Selective laser trabeculoplasty (SLT) is already a first-line glaucoma therapy in Europe, yet it hasn’t reach the same status here in the United States. Still, many practitioners are beginning to recommend the procedure sooner, and the American Academy of Ophthalmology’s Preferred Practice Patterns suggest clinicians consider SLT as a first-line therapy in select patients, such as those who are noncompliant or who struggle with the cost or side effects of medication.1

Now, new research further muddies the waters, suggesting SLT does not provide any improvement in patients’ glaucoma-specific quality of life (QoL) compared with topical mediation.2

An international team of researchers looked at 167 treatment-naïve, mild-to-moderate primary open-angle or exfoliation glaucoma patients who were randomized to either SLT or topical medication as first-line therapy. They used the glaucoma outcomes assessment tool (GOAT) to evaluate the patients’ glaucoma-specific QoL at 12 and 24 months. They also documented IOP reduction and ocular surface parameters.

They found both treatment approaches improved GOAT measures, although the SLT group recorded a significant improvement in “social well-being” compared with the medication group at the two-year mark. Medication seemed to better control IOP long-term, given successful pressure reduction was 18.6% higher in the medication group compared with the SLT group. However, that success comes with a trade-off, as more patients in the medication group presented with conjunctival hyperemia and eyelid erythema compared with the laser group.

“Overall, we did not find evidence that SLT was superior to medication in improving glaucoma-specific QoL,” the researchers concluded in their paper.

For some practitioners, the study raises more questions than it answers, according to Nate Lighthizer, OD, an associate professor at the Oklahoma College of Optometry. The pre-treatment IOP and overall success rates are just one piece of the puzzle.

“SLT is better for quality of life or ‘social well-being,’ which is expected. It also has fewer side effects, which is also expected, but didn't lower IOP by 25% as much as medications did,” he explains. “So while it did not show that SLT is superior to medications, I don't know that the study points towards one treatment being superior to the other. Each treatment has its advantages.”

The key is knowing how to select the right candidates for laser treatment and then educating patients appropriately.

1. Prum BE, Rosenberg LF, Gedde SJ, et al. Primary open-angle glaucoma preferred practice pattern guidelines. Ophthalmology. 2016;123(1):41-111.

2. Ang GS, Fenwick EK, Constantinou M, et al. Selective laser trabeculoplasty versus topical medication as initial glaucoma treatment: the glaucoma initial treatment study randomised clinical trial. Br J Ophthalmol. September 5, 2019. [Epub ahead of print].