Medication Burden Reduction And Predictors Of Response After Pattern Scanning Laser Trabeculoplasty: 6-Month Real-World Outcomes

To evaluate intraocular pressure (IOP) control, reduction in glaucoma medication burden, and predictive factors influencing response after Patterned Scanning Laser Trabeculoplasty (PSLT) at 6 months, with particular focus on treatment simplification and its potential impact on quality of life and adherence.

Single-center real-world study conducted at a tertiary referral hospital in Spain.

Twenty-five patients (50 eyes) with open-angle glaucoma underwent PSLT. Baseline assessment included Goldmann applanation tonometry, Cirrus OCT (RNFL and GCL analysis), automated perimetry, and slit-lamp optic nerve evaluation with a 90D lens. Primary outcomes were percentage IOP reduction and change in number of glaucoma medications at 6 months. Descriptive statistics (frequency, percentage, mean, standard deviation) were used to summarize key variables in the study. Changes in IOP and medications were examined using inferential analysis (paired samples t-test and Wilcoxon signed-ranks test respectively). Multivariable linear regression analysis was performed to identify independent predictors of IOP reduction.

Forty-six eyes completed 6-month follow-up. Mean preoperative IOP was 16.24±3.81 mmHg under 2.02±0.85 medications. IOP remained stable at 6 months with no statistically significant change from baseline (p=0.59); 95.7% maintained IOP <21 mmHg and 69.6% IOP <18 mmHg. Mean number of medications decreased significantly to 0.85±0.89 (p<0.001). At 6 months, 67.4% of patients reduced their medication burden and 47.8% became completely medication-free. Multivariable analysis (R²=0.58, p<0.001) identified higher baseline IOP (p<0.001), male gender (p=0.018), and absence of dry eye/keratitis (p=0.021) as significantly predictors of greater percentage IOP reduction.

PSLT enabled significant reduction in glaucoma medications while maintaining stable IOP at 6 months. Nearly half of treated patients became medication-free, highlighting the procedure’s potential to simplify therapy, improve adherence, and reduce ocular surface exposure to chronic topical treatment. Baseline IOP was the strongest predictor of response, and ocular surface disease negatively influenced efficacy. PSLT may represent an effective medication-sparing strategy in appropriately selected glaucoma patients.