eprintid: 10203258 rev_number: 15 eprint_status: archive userid: 699 dir: disk0/10/20/32/58 datestamp: 2025-01-13 14:34:55 lastmod: 2025-06-03 12:38:27 status_changed: 2025-01-13 14:34:55 type: article metadata_visibility: show sword_depositor: 699 creators_name: Konstantakopoulou, Evgenia creators_name: Gazzard, Gus creators_name: Garway-Heath, David creators_name: Adeleke, Mariam creators_name: Ambler, Gareth creators_name: Vickerstaff, Victoria creators_name: Bunce, Catey creators_name: Nathwani, Neil creators_name: Barton, Keith title: Selective Laser Trabeculoplasty After Medical Treatment for Glaucoma or Ocular Hypertension ispublished: pub divisions: UCL divisions: B02 divisions: C07 divisions: D08 note: © 2025 Konstantakopoulou E et al. JAMA Ophthalmology. This is an open access article distributed under the terms of the CC-BY License (https://jamanetwork.com/pages/cc-by-license-permissions). abstract: IMPORTANCE: Primary selective laser trabeculoplasty (SLT) is a safe primary treatment for open-angle glaucoma (OAG) and ocular hypertension (OHT). However, there is limited evidence on its use as a secondary treatment, ie, after prior use of ocular hypotensive eye drops. OBJECTIVE: To evaluate outcomes following SLT after using hypotensive eye drops for at least 3 years. DESIGN, SETTING, AND PARTICIPANTS: This is a post hoc exploratory analysis of data from a multicenter randomized clinical trial conducted within the UK National Health Service. Participants were patients with OAG or OHT who participated in the LiGHT trial. Data were analyzed from February 2021 to December 2024. INTERVENTION: Participants were initially randomized to either primary SLT or primary hypotensive eye drops and remained on the allocated treatment pathway for 3 years. Participants using eye drops were then allowed to have secondary SLT as a treatment switch (to reduce their medication load) or as a treatment escalation (if more intense treatment was needed). Participants were treated and monitored according to a predefined protocol. MAIN OUTCOME AND MEASURE: The outcomes of interest were rates of incisional glaucoma surgery, medication use, and intraocular pressure. RESULTS: In total, 633 participants entered the extension of the LiGHT trial, and 524 participants (82.8%) completed the extension (72 months). Of 320 participants receiving primary hypotensive eye drops, 112 (35.0%) received SLT: 70 participants switched to SLT, 29 participants had SLT as a treatment escalation, and 13 participants had SLT as a treatment escalation in 1 eye and as a treatment switch in the other eye. Switching to SLT was associated with a reduction in the number of medications (mean [SD], 1.38 [0.62] to 0.59 [0.92] active ingredients; mean difference, 0.79 [95% CI 0.66 to 0.93] active ingredients; P < .001). At 72 months, 69 eyes that switched to SLT (60.5%) needed no medical or surgical treatment, and 62 eyes receiving 1 drug before switching (83.8%) needed no medical treatment. Escalating to SLT was associated with a mean intraocular pressure reduction of 4.6 mm Hg (21.8%), and 30 eyes (62.5%) reached target intraocular pressure at 72 months without the need for surgery; 9 eyes (18.7%) needed a trabeculectomy. CONCLUSIONS AND RELEVANCE: This secondary analysis of a randomized clinical trial found that secondary SLT was associated with a reduction in the medication load for stable, medically treated eyes. For medically uncontrolled eyes, there is evidence that SLT could provide additional intraocular pressure control, but the need for trabeculectomy was not eliminated. TRIAL REGISTRATION:isrctn.org Identifier: ISRCTN32038223 date: 2025 date_type: published publisher: American Medical Association official_url: https://jamanetwork.com/journals/jamaophthalmology/newonline/2025/1 oa_status: green full_text_type: pub language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 2352230 doi: 10.1001/jamaophthalmol.2024.6492 lyricists_name: Konstantakopoulou, Evgenia lyricists_id: EKONS49 actors_name: Konstantakopoulou, Evgenia actors_id: EKONS49 actors_role: owner funding_acknowledgements: 09/104/40 [UK National Institute for Health Research, Health and Technology Assessment Programme]; R190004A [Moorfields Eye Charity] full_text_status: public publication: JAMA Ophthalmology volume: 143 number: 4 pagerange: 295-302 citation: Konstantakopoulou, Evgenia; Gazzard, Gus; Garway-Heath, David; Adeleke, Mariam; Ambler, Gareth; Vickerstaff, Victoria; Bunce, Catey; ... Barton, Keith; + view all <#> Konstantakopoulou, Evgenia; Gazzard, Gus; Garway-Heath, David; Adeleke, Mariam; Ambler, Gareth; Vickerstaff, Victoria; Bunce, Catey; Nathwani, Neil; Barton, Keith; - view fewer <#> (2025) Selective Laser Trabeculoplasty After Medical Treatment for Glaucoma or Ocular Hypertension. JAMA Ophthalmology , 143 (4) pp. 295-302. 10.1001/jamaophthalmol.2024.6492 <https://doi.org/10.1001/jamaophthalmol.2024.6492>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10203258/9/Konstantakopoulou_Selective%20laser%20trabeculoplasty%20after%20medical%20treatment%20for%20glaucoma%20or%20ocular%20hypertension_VoR.pdf