January 31, 2023

Laser in Glaucoma and Ocular Hypertension (LiGHT) Trial: Six-Year Results of Primary Selective Laser Trabeculoplasty versus Eye Drops for the Treatment of Glaucoma and Ocular Hypertension

Author(s): Gus Gazzard (1), Evgenia Konstantakopoulou (2), David Garway-Heath (3), Mariam Adeleke (4), Victoria Vickerstaff (5), Gareth Ambler (6), Rachael Hunter (7), Catey Bunce (8), Neil Nathwani (3), Keith Barton (3); LiGHT Trial Study Group

1 NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; Institute of Ophthalmology, University College London, London, United Kingdom. Electronic address: g.gazzard@nhs.net. 2 NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; Institute of Ophthalmology, University College London, London, United Kingdom; Division of Optics and Optometry, University of West Attica, Athens, Greece. 3 NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; Institute of Ophthalmology, University College London, London, United Kingdom. 4 Department of Statistical Science, University College London, London, United Kingdom; PRIMENT Clinical Trials Unit, University College London, London, United Kingdom. 5 The Research Department of Primary Care and Population Health, University College London, London, United Kingdom; Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, University College London, London, United Kingdom. 6 Department of Statistical Science, University College London, London, United Kingdom. 7 PRIMENT Clinical Trials Unit, University College London, London, United Kingdom. 8 Research Data and Statistics Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom; London School of Hygiene & Tropical Medicine, London, United Kingdom.

PURPOSE: The Laser in Glaucoma and Ocular Hypertension (LiGHT) Trial has shown selective laser trabeculoplasty (SLT) to be clinically and cost-effective as a primary treatment of open-angle glaucoma (OAG) and ocular hypertension (OHT) at 3 years. This article reports health-related quality of life (HRQoL) and clinical effectiveness of initial treatment with SLT compared with intraocular pressure (IOP)-lowering eye drops after 6 years of treatment.

DESIGN: Prospective, multicenter randomized controlled trial.

PARTICIPANTS: Treatment-naive eyes with OAG or OHT initially treated with SLT or IOP-lowering drops.

METHODS: Patients were allocated randomly to initial SLT or eye drops. After the initial 3 years of the trial, patients in the SLT arm were permitted a third SLT if necessary; patients in the drops arm were allowed SLT as a treatment switch or escalation. This study is registered at controlled-trials.com (identifier, ISRCTN32038223).

MAIN OUTCOME MEASURES: The primary outcome was HRQoL at 6 years; secondary outcomes were clinical effectiveness and adverse events.

RESULTS: Of the 692 patients completing 3 years in the LiGHT Trial, 633 patients (91.5%) entered the extension, and 524 patients completed 6 years in the trial (82.8% of those entering the extension phase). At 6 years, no significant differences were found for the EuroQol EQ-5D 5 Levels, Glaucoma Utility Index, and Glaucoma Quality of Life-15 (P > 0.05 for all). The SLT arm showed better Glaucoma Symptom Scale scores than the drops arm (83.6 ± 18.1 vs. 81.3 ± 17.3, respectively). Of eyes in the SLT arm, 69.8% remained at or less than the target IOP without the need for medical or surgical treatment. More eyes in the drops arm exhibited disease progression (26.8% vs. 19.6%, respectively; P = 0.006). Trabeculectomy was required in 32 eyes in the drops arm compared with 13 eyes in the SLT arm (P < 0.001); more cataract surgeries occurred in the drops arm (95 compared with 57 eyes; P = 0.03). No serious laser-related adverse events occurred.

CONCLUSIONS: Selective laser trabeculoplasty is a safe treatment for OAG and OHT, providing better long-term disease control than initial drop therapy, with reduced need for incisional glaucoma and cataract surgery over 6 years.

PMID: 36122660 DOI: 10.1016/j.ophtha.2022.09.009

Keywords: Glaucoma progression; Ocular hypertension; Open-angle glaucoma; Selective laser trabeculoplasty

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