Selective laser trabeculoplasty versus medication for open-angle glaucoma: systematic review and meta-analysis of randomised clinical trials

Abstract

BackgroundThe only widely accepted, effective treatment for open-angle glaucoma (OAG) is to reduce the intraocular pressure (IOP), with medical therapy being the typical first-line therapy. Notably, an alternative therapy is selective laser trabeculoplasty (SLT), which is safe and effective in lowering the IOP. Nonetheless, whether SLT could replace medication as the first-line therapy for OAG is still under debate.MethodsStudies involving randomised controlled trials conducted before August 2019 that compared the efficacy of SLT-related and medication-only treatments for OAG were selected from PubMed, Embase, Cochrane Library and Web of Science. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology was employed to rate the quality of the body of evidence.Results1229 patients in eight trials were included. The overall results revealed no significant differences between SLT-related and medication-only treatments regarding the IOP reduction (mean difference (MD): 0.18, 95% CI −0.72 to 1.07, p=0.70, I2=73%) and the success rate of IOP control (risk ratio: 1.02, 95% CI 0.99 to 1.04, p=0.74, I2=0%). The SLT-related therapy group required significantly fewer medications compared with the medication-only group (MD: −1.06, 95% CI −1.16 to −0.96, p<0.0000, I2=5%). A quantitative analysis was not performed concerning adverse events and quality of life because of the limited data available.ConclusionSLT is safe and has a lower incidence of ocular side effects. SLT can be the choice of first-line therapy for OAG. However, clinicians should consider the cost-effectiveness, as well as the patient’s characteristics, before deciding on the therapeutic option.

Selective laser trabeculoplasty (SLT) performed by optometrists—enablers and barriers to a shift in service delivery

“…Among those, the full management of glaucoma patients by appropriately trained non-medical professionals is expected to double clinic capacity [ 10 , 11 ]. SLT is a clinically- and cost-effective outpatient procedure for lowering IOP [ 1 , 12 ], currently delivered by UK optometrists in an ad-hoc basis.…”

“…During 2012 there were over 8 million items dispensed for the lowering of IOP, resulting in a cost of over £105 million [ 13 , 14 ]. SLT has been shown to allow freedom from eye drops for nearly 75% of treated patients for at least 3 years, whilst leading to fewer ocular adverse events and offering cost savings to the NHS [ 1 , 12 ]. Barriers to implementing SLT in the HES may be impeding the delivery of best care, adding to current backlogs and burdening NHS expenditure.…”

Selective Laser Trabeculoplasty in the Treatment of Ocular Hypertension and Open-Angle Glaucoma: Clinical Review

“…The results of the LIGHT trial were included in a meta-analysis by Chi et al with two other trials in treatment-naïve patients, and similar results were observed in terms of the IOP reduction efficacy of SLT [ 32 , 33 , 34 ].…”

Real-World Data from Selective Laser Trabeculoplasty in Brazil

“…Several studies have showed previously that SLT can be offered as a rst-line treatment for glaucoma and ocular hypertension patients, supporting a change of paradigm in clinical practice. 9,12,25 This is particular important, specially, in a developing country like Brazil, where access to public health services is scarce and the cost of treatment of the eyedrops may represent a barrier to adequate treatment adherence. 17,26 Thus, we believe that the ndings of the present study, as derived from real-world data in a developing country, provides signi cant information regarding patients' clinical course following SLT and may add clinicians to identify the best candidates for laser treatment, increasing the chances of successful management.…”