Abstract
Purpose :
The effective initial treatment of glaucoma faces limitations mainly due to medication non-adherence and limited access to selective laser trabeculoplasty (SLT). DSLT is an innovative, automated, non-contact procedure that reduces intraocular pressure (IOP) without requiring gonioscopy or extensive training. Our study compiles evidence supporting DSLT's efficacy and safety at 12 months.
Methods :
In 2018 we conducted the first-in-human Open Angle Glaucoma (OAG) trial, followed by a subsequent trial to further assess DSLT's safety and effectiveness. This controlled, evaluator-masked comparison of DSLT and SLT involved patients aged ≥40 years with ocular hypertension or OAG. They were either treatment-naïve or using up to three hypotensive medications, with untreated/washout IOP between 22–35 mmHg. The study, conducted across 14 international ophthalmological centers, randomized participants 1:1 to receive DSLT or SLT and followed them up for 12 months. Ongoing studies such as investigator initiated, real-world trials are expected to provide further outcome details and explore further indications, such as angle closure glaucoma.
Results :
We studied 162 randomized patients, 84 underwent DSLT and 77 SLT. Baseline patient and eye characteristics were similar between the groups. At 12-month, patients who underwent DSLT experienced a mean reduction in non-washed-out IOP from the screening value of -3.97 ± 6.21 mmHg (27.9%), while participants treated with SLT saw a mean reduction of -2.58 ± 4.45 mmHg (19.2%). Both arms showed comparable results to the preliminary study, demonstrating up to a 27.1% reduction in IOP at 6 months. Importantly, the mean (±SD) number of medications used by the DSLT group decreased by approximately 50%, from 1.19 (±1.01) at screening to 0.63 (±0.94) at 12 months, mirroring the SLT group's decline from 1.22 (±0.98) to 0.68 (±0.94). Notably, more than half of the participants became medication-free at 12 months (61.7% DSLT and 59.5% SLT participants). No significant side effects occurred.
Conclusions :
This study shows that DSLT is a safe and effective method, maintaining a clinically significant reduction in IOP at the 12-month mark. Given the growing acceptance of laser trabeculoplasty as a primary treatment, DSLT stands poised to address an expanding clinical need in glaucoma care, enhancing the accessibility of laser trabeculoplasty.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.