SLT Preferred POAG Treatment Since LiGHT Trial

Selective laser trabeculoplasty (SLT) has become somewhat of a hot topic in recent years, ever since the Laser in Glaucoma and Ocular HyperTension (LiGHT) trial in 2019 showed that SLT had comparable quality of life and safety outcomes to medications for patients with open-angle glaucoma (OAG) or ocular hypertension (OHT). To understand the current attitude and behaviors regarding SLT vs. medications, researchers of a recent study sought to determine the proportion of glaucoma specialists who prefer SLT to medications and found that over 68% prefer SLT to treat POAG—an increase compared to before the LiGHT trial. The findings were reported in Journal of Glaucoma. Since the LiGHT Trial, use of SLT has risen among US glaucoma specialists compared to medications to treat glaucoma. Photo: Nate Lighthizer, OD. Click image to enlarge. The team surveyed 136 glaucoma specialists from the American Glaucoma Society. Of those, 65% to 71% preferred SLT for treatment-naïve patients with ocular hypertension, mild-to-moderate primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PXG) or pigmentary glaucoma.Over 68% of glaucoma specialists prefer SLT for POAG—a vast increase compared to other studies, which found that 17% to 49% of specialists would consider SLT for first-line therapy and 28% preferred SLT over medications as first-line therapy. The authors attribute this difference to due the fact that these other studies were conducted before or shortly after the publication of the positive findings from the LiGHT trial results in 2019.They also found that over 65% of glaucoma specialists prefer SLT for PXG and pigmentary glaucoma.For mild-to-moderate POAG on one medication, 75% of respondents favored SLT. For advanced POAG on maximum medical therapy, 57% of respondents favored surgery and 38% preferred SLT.The top reasons for recommending SLT were reducing medication nonadherence (93%), suitability for the patient’s glaucoma type or stage (88%) and the physician’s experience performing SLT (83%).In contrast, patients’ inability to position for the procedure (78%), unsuitable glaucoma type or stage (67%) and comorbidities or contraindications to SLT (55%) were primary reasons to not recommend SLT. Physicians in private practice, those who completed fellowship training more recently and those who see more treatment-naïve glaucoma patients were significantly more likely to prefer SLT over medication.The majority reported a preference for SLT over medication for open-angle glaucoma treatment, demonstrating that acceptance of SLT has increased over the past several years, especially for treatment-naïve patients. Glaucoma specialists in non-private practice settings and those in practice for a longer duration since training were less likely to prefer SLT.Patient-related factors, including unsuitable glaucoma type or stage, inability to position and contraindicated ocular comorbidities were the most common reasons why providers chose not to recommend SLT.Glaucoma specialists in private practice, those who completed fellowship training more recently (zero to five years) and those who saw more treatment-naïve OAG patients (more than 10 per week) were significantly more likely to prefer SLT. Conversely, those in academic or other practice settings such as safety-net, large-group and HMO and those in practice for more than 20 years were less likely to prefer SLT.These findings suggest a shift toward broader adoption and earlier use of SLT, reflecting changes in clinical practice patterns and evolving perspectives compared to prior studies.The authors noted there are limitations to this study, as it had a low response rate (11%) from eligible members of the American Glaucoma Society, which may limit the generalizability of the findings. It also only surveyed fellowship-trained U.S. glaucoma specialists, not comprehensive ophthalmologists or optometrists.Click here for the journal source. Liu J, Kim IM, Chen EM, et al. Open-angle glaucoma treatment preferences of US glaucoma specialists. J Glaucoma. [Epub ahead of print.]This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.