SLT: first line of defence

1 November 2023
Autumn 2023

New NICE guidance states that selective laser trabeculoplasty rather than eye drops should be a first-line treatment for glaucoma. Kim Thomas asks what this means for optometrists – and their patients.

In 2022, NICE updated its guidance on the diagnosis and management of glaucoma. Previously, eye drops were the first-line treatment for chronic open angle glaucoma (COAG) and ocular hypertension, but the new guideline recommends offering selective laser trabeculoplasty (SLT) to patients, excluding cases associated with pigment dispersion syndrome (PDS).

The decision to revise the guideline was based on the findings of the LiGHT (Laser in Glaucoma and Ocular Hypertension) trial, led by Professor Gus Gazzard, Director of Surgery at Moorfields Eye Hospital (Gazzard et al, 2019). The trial – the biggest SLT trial in the world to date – enlisted 718 newly diagnosed patients with mild to moderate glaucoma, randomly allocating half to receive SLT and half to receive eye drops. Patients were followed up after three years, and again at six.

SLT was found to have a 90% probability of being the more cost-effective option, and was shown to be safer than previously reported. Patients also responded well to the treatment, with the research finding that SLT provided “superior intraocular pressure stability to drops, at a lower cost”. It also “allows almost three-quarters of patients (74%) to be successfully controlled without drops for at least three years after starting treatment”. The SLT treatment, says Gus, “protected visual field loss better than eye drops, as well as preventing the need for surgery”. In short, he says, “SLT didn’t just cost less, it worked better.”

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