The safety and effectiveness of optometrist-delivered selective laser trabeculoplasty

Abstract

Background: Selective laser trabeculoplasty (SLT) has been demonstrated to have an IOP-lowering effect similar to topical medication when used as a first-line treatment. Accordingly, demand for SLT has increased, requiring other allied health care professionals to be leveraged in the delivery of this service. Current evidence on the safety of optometrists performing SLT is sparse. The aim of this study was to assess the success rate of SLT delivered by optometrists in eyes with newly diagnosed ocular hypertension and/or glaucoma and individuals who had received SLT as a treatment escalation. The secondary aim of the study was to assess complications of SLT delivered by optometrists.

Methods: This was a retrospective study. Success rate was defined as ≥20% reduction in intraocular pressure (IOP), or the cessation of ≥1 class of anti-glaucoma medication in cases of treatment escalation. For the first-line treatment, success was quantified according to the disease diagnosis with specified levels of IOP reduction.

Results: 880 eyes of 574 patients were included in the analysis. The success rate was 70.9% (244/344) in eyes with first-line SLT, whilst 65.3% (343/525) in the treatment escalation group. Overall, adverse events were identified in 2.2% of cases, including uveitis (0.92%), post-procedure transient IOP spike (0.45%), allergic reaction (0.23%), dry eye (0.23%), headache (0.11%), hyphaema (0.11%), and vitreo-macular traction 0.11%).

Conclusion: Optometrists delivered a safe and effective selective laser trabeculoplasty treatment with low rates of adverse events. Inter-optometrist differences in success rates were identified that require further elucidation.