Long-Term Outcomes of Selective Laser Trabeculoplasty for Open-Angle Glaucoma in the Caribbean.

Purpose

To characterize long-term clinical outcomes of monotherapy selective laser trabeculoplasty (SLT) in Afro-Caribbean patients with open-angle glaucoma (OAG).

Design

This was a post hoc analysis of nearly 8 years (median, 3.2; interquartile range, 2.1-7.1) of pooled data from the West Indies Glaucoma Laser Study and its preliminary study.

Methods

Setting: Three eye care practices in Saint Lucia and Dominica.

Participants

Afro-Caribbean adults with mild-moderate OAG treated with ≤2 medications (61 in preliminary study, 72 in West Indies Glaucoma Laser Study).

Intervention

Participants underwent medication washout, baseline intraocular pressure (IOP) determination, and bilateral 360-degree SLT. Participants were followed for up to 94 months. Repeat SLT was performed according to prespecified criteria.

Main outcome measures

The primary outcome was mean IOP reduction from baseline. The secondary outcome was medication-free survival with SLT repeated as needed.

Results

The pooled data set included 265 eyes of 133 Afro-Caribbean participants. The mean (standard deviation) baseline IOP was 21.2 (3.4) and 21.2 (3.9) mmHg in right and left eyes, respectively. Over 8 years, the mean IOP ranged from 12.8 to 15.7 mm Hg and from 13.1 to 15.8 mm Hg, respectively (P < .0001 for every comparison with baseline). The median medication-free survival time for initial SLT was 85.4 months in both eyes. The 94-month medication-free survival of SLT repeated as needed was 71.2% and 71.7%, respectively.

Conclusions

Monotherapy SLT, repeated as needed, safely provides significant IOP reductions in most Afro-Caribbean adults with primary OAG through nearly 8 years of follow-up and has significant potential to delay or prevent glaucoma-related vision loss in black patients in low-resource regions.