Systematic review 1

The results revealed no significant differences between SLT-related and medication-only treatments regarding the IOP reduction (mean difference (MD): 0.18, 95% CI -0.72 to 1.07, p=0.70, I2=73%) and the success rate of IOP control (risk ratio: 1.02, 95% CI 0.99 to 1.04, p=0.74, I2=0%). The SLT-related therapy group required significantly fewer medications compared with the medication-only group (MD: -1.06, 95% CI -1.16 to -0.96, p<0.0000, I2=5%). A quantitative analysis was not performed concerning adverse events and quality of life because of the limited data available.

SLT is safe and has a lower incidence of ocular side effects. SLT can be the choice of first-line therapy for OAG. However, clinicians should consider the cost-effectiveness, as well as the patient's characteristics, before deciding on the therapeutic option «Chi SC, Kang YN, Hwang DK ym. Selective laser trab...»1.

LIGHT randomised controlled trial

Eligible patients had newly diagnosed, untreated OAG or ocular hypertension in one or both eyes, qualified for treatment were included in the study. They were randomly allocated to initial selective laser trabeculoplasty or to eye drops. An objective target intraocular pressure was set according to glaucoma severity. The primary outcome was health-related quality of life at 3 years (assessed by EQ-5D). Secondary outcomes were cost and cost-effectiveness, disease-specific HRQoL, clinical effectiveness, and safety. Analysis was by intention to treat.

Compared with medication, SLT provided a stable, drop-free IOP control to 74 % of patients for at least 3 years, with a reduced need for surgery, lower cost and comparable HRQoL. SLT seems to be the most cost-effective first-line treatment option for OAG and OHT, also providing better clinical outcomes.

The results of this randomised controlled trial are widely generalisable, as patients with OHT and both low- and high-pressure OAG were included, from a range of backgrounds and ethnic origins. This trial focused on newly diagnosed, treatment-naive patients with OHT and/or mild or moderate OAG; the results should, therefore, be interpreted with caution in relation to the efficacy of SLT in advanced OAG stages, or in eyes previously treated for high IOP «Gazzard G, Konstantakopoulou E, Garway-Heath D ym....»2, «Gazzard G, Konstantakopoulou E, Garway-Heath D ym....»3.

• Study quality: high
• Applicability: good

Gus Gazzard et al. Selective laser trabeculoplasty versus drops for newly diagnosed ocular hypertension and glaucoma: the LiGHT RCT. Health Technol Assess. 2019;23:1-102.

Systematic review 2

Meta-analysis of randomized, controlled trials shows that selective laser trabeculoplasty is non-inferior to argon laser trabeculoplasty and medication in intraocular pressure reduction and also in achieving treatment success. Number of medications reduction is similar between selective laser trabeculoplasty and argon laser trabeculoplasty. More robust evidence is needed to determine its efficacy as a repeated procedure «Wong MO, Lee JW, Choy BN ym. Systematic review and...»4.

Systematic review 3

Both selective laser trabeculoplasty and topical medication demonstrate similar success rates and effectiveness in lowering intraocular pressure in patients with open-angle glaucoma «Li X, Wang W, Zhang X. Meta-analysis of selective ...»5.

Systematic review 4

The systemic review compare selective laser trabeculoplasty (SLT) to other glaucoma treatment options in terms of their intraocular pressure (IOP)-lowering effect. Searches performed on PubMed, Cochrane Central Register of Controlled Trials, Ovid, EMBASE, metaRegister of Controlled Trials, and ClinicalTrials.gov. Only randomised controlled trials (RCTs) were included. The main outcome measure was the change in IOP from baseline.

Of 23 RCTs with 17 meeting the inclusion criteria. Three trials compared 360-degree SLT to medical therapy and found no difference between the two treatment options. Three trials indicate no difference between 360degree SLT and medical therapy, with one of the trials indicating greater IOP reduction with latanoprost over 90degree and 180degree SLT. There were no RCTs identified that compared SLT to surgery «Li X, Wang W, Zhang X. Meta-analysis of selective ...»5.

Systematic review 5

The purpose of the systematic review and meta-analysis was to evaluate the efficacy and tolerability of selective laser trabeculoplasty (SLT) and argon laser trabeculoplasty (ALT). Six clinic studies, all of which were random controlled trials, were selected through extensive searches of PubMed, Cochrane Library, Embase, and meeting abstracts. Efficacy measures were weighted by mean differences for intraocular pressure (IOP), as well as change of number of glaucoma medications and relative risks (RRs) for therapeutic IOP responses.

There was no significant difference in therapeutic IOP responses between SLT and ALT, with a pooled RR of 0.84 (95% CI, 0.51-1.38). When compared in patients with previous failed laser treatment (ALT or SLT), WMD was 1.48 (95% CI, 0.75-2.21). Patients who received SLT took fewer glaucoma medications after operations than those who received ALT, with a WMD of 0.29 (95% CI, 0.01-0.56). The frequencies of anterior chamber flare and IOP peak after operation were similar comparing SLT and ALT, with pooled RRs of 0.90 (95% CI, 0.74-1.11) and 0.90 (95% CI, 0.45-1.82), respectively «McAlinden C. Selective laser trabeculoplasty (SLT)...»6.

Six RCTs

Randomized controlled trials (RCTs) comparing SLT versus ALT were searched through August 2013. The main outcome measure was IOP, and secondary outcomes included the number of glaucoma medications, the success rate, and adverse events. Six RCTs, involving 482 eyes treated with laser trabeculoplasty, were included in the meta-analysis. For all patients (including first and previous laser trabeculoplasy), no significant difference in IOP lowering was observed between SLT and ALT at one hour (P = 0.40), one week (P = 0.72), one month (P = 0.37), six months (P = 0.08), one year (P = 0.34), two years (P = 0.58), three years (P = 0.34), four years (P = 0.47), and five years (P = 0.50). A statistically significant difference in favor of SLT was found when comparing the IOP reduction at three months after intervention (weighted mean difference (WMD): 1.19 mmHg [0.41; 1.97]; I(2)=0%; P = 0.003).

For patients who were naive to laser, there was no significant difference of reduction in IOP comparing SLT with ALT at any time point. In patients' previous LT, no statistically significant difference in IOP reduction was found at six months (WMD: 1.92 mmHg [-0.91; 4.74]; I(2) = 77.3%; P = 0.18). There was no significant difference in the reduction in the number of glaucoma medications, the success rate, or adverse event rates between the two treatments «Wang H, Cheng JW, Wei RL ym. Meta-analysis of sele...»7.