The LiGHT Trial: eye drops vs. SLT for glaucoma

Glaucoma is usually the result of abnormally high pressure inside the eye and if left untreated it can lead to vision loss or even blindness.

Prescription eye drops are the main treatment for the condition with several different types that can be used. In some cases, selective laser trabeculoplasty (SLT) is a safe alternative but it is rarely used as the first treatment option.

Recently, The LiGHT Trial, a study that compares glaucoma drops with SLT, was published in The Lancet. Here, one of our expert ophthalmologists Mr Thomas Ressiniotis tells us more about the study and whether there is evidence to show that SLT should be offered as the first-line of treatment for glaucoma.

Can you tell us about the LiGHT Trial?

It is the first randomised controlled study comparing SLT with glaucoma drops. The study takes into account the challenges that busy NHS hospitals are facing. In the study, 718 patients enrolled of which 356 were randomised to the SLT group and 362 to the glaucoma eye drops group.
 

What did the study take into consideration?

As with every study, it is important that we take into account the inclusion and exclusion criteria so that we should not extrapolate the results to every glaucoma patient.

The LiGHT Trial applies to treatment-naïve patients with open-angle glaucoma (where the deviation is no worse than -12 dB in the better eye or -15 dB in the worse eye) or ocular hypertension with visual acuity of 6/36 or better in the eyes to be treated. There was no previous intraocular surgery, except uncomplicated phacoemulsification at least one year before randomisation, and no ocular comorbidities.
 

What were the key results from the trial?

The results showed that at 36 months, 74.2% of SLT patients required no drops to maintain intraocular pressure at target. This led to an overall cost saving to the NHS of £451 per patient in specialist ophthalmology costs.

Health-related quality of life at three years was a primary outcome (assessed by EQ-5D) and was found to be equal between SLT and eyedrops. However, this generic tool has very limited value in assessing treatment effects on the quality of life because glaucoma is an asymptomatic disease until the advanced stages.
 

What can we take away from the trial?

SLT appears to be safe and effective and should be offered as first-line treatment for open-angle glaucoma and ocular hypertension.

Mr Ressiniotis specialises in treating cataracts and glaucoma. You can book an appointment to see him via his Top Doctor’s profile here.