al. JAMA Ophthalmol. .

Abstract

Importance: Primary selective laser trabeculoplasty (SLT) is a safe primary treatment for open-angle glaucoma (OAG) and ocular hypertension (OHT). However, there is limited evidence on its use as a secondary treatment, ie, after prior use of ocular hypotensive eye drops.

Objective: To evaluate outcomes following SLT after using hypotensive eye drops for at least 3 years.

Design, setting, and participants: This is a post hoc exploratory analysis of data from a multicenter randomized clinical trial conducted within the UK National Health Service. Participants were patients with OAG or OHT who participated in the LiGHT trial. Data were analyzed from February 2021 to December 2024.

Intervention: Participants were initially randomized to either primary SLT or primary hypotensive eye drops and remained on the allocated treatment pathway for 3 years. Participants using eye drops were then allowed to have secondary SLT as a treatment switch (to reduce their medication load) or as a treatment escalation (if more intense treatment was needed). Participants were treated and monitored according to a predefined protocol.

Main outcomes and measures: The outcomes of interest were rates of incisional glaucoma surgery, medication use, and intraocular pressure.

Results: In total, 633 participants entered the extension of the LiGHT trial, and 524 participants (82.8%) completed the extension (72 months). Of 320 participants receiving primary hypotensive eye drops, 112 (35.0%) received SLT: 70 participants switched to SLT, 29 participants had SLT as a treatment escalation, and 13 participants had SLT as a treatment escalation in 1 eye and as a treatment switch in the other eye. Switching to SLT was associated with a reduction in the number of medications (mean [SD], 1.38 [0.62] to 0.59 [0.92] active ingredients; mean difference, 0.79 [95% CI 0.66 to 0.93] active ingredients; P < .001). At 72 months, 69 eyes that switched to SLT (60.5%) needed no medical or surgical treatment, and 62 eyes receiving 1 drug before switching (83.8%) needed no medical treatment. Escalating to SLT was associated with a mean intraocular pressure reduction of 4.6 mm Hg (21.8%), and 30 eyes (62.5%) reached target intraocular pressure at 72 months without the need for surgery; 9 eyes (18.7%) needed a trabeculectomy.

Conclusions and relevance: This secondary analysis of a randomized clinical trial found that secondary SLT was associated with a reduction in the medication load for stable, medically treated eyes. For medically uncontrolled eyes, there is evidence that SLT could provide additional intraocular pressure control, but the need for trabeculectomy was not eliminated.

Trial registration: isrctn.org Identifier: ISRCTN32038223.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Konstantakopoulou reported personal fees from AbbVie outside the submitted work. Prof Gazzard reported personal fees from Alcon Laboratories, Allergan/AbbVie, Lumenis, Lumibird/Quantel/Ellex, and Zeiss during the conduct of the study and personal fees from Ciliatech, Elios Vision, Genentech/Roche, Glaukos, Haag-Streit Group, Iantrek, iStar Medical, Oertli, Reichert, Ripple Therapeutics, Santen, Sight Sciences, Thea, and Vialase and serving as a member of organizing or meeting program committees for American Society of Cataract and Refractive Surgery, British Council for Prevention of Blindness, European Glaucoma Society, European Society Of Cataract & Refractive Surgeons, European Vision Institute Clinical Research Network, Glaucoma-UK, Moorfields NHS Trust, National Institute for Health and Care Excellence, Royal College of Ophthalmologists UK and Éire Glaucoma Society, University College London, and World Glaucoma Congress outside the submitted work. Dr Garway-Heath reported personal fees from AbbVie, Dompe, Janssen, Omikron, and Santen and grants from Janssen, Santen, Viatris, and Alcon Research Institute outside the submitted work. Dr Barton reported personal fees from AbbVie, Advanced Ophthalmic Innovations, Alcon, Allergan, Calilia, Elios Vision, EyeD Pharma, iStar Medical, Ivantis, JamJoom Pharmaceuticals, Laboratoires Thea, Liquid Medical, Myra Vision, Nova Eye Medical, Ph Pharma, Radiance Therapeutics, Roche, Santen Pharmaceutical, and Sight Sciences and owning stock in Aquesys, C-mer Holdings, Elios Vision, International Glaucoma Registry, Ivantis, MedEther Ophthalmology (Hong Kong), Myra Vision, Vision Futures, and Vision Medical Events outside the submitted work; in addition, Dr Barton had a patent for National University of Singapore issued. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Laser in Glaucoma and Ocular Hypertension Randomized Clinical Trial Participant Recruitment Flowchart
SLT indicates selective laser trabeculoplasty. aTwo participants were initially randomized twice due to a software failure, where the initial randomization was not visible and subsequently a second randomization was carried out. One of these participants was initially randomized to medication but was subsequently randomized to, and received, SLT. The other was initially randomized to SLT but was subsequently randomized to, and received, medication. These participants are included in the diagram according to the second randomizations.
Figure 2.
Figure 2.. Kaplan-Meier Plot of Time to Surgery During the Study’s Extension
Eyes receiving primary medical treatment have been split into eye drops only, escalation to selective laser trabeculoplasty (SLT), and switch to SLT; the unit of analysis is by eye. Month 0 signifies the initiation of the study’s extension and the offer of SLT; month 36 signifies the end of the study’s extension (the total trial monitoring period is 6 years).
See this image and copyright information in PMC

Comment on

References

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