Laser in Glaucoma and Ocular Hypertension (LiGHT) Trial: Six-Year Results of Primary Selective Laser Trabeculoplasty versus Eye Drops for the Treatment of Glaucoma and Ocular Hypertension
Type of article: In Brief
MedED Catalogue Reference: MOIB006
Keywords: Glaucoma, intraocular pressure, retinal diseases, ophthalmology, laser trabeculoplasty, ocular hypertension, selective progression of glaucoma, eye drops, LiGHT trial
Sources: Opthalmology
Original Published In Opthalmology: February 2023
This research extends on the initial results of the 2019 Laser in Glaucoma and Ocular Hypertension (LiGHT) trial.
The LiGHT trial was a prospective multicenter randomised controlled trial which compared the results of treating patients with open-angle glaucoma (OAG) and ocular hypertension(OHT) with either selective laser trabeculoplasty (SLT) or intraocular pressure (IOP)-lowering eye drops. The trial found that the use of SLT was a more cost-effective solution in both OHT and OAG patients three years after initial treatment. In addition, patients treated with SLT did not require additional drops and had a reduced rate of glaucoma surgeries and a very low rate of adverse events.
In this study, Gazzard et al. set out to determine whether these results were replicated after a more extended period, identified as six years from the initiation of treatment. Their primary outcome was to assess the health-related quality of life measures; their secondary objective was to measure the initial treatment's clinical effectiveness and adverse events.
Of the 692 patients completing three years in the LiGHT Trial, 633 patients (91.5%) entered the extension, and 524 patients completed 6 years in the trial (82.8% of those entering the extension phase).
The study found the following:
• “No significant differences were found for the EuroQol EQ-5D 5 Levels, Glaucoma Utility Index, and Glaucoma Quality of Life-15 (P > 0.05 for all) for either treatment with SLT or the IOP eye drops.
• The SLT arm showed better Glaucoma Symptom Scale scores than the eye drops arm (83.6 ± 18.1 vs. 81.3 ± 17.3, respectively).
• 69.8% of eyes in the SLT arm remained at or less than the target IOP without medical or surgical treatment.
• More eyes in the drops arm exhibited disease progression (26.8% vs. 19.6%, respectively; P = 0.006).
• Trabeculectomy was required in 32 eyes in the drops arm compared with 13 eyes in the SLT arm (P < 0.001); more cataract surgeries occurred in the drops arm (95 compared with 57 eyes; P = 0.03).
• No laser-related severe adverse events occurred.”
The researchers concluded that selective laser trabeculoplasty provided better long-term disease control than initial drop therapy for patients with OAG and OHT. These patients required less incisional glaucoma and cataract surgery over the 6-year study period, and the treatment was more cost-effective and safer
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