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Type: Journal article
Title: Selective laser trabeculoplasty versus topical medication as initial glaucoma treatment: the glaucoma initial treatment study randomised clinical trial
Author: Ang, G.S.
Fenwick, E.K.
Constantinou, M.
Gan, A.T.L.
Man, R.E.K.
Casson, R.J.
Finkelstein, E.A.
Goldberg, I.
Healey, P.R.
Pesudovs, K.
Sanmugasundram, S.
Xie, J.
McIntosh, R.
Jackson, J.
Wells, A.P.
White, A.
Martin, K.
Walland, M.J.
Crowston, J.G.
Lamoureux, E.L.
Citation: British Journal of Ophthalmology, 2020; 104(6):813-821
Publisher: BMJ
Issue Date: 2020
ISSN: 0007-1161
Statement of
Ghee Soon Ang, Eva K Fenwick , Marios Constantinou, Alfred Tau Liang Gan, Ryan Eyn Kidd Man, Robert J Casson ... et al.
Abstract: BACKGROUND/AIMS:To determine if selective laser trabeculoplasty (SLT) is superior to topical medication as a first-line treatment for glaucoma on quality of life (QoL) and clinical outcomes. METHODS:In this international, longitudinal, multisite randomised controlled trial, treatment naïve mild-to-moderate primary open angle or exfoliation glaucoma patients were randomised 1:1 to SLT or topical medication. Glaucoma-specific QoL (primary outcome) was measured using the Glaucoma Outcomes Assessment Tool (GOAT; 342 items, 12 domains). Secondary outcomes included rate of successful intraocular pressure (IOP) reduction (>25% reduction from baseline) and presence of ocular surface disease including conjunctival hyperaemia and eyelid erythema. Our intention-to-treat analysis was performed at months 12 and 24. RESULTS:Of 167 enrolled patients, 83 and 84 were randomised to SLT and topical medication, respectively; and 145 (n=75 SLT, n=70 medication) completed 24-month follow-up. While both treatment arms achieved significant within-group gains in GOAT outcomes at both endpoints, SLT patients reported a greater between-group improvement in 'social well-being' compared with medication patients (mean±SE=0.28±0.13; p=0.034) at 24 months. At month 24, the rate of successful IOP reduction was 18.6% (95% CI 3.0% to 34.3%, p=0.022) higher (absolute difference) in the medication compared with SLT group. More individuals in the medication group had conjunctival hyperaemia and eyelid erythema compared with SLT at 24 months. CONCLUSION:Overall, we did not find evidence that SLT was superior to medication in improving glaucoma-specific QoL. While we found superior IOP reduction in the medication arm, eyelid erythema and conjunctival hyperaemia were more prevalent in these patients compared with the SLT group. TRIAL REGISTRATION:ACTRN12611000720910.
Keywords: clinical trial
Description: Published Online First 5 September 2019
Rights: © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
DOI: 10.1136/bjophthalmol-2018-313396
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Appears in Collections:Aurora harvest 4
Opthalmology & Visual Sciences publications

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