Clinical Outcomes Of Selective Laser Trabeculoplasty Versus Eye Drops As First-Line Treatment In An Asian Population

While the use of selective laser trabeculoplasty(SLT) has become increasingly prevalent for the first-line treatment of Glaucoma, there currently exists limited data comparing the use of SLT vs topical medications in Asian patients. The study looks at the difference in response between the two treatments within our Singaporean population as well as the differences in sequalae. Specifically it examines differences in ocular surface complaints between the two groups as it is a common complaint with the topical medication group, affecting adherence and thus disease progression, whilst SLT is widely purported to provide stable IOP control without the need for daily eye drops and possibly improve quality of life for many individuals

The Glaucoma Intensive Treatment Study (GITS) is a 2-year, Phase III, multinational, double-masked, randomized controlled trial comparing SLT versus topical medication as first-line treatment in mild-to-moderate glaucoma. We present the previously unreported Asian subgroup comprising patients from Singapore.

Consecutive treatment-naïve patients with primary open angle or exfoliation glaucoma were identified at 3 centers in Singapore. Patients were randomised 1:1 to either SLT or topical medication. Outcomes measures included intraocular pressure (IOP), visual acuity (VA) and visual field (VF) deficit. Treatment success was defined as a ≥ 25% reduction from baseline IOP based on the Asia Pacific Glaucoma Guidelines. Assesment for ocular surface disease for erythema, blepharitis, hyperaemia, follicles, papillae, tear break up time (TBUT) and keratopathy was also performed. An intention-to-treat analysis along with patient related outcome measures in the form of a survey was conducted.

A total of 47 patients were enrolled. 25 were randomized to topical medication and 22 to SLT. At the 24month visit, there was no difference in the proportion of patients who responded to treatment (defined as reduction of >25% from participants’ baseline IOP measurement) with  80% responding to topical medication vs 75% responding to SLT and a non-significant proportionality difference 15.0 (95% CI -19.6% - 29.6%). Interestingly, at 12months, significantly more patients on topical medications had hyperaemia than patients treated with SLT (-35.24% 95% CI 56.49% -13.98%). At 24months, a significantly higher proportion of patients treated with eye drops had tear-break-up time of <10 seconds (-21.0% 95% CI -41.47% - 0.53%).

In our cohort, SLT was largely comparable to topical medication in terms of clinical efficacy and reported side effects. However, a significantly greater proportion of patients on topical medications experienced hyperemia and decreased TBUT.Overall patients who underwent SLT had significantly more confidence in their therapy, showed less side effects, complained less about changes in appearance of the eyes and were less inconvenienced by the use of eye drops.