SLT or Selective Laser Trabeculplasty, has been around for many years and there have already been several studies showing efficacy. However, this technology was not widely adopted in the UK until recently, mainly due to the lack of robust clinical evidence.

The Light trial, (Laser in Glaucoma and ocular HyperTension) published in The Lancet, has transformed our everyday glaucoma practice.

Introduction

SLT or Selective Laser Trabeculplasty, has been around for many years and there have already been several studies showing efficacy. However, this technology was not widely adopted in the UK until recently, mainly due to the lack of robust clinical evidence.

The Light trial, (Laser in Glaucoma and ocular HyperTension) published in The Lancet, has transformed our everyday glaucoma practice.

LIGHT trial

Why is the Light Trial a Landmark for Glaucoma?

The LIGHT trial is the first randomised controlled study comparing SLT with glaucoma drops.

It is a real-life study, taking into account the challenges busy NHS hospitals are facing.

It is a very powerful study, with 718 patients enrolled, of which 356 were randomised to the selective laser trabeculoplasty group and 362 to the glaucoma eye drops group.

Well-defined Inclusion/Exclusion Criteria

As with every study, it is important that we take into account the inclusion and exclusion criteria, because we should not extrapolate the results to every glaucoma patient.

The Light trial applies to treatment-naive patients with open angle glaucoma (mean deviation not worse than −12 dB in the better eye or −15 dB in the worse eye ) or ocular hypertension, visual acuity of 6/36 or better in the eyes to be treated, and no previous intraocular surgery, except uncomplicated phacoemulsification at least 1 year before randomisation and no ocular comorbidities.

 

Why is the LIGHT Trial a Landmark for Glaucoma?

The LIGHT trial is the first randomised controlled study comparing SLT with glaucoma drops.

It is a real-life study, taking into account the challenges busy NHS hospitals are facing.

It is a very powerful study, with 718 patients enrolled, of which 356 were randomised to the selective laser trabeculoplasty group and 362 to the glaucoma eye drops group.

LIGHT trial

Well-defined Inclusion/Exclusion Criteria

As with every study, it is important that we take into account the inclusion and exclusion criteria, because we should not extrapolate the results to every glaucoma patient.

The Light trial applies to treatment-naive patients with open angle glaucoma (mean deviation not worse than −12 dB in the better eye or −15 dB in the worse eye ) or ocular hypertension, visual acuity of 6/36 or better in the eyes to be treated, and no previous intraocular surgery, except uncomplicated phacoemulsification at least 1 year before randomisation and no ocular comorbidities.

What were the Key Results?

At 36 months, 74·2% of patients in the selective laser trabeculoplasty group required no drops to maintain intraocular pressure at target.

Overall cost saving to the NHS of £451 per patient in specialist ophthalmology costs.

Health-related quality of life at 3 years was a primary outcome (assessed by EQ-5D) and was found to be equal between SLT and drops. However, this generic tool has very limited value in assessing treatment effects on the quality of life, because glaucoma is an asymptomatic disease until the advanced stages.

Overall Message

Selective laser trabeculoplasty appears to be safe and effective and should be offered as a first-line treatment for open angle glaucoma and ocular hypertension.

Thomas Ressiniotis SLT

Thomas Ressiniotis performing SLT

What were the Key Results?

At 36 months, 74·2% of patients in the selective laser trabeculoplasty group required no drops to maintain intraocular pressure at target.

Overall cost saving to the NHS of £451 per patient in specialist ophthalmology costs.

Health-related quality of life at 3 years was a primary outcome (assessed by EQ-5D) and was found to be equal between SLT and drops. However, this generic tool has very limited value in assessing treatment effects on the quality of life, because glaucoma is an asymptomatic disease until the advanced stages.

Thomas Ressiniotis SLT

Thomas Ressiniotis performing SLT

Overall Message

Selective laser trabeculoplasty appears to be safe and effective and should be offered as a first-line treatment for open angle glaucoma and ocular hypertension. 

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