Laser in Glaucoma and Ocular Hypertension Trial (LIGHT) in China – A Randomized Controlled Trial: Design and Baseline Characteristics

Yang, Yangfan; Jiang, Yuzhen; Sheng, Huang; Zhang, Xinyi; Nathwani, Neil; Lin, Mingkai; Xing, Liu; Fan, Yanmei; Xu, Jiangang; Gazzard, Gus; Yu, Minbin

doi:10.1016/j.ajo.2021.04.020

Cited by 9 publications

(4 citation statements)

References 45 publications

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“…The details about the LiGHT China design have been published previously. 17 Briefly, patients with newly diagnosed, untreated POAG in one or both eyes (including normal tension glaucoma (NTG)) or OHT qualifying for treatment according to National Institute for Health and Care Excellence guidelines 18 were enrolled. Exclusion criteria included contraindications to SLT, unable to accept randomisation, having visually significant cataract or were having treatment for another ophthalmic condition, having any history of treatment for POAG or OHT or previous intraocular surgery.…”

Section: Methodsmentioning

confidence: 99%

“…The key points of the protocol have been attached as an online supplemental appendix . 17 The series of examinations started with a standardised questionnaire that consisted of questions on the participants’ personal information, general health condition, past history, family history, lifestyle and so forth. Complete ophthalmological examinations including Goldmann applanation tonometry (GAT), Schiotz tonometer, slit-lamp examination, gonioscopy, automated visual field test and Heidelberg Retinal Tomograph disc imaging were performed.…”

Section: Methodsmentioning

confidence: 99%

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Intraocular pressure and diurnal fluctuation of open-angle glaucoma and ocular hypertension: a baseline report from the LiGHT China trial cohort

et al. 2022

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AimsTo report the baseline intraocular pressure (IOP) characteristics and its diurnal fluctuation in the Laser in Glaucoma and Ocular Hypertension China cohort.Methods622 primary open-angle glaucoma (POAG) patients and 149 ocular hypertension (OHT) patients were recruited at Zhongshan Ophthalmic Center from 2015 to 2019. Standardised ocular examinations were performed including IOP measurement using the Goldmann applanation tonometer. Daytime phasing IOP was recorded at 8:00, 10:00, 11:30, 14:30, 17:00 hour.ResultsThe mean baseline IOP was 20.2 mm Hg for POAG patients and 24.4 mm Hg for OHT. Multiple regression analysis revealed that thicker central corneal thickness (CCT) was correlated with higher IOP in both POAG and OHT. Male gender and younger age were correlated with higher IOP only for POAG. As for diurnal IOP fluctuation, mean IOP fluctuation was 3.4 mm Hg in POAG eyes and 4.4 mm Hg in OHT. The peak and trough IOP occurred at 8:00 and 14:30 hour in both POAG and OHT eyes.ConclusionsYounger age, male gender and thicker CCT are correlated to higher IOP in POAG patients while only thicker CCT is related to higher IOP in OHT patients. Peak IOP appears mostly at early morning or late afternoon and trough value occurs mostly at early afternoon.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Intraocular pressure and diurnal fluctuation of open-angle glaucoma and ocular hypertension: a baseline report from the LiGHT China trial cohort

et al. 2022

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“…The mean fluctuation was 3.4 mmHg in POAG eyes and 4.4 mmHg in eyes with ocular hypertension [33]. A second study from the same group evaluates whether SLT as first-line therapy provides superior economic and health-related QoL outcomes to medical treatment in China [34]. They found that the Chinese patients were younger, more myopic, and had more severe visual field defects than the patients of the original LiGHT study from the United Kingdom [34].…”

Section: Laser In Glaucoma and Ocular Hypertension Studymentioning

confidence: 99%

“…A second study from the same group evaluates whether SLT as first-line therapy provides superior economic and health-related QoL outcomes to medical treatment in China [34]. They found that the Chinese patients were younger, more myopic, and had more severe visual field defects than the patients of the original LiGHT study from the United Kingdom [34]. Wrigth et al compared visual field outcomes of patients treated initially with medical therapy versus patients who had SLT first [35].…”

