According to the World Health Organization, glaucoma is the second leading cause of blindness worldwide. At least 3 million Americans have glaucoma, but less than half of those people know they have the disease. Risk factors for glaucoma include a positive family history of glaucoma, diabetes, and nearsightedness. Glaucoma also increases in incidence with age, becoming much more common after age 60. In a vast majority of cases, glaucoma is asymptomatic, which makes the diagnosis much more challenging. In most cases, significant loss of vision can be prevented with early diagnosis and appropriate treatment.
Classically, first-line treatment for glaucoma has been eye drops which work in various ways to lower eye pressure. Medications, however, can cause multiple issues. Eye drops often have side effects, most commonly worsening of dry eye symptoms. Medications have to be refilled regularly and the cost is often an issue. Insurance plans constantly change their formularies, brand name medications are increasingly difficult to get covered by insurance policies and generic drops are often on backorder for months at a time due to insufficient production. Eye drops must be taken consistently to be effective, and patients often forget to take medications routinely. Many glaucoma patients are on multiple drops and compliance decreases with each medication added. It can also be very difficult to accurately get drops in the eye, especially for elderly patients or patients with arthritis or other chronic medical conditions. It is also important to consider that once starting glaucoma drops, they are often taken for one’s entire life!
In the LiGHT study (Laser in Glaucoma and Ocular Hypertension), researchers compared eye drops to laser treatment (Selective Laser Trabeculoplasty or SLT) for the initial treatment of glaucoma in newly diagnosed patients. Patients were randomized to either drop or laser treatment and multiple outcomes were followed. The most remarkable finding from the study was that 74% of laser patients remained drop-free at 3 years post-laser and were more likely to be within their target eye pressures at clinic visits than those patients treated with an eye drop. There were no significant complications in the laser group and treatment with laser was more cost-effective on average for both the patient and the health care system in general.
This was the first randomized controlled study to evaluate the efficacy and safety of SLT as a FIRST LINE treatment for glaucoma. The results show a better efficacy (74% of patients remained drop-free at 3 years) and a better safety profile than had been previously reported. This may be due to the fact that patients were receiving the treatment earlier in the disease course. However, these data suggest that SLT as a primary treatment for glaucoma is AT LEAST as effective as medical therapy, and we should be seriously considering laser treatment for most glaucoma patients.
