Selective laser trabeculoplasty promising for glaucoma

By Joanna Lyford, Senior medwireNews Reporter

Selective laser trabeculoplasty (SLT) leads to significant reductions in intraocular pressure in people with primary open-angle glaucoma, a study has found.

SLT may therefore represent a "powerful tool for reducing glaucoma-related blindness," particularly in the developing world, says the study author writing in JAMA Ophthalmology.

Tony Realini (West Virginia University, Morgantown, USA) investigated the efficacy of SLT in people of African descent. African-derived populations in the developing world have a substantially higher prevalence of glaucoma than non-African populations in developed nations, Realini notes.

The study recruited 61 people living in the Caribbean island of Saint Lucia. All were of African descent, 69% were women, and their mean age was 61.5 years. All patients had primary open-angle glaucoma and were taking topical medication.

Mean on-treatment intraocular pressure in the right and left eyes was 17.3 and 17.5 mmHg, respectively, and increased to 21.4 and 21.1 mmHg, respectively, 1 month after stopping medication.

At this point, participants underwent bilateral 360-degree SLT treatment. The entire circumference of the angle was treated, with approximately 25 spots placed per quadrant.

Intraocular pressure started to fall within 1 week of treatment, to a mean of 16.6 and 15.6 mmHg in the right and left eyes, respectively, and continued to fall until 1 month after treatment, to a mean of 13.5 and 12.9 mmHg, respectively.

After around 1 month intraocular pressure stabilized and remained constant until the end of the 12-month follow up. At this time, 77.7% of patients were considered to be treatment successes, defined as having at least a 10% reduction in post-washout baseline intraocular pressure.

Furthermore, 93% of SLT treatment successes had intraocular pressures below those that they had achieved with topical medication.

With regard to toxicity, all but two patients developed moderate photophobia on the day after SLT but in most cases it resolved within 2 to 3 days. Just one patient sought treatment for photophobia and received a 3-day course of topical non-steroidal anti-inflammatory drug; the photophobia had resolved within 1 week of SLT.

Realini reports: "In the current study, a single SLT treatment produced mean intraocular pressure reductions in the range of 33% to 40% (7-8 mmHg) without the need for medical therapy for at least a year in most patients…

"If both repeatability and generalizability of SLT can be demonstrated in this population, our goal is to develop a public health initiative structured around a mobile glaucoma laser program to serve the treatment needs of this region."

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