Review: This analysis of randomised controlled trials conducted before August 2019 compared the efficacy of selective laser trabeculoplasty (SLT)-related and medication-only treatments for open-angle glaucoma (OAG). Overall, 1,229 patients in eight trials were included.
The results revealed no significant differences between SLT-related and medication-only treatments regarding intraocular pressure (IOP) reduction and the success rate of IOP control. The SLT-related therapy group required significantly fewer medications compared with the medication-only group. The conclusions were that SLT is safe and has a lower incidence of ocular side effects compared to medications, and can be a first-line therapy for OAG.
Comment: The decision regarding when to start treatment for early or possible glaucoma can be difficult, as the clinician is often committing the patient to treatment for life. All currently available treatments for OAG involve the reduction of IOP. Traditionally, topical medication has been the first-line treatment for glaucoma, with prostaglandin analogues usually the first choice. However, the advent of SLT has presented another option that now, according to studies, is of similar efficacy to medication.
While cost and significant adverse events were not evaluated in this study, it is well known that over time, eye drops can have significant side effects including ocular irritation and prostaglandin-associated orbitopathy. In addition, studies have shown that up to half of patients on topical medications do not use them as regularly as instructed. Thus, SLT can be a favourable alternative to medications for some individuals. It is important to note, however, that some individuals do not have an appreciable IOP-lowering response to SLT and will still need further IOP-lowering medication. In addition, patients need to be counselled regarding the temporary effects of SLT and potential need to repeat treatment after one to two years.
SLT versus medication for open-angle glaucoma: systematic review and meta-analysis of randomised clinical trials
Chi SC, et al.
Br J Ophthalmol. 2020 Nov;104(11):1500-1507.
Dr Jay Meyer is an Auckland-based consultant ophthalmologist specialising in cornea/external diseases and glaucoma. He is also a senior lecturer at Auckland University and works in private practice at Eye Institute.