Abstract
Purpose :
To demonstrate the responsiveness to selective laser trabeculoplasty in newly diagnosed open-angle glaucoma and enhance the precision of first-line treatment decisions with high-quality evidence.
Methods :
In the Laser-1st arm of the LiGHT China trial, newly diagnosed open-angle glaucoma received selective laser trabeculoplasty. Repeat laser was the primary choice of treatment escalation, triggered by intraocular pressure above the target or glaucoma progression. Intraocular pressure reduction, especially maximum reduction during the follow-up, was the indicator of responsiveness. Kruskal-Wallis test and Chi-squared test were the main statistical methods. Support vector machine and logistic regression were developed for early prediction of responsiveness.
Results :
Selective laser trabeculoplasty significantly reduced intraocular pressure by 4.5mmHg (95% confidence interval: 3.9mmHg to 5.1mmHg) on average at 2 months, while repeat laser reduced 3.3mmHg (95% confidence interval: 2.7mmHg to 3.8mmHg). The efficacy of the laser was intraocular pressure-dependent (P<0.001). However, the efficacy of repeat laser did not rely on the efficacy of initial laser (P=0.39), and most patients benefited from repeat laser for prolonged duration of disease control (P<0.001). Maximum intraocular pressure reduction of less than 20% during the follow-up after both initial laser and repeat laser were observed in 26 eyes of 17 patients. They achieved merely 10.8% (standard deviation 5.6%) reduction from laser on average, but gained 23.7% (standard deviation 8.8%) from subsequent topical medication. The subgroup with poor responsiveness to laser was found to have features including younger age (P=0.01), a higher proportion of females (P=0.03), and lower baseline intraocular pressure (P<0.001), which were still significant in multivariate regression. Predictive models achieved 0.79 (standard deviation 0.08) area under the receiver operating characteristic curves and 0.62 (standard deviation 0.03) f1 score in cross-validation.
Conclusions :
Selective laser trabeculoplasty effectively lowered intraocular pressure in newly diagnosed open-angle glaucoma. Repeat laser as an additional treatment was a general solution, regardless of the efficacy of initial laser. Instead, potential non-responders to selective laser trabeculoplasty could be early-detected based on baseline characteristics.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.