Section: Laser In Glaucoma and Ocular Hypertension Studymentioning

confidence: 99%

Follow-up studies of the classical landmark studies in Glaucoma

Meier-Gibbons

Töteberg‐Harms

2022

Current Opinion in Ophthalmology

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Purpose of reviewIt was not until the nineteen nineties that there was scientific evidence for the primary treatment concept of glaucoma, lowering intraocular pressure. The treatment concept of lowering intraocular pressure is now proven by randomized controlled clinical trials (landmark studies). This review provides an overview of the follow-up studies to these landmark studies from the last 18 months.Recent findingsThe 20-year data of the ocular hypertension treatment study showed a 49% incidence of primary open-angle glaucoma. The data of this landmark study was used for developing different machine learning algorithms. Bilateral disease, disc hemorrhages, and higher intraocular pressure (IOP) were risk factors for visual field deterioration in the United Kingdom Glaucoma Treatment Study. The Advanced Glaucoma Intervention Trial and the Collaborative Initial Glaucoma Treatment Study identified demographic factors, comorbidity, and clinical variables associated with visual field damage. Analysis was performed on Chinese subsets from the Laser in Glaucoma and Ocular Hypertension Study (LiGHT). Looking at all the follow-up studies to the tube shunt landmark studies, preoperative IOP, neovascular glaucoma, Ahmed implantation, and younger age were predictors of failure. A follow-up study to the Effectiveness in Angle-Closure Glaucoma in Lens Extraction Study showed that patients were ten times more likely to maintain a drop-free target IOP after lens extraction than after laser iridotomy. A superior location for iridotomy results in significantly more significant angle widening than temporal or nasal locations, as shown by a follow-up study to the Zhongshan Angle Closure Prevention Trial using OCT and gonioscopy.SummaryThe number of published follow-up studies to the landmark studies in glaucoma show the ongoing development of clinical questions in management of glaucoma.

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Responsiveness to Selective Laser Trabeculoplasty in Open-Angle Glaucoma and Ocular Hypertension

Yang,

Xu,

Chen

et al. 2024

JAMA Ophthalmol

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ImportanceSelective laser trabeculoplasty (SLT) is becoming the recommended first choice in the treatment of open-angle glaucoma (OAG). However, whether repeat SLT can be recommended regardless of initial response remains controversial.ObjectiveTo assess the potential of OAG and ocular hypertension (OHT) undergoing repeat laser to respond favorably to SLT, termed responsiveness to SLT.Design, Setting, and ParticipantsThis post hoc analysis of the Laser in Glaucoma and Ocular Hypertension Trial in China (LiGHT China) was conducted from March 2015 to April 2023 in Zhongshan Ophthalmic Center. Of 1376 newly diagnosed OAG and OHT eyes of 771 adults in the original trial, 180 eyes of 105 participants were included in the present study, which underwent initial and repeat SLT as primary treatments.ExposuresStandard SLT was the primary treatment. Repeat SLT was the first choice of treatment escalation regardless of initial response. IOP reduction after SLT and the duration of effect were analyzed. The maximum reduction in IOP within 2 years after initial SLT and repeat SLT was used to identify potential nonresponsiveness.Main Outcomes and MeasuresIOP reduction 2 months after SLT.ResultsA total of 180 eyes from 105 Chinese participants (mean [SD] age, 45.6 [14.5] years; 58 [55.2%] male and 47 [44.8%] female) underwent repeat SLT. Initial SLT and repeat SLT were both associated with a reduction in IOP (mean, 4.5 mm Hg; 95% CI, 3.9 to 5.1; P &lt; .001 and mean, 3.3 mm Hg; 95% CI, 2.7 to 3.8; P &lt; .001, respectively). The mean (SD) IOP after repeat SLT was 15.8 (3.4) mm Hg, similar to 16.0 (4.0) mm Hg after initial SLT (difference, −0.4mm Hg; 95% CI, −1.0 to 0.3; P = .24). Duration of effect after repeat SLT was longer than after initial SLT (1043 days vs 419 days; hazard ratio, 0.38; 95% CI, 0.29 to 0.50; P &lt; .001). IOP reduction after initial SLT was uncorrelated with that after repeat SLT, and 153 eyes (85.0%) responded favorably to SLT at least once. A subset of 27 eyes (15.0%) was identified as potentially nonresponsive and found distinctive with older age (mean [SD], 54.1 [12.5] years vs 44.2 [14.2] years; difference, 10.5 years; 95% CI, 2.9 to 18.1; P = .009), higher proportion of female participants (difference, 27.5%; 95% CI, 3.6 to 51.5; P = .03), and lower baseline IOP (difference, −3.2 mm Hg; 95% CI, −5.2 to −1.3; P = .001).Conclusions and RelevanceThese post hoc analyses showed that most cases of OAG and OHT were highly responsive to SLT and support the consideration of repeat SLT regardless of initial response, while individuals who are nonresponsive to this treatment may have specific features.

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Laser in Glaucoma and Ocular Hypertension Trial (LIGHT) in China – A Randomized Controlled Trial: Design and Baseline Characteristics

Cited by 9 publications

References 45 publications

Intraocular pressure and diurnal fluctuation of open-angle glaucoma and ocular hypertension: a baseline report from the LiGHT China trial cohort

Intraocular pressure and diurnal fluctuation of open-angle glaucoma and ocular hypertension: a baseline report from the LiGHT China trial cohort

Follow-up studies of the classical landmark studies in Glaucoma

Responsiveness to Selective Laser Trabeculoplasty in Open-Angle Glaucoma and Ocular Hypertension

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