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Kate Coleman, Linda visser, Emil goosen, William Eric Sponsel, Abdirask Dalmar, Jennifer Galley; SLT as an essential tool for management of glaucoma in the African eye. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):933.
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© ARVO (1962-2015); The Authors (2016-present)
Sub-Saharan Africa has fewer than 1 Ophthalmologist per million population. Sight preserving support services, including optometry and access to glaucoma medications, are absent in all but a few urban populations. Our experience in Africa since 2006, working in partnership with African eye surgeons, has revealed a remarkably high incidence of untreated early and advanced glaucoma. This study reports initial experience using SLT in adult glaucoma patients in Durban, South Africa.
Lumenis Selecta SLT was performed on either or both eyes of consecutive glaucoma patients. After recording pre-treatment IOP by applanation,1800 treatment with ~50 spots was performed, titrating from 0.5 mJ, in +.1 mJ increments until bubbles arose from ~1 in every 3 spots placed. Repeat tonometry was scheduled at 1 and 6 months post-SLT. Significance of change in IOP from baseline was assessed by 2-tailed paired t-test.
Among 90 treated patients (65 black, 22 Indian, 3 white; 48M, 42F; mean age 59 ±[sem]1.3yrs ), 63 (70%) returned for at least one of the two scheduled follow-up visits. 20 patients (31.7%) had a prior history of glaucoma filtration surgery in at least one eye. At 1 mo, treated right eyes (n=35) showed reduction of -4.6mmHg (-25.3%) from the associated pre-treatment IOP, from 19.1 to 14.5mmHg. Among left eyes the corresponding findings were n=38; ∆-7.6 (-36.0%) from 21.2 to 13.6mmHg. The 6 mo values were OD n=33; ∆-4.7 (-24.9%) from 18.9 to 14.2mmHg, and OS n=32; ∆-5.9 (-30%). All results had P < 0.0001. No evidence for any systematic bias influencing follow-up attrition was evident from the available clinical data.
SLT appears to be a very effective choice of treatment to reduce intraocular pressure among glaucomatous eyes of South African adults, with or without a history of medical and surgical glaucoma therapy. Mean reductions of IOP of 25-30% were sustained for 6 months without supplementary therapy. If such findings can be confirmed among other populations on the continent, the potential for SLT to help prevent visual loss in Africa would be inestimable. Further investigation is needed to identify duration of effect, utility of supplementary therapy, and to improve follow-up compliance. The impact of these findings may be highly significant where glaucoma medications and general services are essentially unavailable.
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