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Clinical and Patient-Reported Outcomes of Primary Selective Laser Trabeculoplasty in Open Angle Glaucoma & Ocular Hypertension

Garg, Anurag; (2021) Clinical and Patient-Reported Outcomes of Primary Selective Laser Trabeculoplasty in Open Angle Glaucoma & Ocular Hypertension. Doctoral thesis (M.D(Res)), UCL (University College London). Green open access

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Abstract

Aims To investigate the clinical efficacy of primary selective laser trabeculoplasty (SLT) as initial therapy in newly-diagnosed treatment-naïve open-angle-glaucoma (OAG)/ ocular hypertension (OHT) patients. To also investigate patient-reported outcome measures related to health-related quality of life (HRQL) between primary SLT and topical medication. Methods Pre-specified and post-hoc analyses performed using data derived from the Laser in Glaucoma and Ocular Hypertension (‘LiGHT’) Trial, a multi-centre randomised-controlled trial. Results 718 patients (1235 eyes) were randomised: 356 patients (613 eyes) were allocated to SLT (Laser-1st pathway) and 362 patients (622 eyes) to medical treatment (Medicine-1st pathway). Early absolute IOP-lowering following primary SLT was no different between OHT and OAG eyes (adjusted mean difference = -0.05mmHg; 95% confidence interval (CI) -0.6 to 0.5mmHg; p=0.85). No difference was noted in early absolute IOP-lowering between topical medication and primary SLT (adjusted mean difference = -0.1mmHg; 95% CI, -0.6 to 0.4mmHg; p=0.67). At 36-months, 536 eyes (87.7% of 611 eyes) of 314 patients (88.5% of 355 patients) were available for analysis in Laser-1st pathway. 74.6% of eyes (400 eyes) treated with primary SLT achieved drop-free “disease-control” at 36-months; 58.2% (312 eyes) following single SLT. 6 eyes of 6 patients experienced immediate post-laser IOP spike with 1 eye requiring treatment. 115 eyes of 90 patients received repeat SLT during the first 18 months of the trial. Repeat treatment maintained drop-free IOP control in 67% of these eyes for a subsequent 18 months, with no clinically-relevant adverse events. At 36-months, there was no significant difference in all HRQL measures between the treatment arms, including EQ-5D-5L (adjusted mean difference = 0.01; 95% CI, –0.01 to 0.03; p=0.23). Conclusions This work supports primary SLT to be a safe and clinically effective alternative to topical treatment that could be offered as a first-line IOP lowering treatment to patients with OAG or OHT.

Type: Thesis (Doctoral)
Qualification: M.D(Res)
Title: Clinical and Patient-Reported Outcomes of Primary Selective Laser Trabeculoplasty in Open Angle Glaucoma & Ocular Hypertension
Event: UCL (University College London)
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Copyright © The Author 2021. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Institute of Ophthalmology
URI: https://discovery.ucl.ac.uk/id/eprint/10130498
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