Selective Laser Trabeculoplasty as Primary Glaucoma Treatment in Community Practice

Background and aims
Glaucoma, the leading cause of irreversible blindness, is primarily managed by reducing elevated
intraocular pressure (IOP). Traditionally, medical therapy has been first line treatment for
elevated IOP, and selective Laser Trabeculoplasty (SLT) has been adopted an as alternative
option. This study aims to evaluate the effectiveness of SLT in reducing IOP in treatment-naïve
patients.
Methods
Single center retrospective design to evaluate effectiveness of SLT in treatment-naïve patients.
Results
After one round of SLT, 48% of patients achieved target IOP. A second round of SLT increased
efficacy by 12%, raising total success to 60%. Type and severity of glaucoma were significant
predictors of response (p<0.05). Primary open angle glaucoma and ocular hypertension had
higher success, while pseudoexfoliation syndrome, pseudoexfoliation glaucoma, advanced
diseases were more likely to fail.
Conclusion
SLT is a safe and effective first-line treatment in reducing IOP in treatment naïve patients,
particularly in early disease. This may be especially useful for rural patients where regular
monitoring and follow up can be challenging. SLT has also demonstrated greater cost-effectiveness compared to contemporary IOP-lowering drops, offering drop independence,
lowering the need for glaucoma surgery, and carrying a very low risk of adverse events.