July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Primary Selective Laser Trabeculoplasty for Primary Open Angle Glaucoma & Ocular Hypertension: Early clinical outcomes from a prospective, multi-centre randomised controlled UK trial
Author Affiliations & Notes
  • Anurag Garg
    Glaucoma, Moorfields Eye Hospital, London, United Kingdom
  • Vicki Vickerstaff
    University College London, London, United Kingdom
  • Neil Nathwani
    Glaucoma, Moorfields Eye Hospital, London, United Kingdom
  • Evgenia Konstantakopoulou
    Glaucoma, Moorfields Eye Hospital, London, United Kingdom
  • Emily Dowse
    Glaucoma, Moorfields Eye Hospital, London, United Kingdom
  • Gus Gazzard
    Glaucoma, Moorfields Eye Hospital, London, United Kingdom
  • Footnotes
    Commercial Relationships   Anurag Garg, None; Vicki Vickerstaff, None; Neil Nathwani, None; Evgenia Konstantakopoulou, None; Emily Dowse, None; Gus Gazzard, Alcon (R), Allergan (R), Ellex (R), Lumenis (R), Merck (R), Pfizer (R), Santen (R), Thea (R)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 6091. doi:
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    • Get Citation

      Anurag Garg, Vicki Vickerstaff, Neil Nathwani, Evgenia Konstantakopoulou, Emily Dowse, Gus Gazzard; Primary Selective Laser Trabeculoplasty for Primary Open Angle Glaucoma & Ocular Hypertension: Early clinical outcomes from a prospective, multi-centre randomised controlled UK trial. Invest. Ophthalmol. Vis. Sci. 2018;59(9):6091.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : We report preliminary early (12-month) clinical outcomes of primary SLT in newly diagnosed, treatment-naive POAG and OHT patients participating in the Laser in Glaucoma & Ocular Hypertension (LiGHT) Trial.

Methods : 355 newly diagnosed, treatment-naive POAG/OHT patients (612 eyes) received SLT. ‘Treat in pursuit of control’ study design set a stringent, individualised pre-defined Target IOP based on baseline IOP and disease severity. Treatment escalation and success criteria were also strictly defined. Patients received initial 360 degree SLT and were followed to 36 months. We report 12 month outcomes. Visual acuity, intraocular pressure (IOP), achievement of Target IOP and complications were recorded. Second SLT was permitted if treatment escalation was required. If after 2 SLT treatments target IOP was not met, patients were commenced on topical IOP lowering medication. Statistical analysis was performed using STATA15. Mixed effects multilevel modelling was used to identify predictors of success.

Results : 355 patients (612 eyes) were treated. 335 patients (578 eyes) were reviewed at 12 months (+/- 3 months). By this time, 489 eyes had received 1 SLT & 89 eyes had received 2 SLTs. At 12 months, 62 eyes had been commenced on topical medication following either 1 or 2 SLTs. Mean (SD) IOP measured 24.4 (5.2) mmHg at baseline & 16.9 (3.5) mmHg at 12 months. Mean IOP reduction was 7.7mmHg (31%) (p<0.001, 95% confidence interval, 7.3-8.1mmHg, paired samples t-test). At 12 months, 490/578 eyes that had received 1 or 2 SLTs were at Target IOP, without medication = 84% success based on strict success criteria. Incidence of adverse events during SLT was low. Only 1 patient developed post-laser IOP spike. Most commonly reported adverse events during follow up included discomfort, blurred vision and photophobia. Multilevel modelling identified glaucoma severity and IOP at 2 months as strong predictors of success at 12 months.

Conclusions : Preliminary data suggest primary SLT is safe & effective at lowering IOP in newly diagnosed, treatment-naïve POAG/OHT patients, providing ~30% reduction in IOP from baseline. Severity of diagnosis and IOP at 2 months are possible predictors of early success at 12 months.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

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