Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial.
Gazzard Gus, Konstantakopoulou Evgenia, Garway-Heath David, Garg Anurag, Vickerstaff Victoria, Hunter Rachael, Ambler Gareth, Bunce Catey, Wormald Richard, Nathwani Neil
AI Summary
This study found SLT is as effective as eye drops for first-line glaucoma/ocular hypertension treatment, with 74% needing no drops at 3 years and being more cost-effective, supporting its routine use.
Abstract
Background
Primary open angle glaucoma and ocular hypertension are habitually treated with eye drops that lower intraocular pressure. Selective laser trabeculoplasty is a safe alternative but is rarely used as first-line treatment. We compared the two.
Methods
In this observer-masked, randomised controlled trial treatment-naive patients with open angle glaucoma or ocular hypertension and no ocular comorbidities were recruited between 2012 and 2014 at six UK hospitals. They were randomly allocated (web-based randomisation) to initial selective laser trabeculoplasty or to eye drops. An objective target intraocular pressure was set according to glaucoma severity. The primary outcome was health-related quality of life (HRQoL) at 3 years (assessed by EQ-5D). Secondary outcomes were cost and cost-effectiveness, disease-specific HRQoL, clinical effectiveness, and safety. Analysis was by intention to treat. This study is registered at controlled-trials.com (ISRCTN32038223).
Findings
Of 718 patients enrolled, 356 were randomised to the selective laser trabeculoplasty and 362 to the eye drops group. 652 (91%) returned the primary outcome questionnaire at 36 months. Average EQ-5D score was 0·89 (SD 0·18) in the selective laser trabeculoplasty group versus 0·90 (SD 0·16) in the eye drops group, with no significant difference (difference 0·01, 95% CI -0·01 to 0·03; p=0·23). At 36 months, 74·2% (95% CI 69·3-78·6) of patients in the selective laser trabeculoplasty group required no drops to maintain intraocular pressure at target. Eyes of patients in the selective laser trabeculoplasty group were within target intracoluar pressure at more visits (93·0%) than in the eye drops group (91·3%), with glaucoma surgery to lower intraocular pressure required in none versus 11 patients. Over 36 months, from an ophthalmology cost perspective, there was a 97% probability of selective laser trabeculoplasty as first treatment being more cost-effective than eye drops first at a willingness to pay of £20 000 per quality-adjusted life-year gained.
Interpretation
Selective laser trabeculoplasty should be offered as a first-line treatment for open angle glaucoma and ocular hypertension, supporting a change in clinical practice.
Funding: National Institute for Health Research, Health and Technology Assessment Programme.
MeSH Terms
Shields Classification
Key Concepts5
In a multicentre randomized controlled trial (LiGHT) of 718 treatment-naive patients with open-angle glaucoma or ocular hypertension, the average EQ-5D score (health-related quality of life) at 3 years was 0.89 (SD 0.18) in the selective laser trabeculoplasty group versus 0.90 (SD 0.16) in the eye drops group, with no significant difference (difference 0.01, 95% CI -0.01 to 0.03; p=0.23).
In a multicentre randomized controlled trial (LiGHT) of 718 treatment-naive patients with open-angle glaucoma or ocular hypertension, 74.2% (95% CI 69.3-78.6) of patients in the selective laser trabeculoplasty group required no drops to maintain intraocular pressure at target at 36 months.
In a multicentre randomized controlled trial (LiGHT) of 718 treatment-naive patients with open-angle glaucoma or ocular hypertension, eyes of patients in the selective laser trabeculoplasty group were within target intraocular pressure at more visits (93.0%) than in the eye drops group (91.3%), and glaucoma surgery to lower intraocular pressure was required in none of the selective laser trabeculoplasty patients versus 11 patients in the eye drops group.
Over 36 months, from an ophthalmology cost perspective, there was a 97% probability of selective laser trabeculoplasty as first treatment being more cost-effective than eye drops first at a willingness to pay of £20,000 per quality-adjusted life-year gained in a multicentre randomized controlled trial (LiGHT) of 718 treatment-naive patients with open-angle glaucoma or ocular hypertension.
A multicentre, observer-masked, randomized controlled trial (LiGHT) compared selective laser trabeculoplasty to eye drops as first-line treatment for treatment-naive patients with open-angle glaucoma or ocular hypertension, recruiting 718 patients between 2012 and 2014 at six UK hospitals.
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