Resident-Performed Selective Laser Trabeculoplasty in Open Angle Glaucoma Patients

Abstract

 

Purpose

 

To evaluate the efficacy and safety of selective laser trabeculoplasty (SLT) performed by resident ophthalmologists.

 

Methods

 

Records of consecutive patients treated with SLT by resident ophthalmologists at the San Francisco Veterans Administration Hospital over a two-year period were reviewed retrospectively. Data including age, indication for treatment, laser settings, pre and postoperative intraocular pressures (IOP), number of eye drop medications, and complications were recorded. Analysis accounted for non-independence of measurements made on eyes in the same patient; change scores were assessed using a clustered Wilcoxon test.

 

Results

 

A total of 83 patients underwent 112 SLT operations from November 2009 to December 2011. Average IOP at referral was 19.3. IOP decreased to 18.1 on the day of SLT (p-value 0.024, clustered Wilcoxon signed rank). Mean decrease in postoperative IOP compared to referral was 4.1 (21%) at 3 months and 4.2 (22%) at 24 months. Increased treatment, defined by number of laser shots, was not associated with better IOP control, but was associated with reduced drop requirements (p = 0.001, linear regression). There was no significant difference in IOP reduction at 6 months among residents (p = 0.09, linear mixed effects regression). There was no significant change in visual acuity 12 months after treatment (P=0.54, clustered Wilcoxon), or with increasing treatment (P=0.85, linear mixed effects regression). Referral IOP was associated with an odds ratio of 1.26 (1.10-1.45), 1.25 (1.11-1.42) and 1.34 (1.16-1.54) for success with each point increase in referral IOP at 3, 6, and 12 months respectively (all p-values <0.01). In a multivariate analysis, referral IOP was the greatest predictor of efficacy, defined as a decrease of IOP > 20%.

 

Conclusions

 

We find no evidence that resident performed SLT varies in efficacy or safety among residents or differs from the 20-30% IOP reductions reported in the literature for attending performed SLT. Increasing treatment may lead to less need for topical drops without significant side effects. Patients with higher pre-treatment IOP were most likely to receive benefit from the procedure.

 

 

Intraocular pressure at referral, treatment day (before and after treatment) and follow-up appointments. Values are average of all measured patient IOP at each visit time point. Error bars show standard error of the mean for each measurement.

 

Keywords: 578 laser • 735 trabecular meshwork • 462 clinical (human) or epidemiologic studies: outcomes/complications