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Selective laser trabeculoplasty versus topical medication as initial glaucoma treatment: the glaucoma initial treatment study randomised clinical trial.

Publication ,  Journal Article
Ang, GS; Fenwick, EK; Constantinou, M; Gan, ATL; Man, REK; Casson, RJ; Finkelstein, EA; Goldberg, I; Healey, PR; Pesudovs, K; Sanmugasundram, S ...
Published in: Br J Ophthalmol
June 2020

BACKGROUND/AIMS: To determine if selective laser trabeculoplasty (SLT) is superior to topical medication as a first-line treatment for glaucoma on quality of life (QoL) and clinical outcomes. METHODS: In this international, longitudinal, multisite randomised controlled trial, treatment naïve mild-to-moderate primary open angle or exfoliation glaucoma patients were randomised 1:1 to SLT or topical medication. Glaucoma-specific QoL (primary outcome) was measured using the Glaucoma Outcomes Assessment Tool (GOAT; 342 items, 12 domains). Secondary outcomes included rate of successful intraocular pressure (IOP) reduction (>25% reduction from baseline) and presence of ocular surface disease including conjunctival hyperaemia and eyelid erythema. Our intention-to-treat analysis was performed at months 12 and 24. RESULTS: Of 167 enrolled patients, 83 and 84 were randomised to SLT and topical medication, respectively; and 145 (n=75 SLT, n=70 medication) completed 24-month follow-up. While both treatment arms achieved significant within-group gains in GOAT outcomes at both endpoints, SLT patients reported a greater between-group improvement in 'social well-being' compared with medication patients (mean±SE=0.28±0.13; p=0.034) at 24 months. At month 24, the rate of successful IOP reduction was 18.6% (95% CI 3.0% to 34.3%, p=0.022) higher (absolute difference) in the medication compared with SLT group. More individuals in the medication group had conjunctival hyperaemia and eyelid erythema compared with SLT at 24 months. CONCLUSION: Overall, we did not find evidence that SLT was superior to medication in improving glaucoma-specific QoL. While we found superior IOP reduction in the medication arm, eyelid erythema and conjunctival hyperaemia were more prevalent in these patients compared with the SLT group. TRIAL REGISTRATION: ACTRN12611000720910.

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Published In

Br J Ophthalmol

DOI

EISSN

1468-2079

Publication Date

June 2020

Volume

104

Issue

6

Start / End Page

813 / 821

Location

England

Related Subject Headings

  • Treatment Outcome
  • Trabeculectomy
  • Quality of Life
  • Ophthalmology & Optometry
  • Ophthalmic Solutions
  • Middle Aged
  • Male
  • Lasers, Solid-State
  • Laser Therapy
  • Intraocular Pressure
 

Citation

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Ang, G. S., Fenwick, E. K., Constantinou, M., Gan, A. T. L., Man, R. E. K., Casson, R. J., … Lamoureux, E. L. (2020). Selective laser trabeculoplasty versus topical medication as initial glaucoma treatment: the glaucoma initial treatment study randomised clinical trial. Br J Ophthalmol, 104(6), 813–821. https://doi.org/10.1136/bjophthalmol-2018-313396
Ang, Ghee Soon, Eva K. Fenwick, Marios Constantinou, Alfred Tau Liang Gan, Ryan Eyn Kidd Man, Robert J. Casson, Eric A. Finkelstein, et al. “Selective laser trabeculoplasty versus topical medication as initial glaucoma treatment: the glaucoma initial treatment study randomised clinical trial.Br J Ophthalmol 104, no. 6 (June 2020): 813–21. https://doi.org/10.1136/bjophthalmol-2018-313396.
Ang GS, Fenwick EK, Constantinou M, Gan ATL, Man REK, Casson RJ, et al. Selective laser trabeculoplasty versus topical medication as initial glaucoma treatment: the glaucoma initial treatment study randomised clinical trial. Br J Ophthalmol. 2020 Jun;104(6):813–21.
Ang, Ghee Soon, et al. “Selective laser trabeculoplasty versus topical medication as initial glaucoma treatment: the glaucoma initial treatment study randomised clinical trial.Br J Ophthalmol, vol. 104, no. 6, June 2020, pp. 813–21. Pubmed, doi:10.1136/bjophthalmol-2018-313396.
Ang GS, Fenwick EK, Constantinou M, Gan ATL, Man REK, Casson RJ, Finkelstein EA, Goldberg I, Healey PR, Pesudovs K, Sanmugasundram S, Xie J, McIntosh R, Jackson J, Wells AP, White A, Martin K, Walland MJ, Crowston JG, Lamoureux EL. Selective laser trabeculoplasty versus topical medication as initial glaucoma treatment: the glaucoma initial treatment study randomised clinical trial. Br J Ophthalmol. 2020 Jun;104(6):813–821.

Published In

Br J Ophthalmol

DOI

EISSN

1468-2079

Publication Date

June 2020

Volume

104

Issue

6

Start / End Page

813 / 821

Location

England

Related Subject Headings

  • Treatment Outcome
  • Trabeculectomy
  • Quality of Life
  • Ophthalmology & Optometry
  • Ophthalmic Solutions
  • Middle Aged
  • Male
  • Lasers, Solid-State
  • Laser Therapy
  • Intraocular Pressure