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14-03-2019 | Ophthalmology | News | Article

LiGHT shone on laser trabeculoplasty as first-line glaucoma treatment

medwireNews: Selective laser trabeculoplasty offers superior intraocular pressure stability to that of eye drops and is more cost-effective when used as a first-line treatment for patients with open angle glaucoma (OAG) or ocular hypertension, results of the LiGHT trial show.

Furthermore, at 3 years posttreatment, almost three-quarters (74.2%) of patients did not require drops to maintain intraocular pressure at their personalised target.

This is important because “[p]re­trial patient and public involvement activities with glaucoma patients identified drop­free disease control as the most desired outcome”, write Gus Gazzard (Moorfields Eye Hospital NHS Foundation Trust, London, UK) and co-authors in The Lancet.

Based on their findings they say: “Selective laser trabeculoplasty should be offered as a first-line treatment for open angle glaucoma and ocular hypertension, supporting a change in clinical practice.”

The researchers found that at 3 years after the initial treatment, patients randomly assigned to receive selective laser trabeculoplasty (n=356) had a similar health-related quality of life to those assigned to intraocular pressure lowering eye drops (n=362), with EuroQol EQ­5D scores of 0.89 and 0.90, respectively.

There was also no significant difference between the two treatments in Glaucoma Utility Index, Glaucoma Symptom Scale and Glaucoma Quality of Life-15 scores, but scores generally “suggested better health­related quality­of­life outcomes for the selective laser trabeculoplasty group”, Gazzard et al remark.

Patients who received selective laser trabeculoplasty were within their target intraocular pressure range at a greater proportion of visits than those who received eye drops (93.0 vs 91.3%) and did not need any glaucoma surgery during follow-up, compared with 11 surgeries among patients in the eye drop group.

The investigators calculated that starting treatment with selective laser trabeculoplasty resulted in a cost saving of £ 451 (€ 526; US$ 592) per patient in specialist ophthalmology costs, compared with eye drops. They say this was equivalent to the cost of five additional ophthalmology specialist appointments and greater than the cost of selective laser trabeculoplasty for two additional patients.

Furthermore, at a willingness to pay at £ 20,000 (€ 23,307; $ 26,263) per quality-adjusted life year gained, the probability of selective laser trabeculoplasty being a cost­effective treatment for OAG and ocular hypertension was 97%.

In an accompanying comment, Jonathan Young and Joseph Caprioli, both from the University of California, Los Angeles in the USA, write: “In an ageing population, as glaucoma is becoming more prevalent and medical costs are escalating, the LiGHT trial provides evidentiary support for ophthalmologists to consider selective laser trabeculoplasty as first-line treatment for ocular hypertension and open-angle glaucoma.”

They add: “Based on UK standards, the 3-year cost savings for giving selective laser trabeculoplasty first appear to be substantial. In the USA, where the price of medications is higher than in some single-payer systems, the cost savings might be even greater.”

By Laura Cowen

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group