This paper appraised existing randomised clinical trials (RCTs), which compared selective laser tabeculoplasty (SLT) with medical therapy for open-angle glaucoma (OAG), and performed a systematic review and meta-analysis. A total of 1229 patients in eight trials were included from PubMed, Embrace, Cochrane and Web of Science. The results revealed that SLT-related treatment was not inferior to medication-only treatment in IOP reduction and success rate of IOP control. SLT significantly decreased the mean number of medications needed and it is a safe procedure during the long-term follow-up and had a lower incidence of ocular side-effects. The analysis suggests that SLT may be a choice of first-line therapy in OAG. The authors recommended that clinicians should consider the cost-effectiveness concern and characteristics of their patients before deciding the treatment method. Further trials are required to investigate the predictors of success of SLT and optimal post-SLT treatment.