Product information and disease description Place of product in therapy Approaches to treatment Current treatment options and standard of care

Laser trabeculoplasty

9 evidence topics · 5 sources

AAO Preferred Practice Pattern: initial or adjunctive laser therapy

“Laser trabeculoplasty surgery may be used as initial or adjunctive therapy in patients with POAG.” (opens the source at this quote in a new tab)
“A 2022 Cochrane Systematic Review found that laser trabeculoplasty surgery may be more effective than topical drops in slowing the progression of visual field loss in OAG and may be similar to topical drops in controlling IOP at a lower cost.” (opens the source at this quote in a new tab)
“Several studies have demonstrated that repeat SLT is both safe and effective and that it achieves a similar reduction in IOP and duration of response as the initial treatment.” (opens the source at this quote in a new tab)

European Glaucoma Society guidelines: first-line option

“It is recommended to initiate the treatment for IOP lowering with monotherapy (see Ch II.3.4, Fc XVII, XVIII and XIX). Laser trabeculoplasty is also a good option for first-line treatment (see Ch II.3.12.2).” (opens the source at this quote in a new tab)
“There is no evidence regarding effectiveness of trabeculoplasty in patients with severe glaucoma and pigmentary glaucoma (PG). SLT and argon laser trabeculoplasty (ALT) have similar efficacy and are more effective in people with higher IOP.” (opens the source at this quote in a new tab)

NICE NG81: 360° SLT as initial treatment

“Offer 360° SLT to people with newly diagnosed COAG that is not advanced (excluding cases associated with pigment dispersion syndrome).” (opens the source at this quote in a new tab)
“that having 360° SLT can delay the need for eye drops and can reduce but does not remove the chance they will be needed at all” (opens the source at this quote in a new tab)
“Consider a second 360° SLT for people with COAG if the effect of an initial successful SLT has subsequently reduced over time. [2022]” (opens the source at this quote in a new tab)

LiGHT trial: 3-year results

“Of 718 patients enrolled, 356 were randomised to the selective laser trabeculoplasty and 362 to the eye drops group.” (opens the source at this quote in a new tab)
“At 36 months, 74·2% (95% CI 69·3-78·6) of patients in the selective laser trabeculoplasty group required no drops to maintain intraocular pressure at target.” (opens the source at this quote in a new tab)

LiGHT trial: 6-year results

“Of eyes in the SLT arm, 69.8% remained at or less than the target IOP without the need for 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 serious laser-related adverse events occurred.” (opens the source at this quote in a new tab)

LiGHT: drop-free intraocular pressure control and medication use in both arms at 6 years

“Drop-free IOP control at 72 months, obtained without incisional surgery, was achieved in 69.8% of eyes initially treated with SLT compared with 18.0% of eyes initially treated with IOP-lowering eye drops.” (opens the source at this quote in a new tab)
“At 72 months, 61.2% of eyes initially treated with eye drops were using 1 or 2 medications compared with 18.5% of eyes initially treated with SLT.” (opens the source at this quote in a new tab)
“Of the eyes initially treated with eye drops and being drop free at 72 months, 79.5% of eyes (66 eyes) had switched to SLT, and 20.5% underwent either cataract surgery alone or cataract surgery and SLT.” (opens the source at this quote in a new tab)

LiGHT: eyes at target intraocular pressure and number of laser treatments required

“Overall, 94.2% of eyes initially treated with SLT were at target at 72 months, and target IOP was achieved at 92.8% of visits, compared with 94.7% of eyes and 93.2% of visits for eyes initially treated with medication.” (opens the source at this quote in a new tab)
“Of the eyes initially treated with SLT and being drop and surgery free at 6 years, 90% of eyes (295 eyes) needed up to 2 SLT treatments in total.” (opens the source at this quote in a new tab)

LiGHT: adverse events of selective laser trabeculoplasty over 6 years

“A total of 274 transient SLT-related adverse events were reported, including 10 incidents of a rise in IOP (1.0% of all SLT treatments, with only 1 eye requiring treatment).” (opens the source at this quote in a new tab)
“The safety profile of SLT remains very good, with no sight-threatening complications.” (opens the source at this quote in a new tab)
“Intraocular pressure rose > 5 mmHg from IOP before treatment in only 1% of treated eyes, and of these, only 1 eye needed treatment.” (opens the source at this quote in a new tab)

LiGHT: timing of trabeculectomy during the 6-year trial

“Of the 32 eyes that needed a trabeculectomy during trial’s 6-year duration, 11 eyes initially treated with drops underwent a trabeculectomy during the first 3 years of the trial; none of the eyes initially treated with SLT required a trabeculectomy during the initial 3 years of the trial.” (opens the source at this quote in a new tab)