If you have ocular hypertension and/or glaucoma, treatment to preserve your vision is critical. Most patients are prescribed eye drops that lower their intraocular pressure (IOP), but administering daily eye drops can be a burden for some people. The other less common option is a surgery called selective laser trabeculoplasty (SLT). 

The Laser in Glaucoma and Ocular Hypertension (LiGHT) clinic trial compared these two treatment options. In 2020, David M. Wright, Ph.D., performed a methodological analysis of the LiGHT trial and explained which treatment option leads to more rapid visual field (VF) progression.* 

What was done in the LiGHT clinical trial?

The study consisted of 718 patients who were diagnosed with either open-angle glaucoma (OAG) or ocular hypertension. Participants were randomly divided into two treatment groups:

• 356 participants underwent SLT
• 362 participants were prescribed IOP-lowering eye drops

The trial focused on these outcomes: 

• Health-related quality of life (HRQOL)
• Cost and cost-effectiveness
• Clinical effectiveness
• Safety

How does Dr. Wright’s analysis differ from the original study?

The initial study analyzed outcomes after three years. According to Wright, a significant difference was not found, as three years is not long enough to detect visual field progression. During his evaluation, the trial was still collecting data at six years, which is when he and his team conducted their analysis. The initial study also simply compared averages to the two participant groups, whereas Dr. Wright conducted a more detailed and statistical analysis.

“If we look closely, we can see that a slightly larger proportion of the medicine first eyes had faster progression, 26.2% vs. 16.9% in the laser first eyes,” said Wright. “Approximately one in four eyes in the medicine first group had moderate or fast progression compared with approximately one in six in the laser first group.”

According to Dr. Wright, the better outcomes in the laser first group is likely because: 

• Avoidance of the low adherence to eye drop medication 
• Greater stability in IOP after laser surgery

For those interested in reading the original study, you can find it on The Lancet website.

*Cimberle, M. (2020, June 29). LiGHT trial shows more visual field progression with medication vs. laser. Ocular Surgery News. https://www.healio.com/news/ophthalmology/20200629/light-trial-shows-more-visual-field-progression-with-medication-vs-laser

Any sources from outside of Prevent Blindness do not imply an endorsement from Prevent Blindness. The contents of the material used are the responsibility of the authoring organization, Responsum Health.