VF outcomes in ocular hypertension, glaucoma slightly better with laser than eye drops

Selective laser trabeculoplasty (SLT) appears to be more favourable than medical therapy in the first-line treatment of patients with ocular hypertension and glaucoma, with the former associated with slower visual field (VF) progression, according to data from the Laser in Glaucoma and Ocular Hypertension Trial (LiGHT).

LiGHT included 344 patients (588 eyes) treated first with intraocular pressure (IOP)-lowering eye drops and 344 patients (590 eyes) treated first with SLT. The average age of the overall population was 63 years, and 54.2 percent were male.

The researchers measured VF using standard automated perimetry and arranged in series (median length and duration, 9 VFs over 48 months). They assessed pointwise VF progression rates, which were then averaged to produce a global progression estimate for each eye. Progression was defined as fast (<–1 dB/year) or moderate (<–0.5 dB/year).

A higher number of eyes underwent moderate or fast total deviation (TD) progression in the medical therapy group than with the SLT group (26.2 percent vs 16.9 percent; risk ratio [RR], 1.55, 95 percent confidence interval [CI], 1.23–1.93; p<0.001). Results for pointwise rates were similar (26.1 percent vs 19.0 percent; RR, 1.37, 95 percent CI, 1.33–1.42; p<0.001).

Additionally, pointwise pattern deviation (PD) rates on IOP-lowering medication vs SLT were more frequently categorized as moderate or fast (11.5 percent vs 8.3 percent; RR, 1.39, 95 percent CI, 1.32–1.46; p<0.001).

There was no significant between-group difference seen in the proportion of eyes that underwent moderate or fast PD progression (9.9 percent with medical therapy vs 7.1 percent with SLT; RR, 1.39, 95 percent CI, 0.95, 2.03; p=0.0928).

The findings suggest that SLT may delay or completely avert the need for more intense medical and surgical intervention in a significant proportion of patients with glaucoma and ocular hypertension.