Selective laser trabeculoplasty (SLT) is a well-established treatment for open-angle glaucoma (OAG) and ocular hypertension (OHT). This post-hoc secondary analysis of the LiGHT trial extension examined SLT as a secondary intervention after 3 years of protocolised medical therapy in patients with OAG or OHT. Three-hundred-and-twenty patients were enrolled across 6 UK hospitals. Participants had a diagnosis of OAG or OHT and a visual acuity of 6/36 or better in the treated eye. Those with prior intraocular surgery were excluded, except for uncomplicated phacoemulsification performed at least 1 year before enrolment. After 3 years of medical therapy, patients were offered SLT either as a ‘switch’ if intraocular pressure (IOP) was controlled but drop burden was high, or as ‘escalation’ therapy if IOP remained above target. In the switch group (n=128 eyes), mean medication use fell from 1.38 to 0.59 active ingredients at 72 months, with 60% achieving target IOP without drops or surgery. In the escalation group (n=48 eyes), mean IOP reduced by 4.6mmHg (21.8%), and 62.5% reached target IOP without surgery, though 18.7% later required trabeculectomy. In comparison, 5.4% of eyes that continued medical therapy alone required trabeculectomy. Findings indicate that secondary SLT can meaningfully reduce medication load in well-controlled eyes and provide additional IOP lowering in uncontrolled cases. The benefit appears greatest for those seeking to reduce their reliance on topical therapy rather than for patients with progressive disease requiring surgical escalation. Limitations include the post-hoc nature of the analysis and relatively small subgroup sizes, which may limit statistical precision. Selection bias may also be present, as patients opting for SLT could represent a more adherent or motivated population.
Selective laser trabeculoplasty after medical treatment
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