UK Study Finds Optometrist-Performed SLT Safe, Effective

A study on the safety and efficacy of more than 850 SLT procedures performed by three optometrists in the United Kingdom revealed a high success rate and minimal complications, affirming the proficiency of ODs in administering this first-line treatment for glaucoma and ocular hypertension. Photo: Nate Lighthizer, OD. Click image to enlarge. In recent years, selective laser trabeculoplasty (SLT) has become accepted as first-line treatment for ocular hypertension and primary open-angle glaucoma, delivering an intraocular pressure (IOP)-lowering effect similar to topical medication while eliminating the burden and compliance issues associated with daily drops. With the ophthalmology workforce in the US insufficient to meet public need, 14 states have authorized optometrists to perform SLT—a source of contention between the professions that has led some in the medical establishment to disparage the capabilities of the optometric profession. However, an analysis published last summer in the US validated the safety and low complication rate of optometrist-performed SLT, marking the largest study of its kind. Yesterday, a new report in the journal Eye detailed comparable results of a UK-based analysis, concluding that “optometrists delivered a safe and effective SLT treatment with low rates of adverse events.”The study employed a retrospective design, assessing the success and safety of SLT administered by three UK optometrists in 880 eyes from 574 patients newly diagnosed with ocular hypertension or open-angle glaucoma and no prior ocular surgery. All patients underwent SLT as either a primary treatment or as an additional therapy following the inadequate control of IOP with topical medications. Success was defined as a ≥20% reduction in IOP for first-line treatment and either a similar IOP reduction or the cessation of ≥1 class of anti-glaucoma medication for escalation treatments. The results were highly encouraging: the overall success rate of optometrist-performed SLT as a primary treatment option was reported at 70.9%, with an escalation therapy success rate of 65.3%. The safety profile was notably positive, with an overall complication rate of just 2.2%, primarily involving mild and transient adverse effects such as post-operative uveitis (0.92%) and temporary increases in IOP (0.45%). Other complications included allergic reaction (0.23%), dry eye (0.23%), headache (0.11%), hyphema (0.11%) and vitreomacular traction (0.11%). As reported in prior studies, baseline IOP was the main predictor of IOP success. For every 1mm Hg increase in IOP, the probability of success rose by 2.9%.The authors highlight several limitations in their paper, including that nearly two-thirds of SLT procedures were performed by a single optometrist. They also pointed out that the optometrists “were trained under three different fellowship-trained glaucoma specialists, and the patient mix was not consistent between optometrists.” Since this study was not designed to evaluate inter-optometrist differences in success rates, the authors note that this topic deserves further exploration.In conclusion, “This study involving a large number of cases demonstrates that optometrists can deliver a safe and effective selective laser trabeculoplasty service,” the authors summarized, while reiterating the important role these doctors can have in satisfying demand for SLT.Click here for the journal source. Swystun AG, Langton E, Kelly S, et al. The safety and effectiveness of optometrist-delivered selective laser trabeculoplasty. Eye. May 20, 2025. [Epub ahead of print].