15-minute laser treatment best for glaucoma

Author: Mark Gould

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A new study* has shown that using a laser-based treatment on newly diagnosed cases of glaucoma is more successful and more cost-effective than the current method of using intraocular pressure lowering eye drops.

Glaucoma in some form affects approximately two percent of the UK population over 40 years of age and is one of the leading causes of blindness in the UK.

A three-year trial, carried out by researchers at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, the largest ever of its kind, saw 718 patients newly-diagnosed with glaucoma or ocular hypertension assigned one of two treatment pathways.

One pathway was the current standard treatment of administering eye drops designed to lower intraocular pressure (IOP) and the other involved a procedure called selective laser trabeculoplasty (SLT), a quick procedure which is done in the clinic using anaesthetic eye drops and which lowers IOP by using lasers to increase the ease with which fluid can leave the eye.

Patients who received SLT were more regularly at the target IOP. There was also less chance of treatment escalation being required and a lower need for both glaucoma surgery and cataract extractions than was required by patients who received the eye drops.

The results suggest annual savings to the NHS of £1.5m in direct treatment costs for newly diagnosed cases of open angle glaucoma. However, if the results from this study prove to be the same in patients who have not been newly diagnosed with glaucoma but have had the condition for some time then the savings for the NHS could reach up to £250 million per year.

The lead researcher on the study Mr Gus Gazzard, consultant ophthalmologist and glaucoma service director at Moorfields, said: “In this study, we have shown that a simple, safe, pain-free laser treatment not only works better than eye-drops at preventing glaucoma from deteriorating but also costs the NHS less. These results strongly suggest that laser should be the first treatment for glaucoma in all newly diagnosed patients and will provoke further interest in its use in patients who are already on treatment.

“In the results so far we’ve already seen eye pressure lowering that has lasted far longer than the older early data had suggested, so we’re excited by the prospect of seeing very long-term pressure control given that glaucoma is a long-term, chronic disease.”

The trial, which was predominantly funded by the National Institute for Health Research, Health and Technology Assessment Programme (NIHR HTA), was held across the NIHR Biomedical Research Facility (BRC) at Moorfields and UCL and with the support of the PRIMENT clinical trials unit at UCL.

An ongoing follow-up study, also funded by the NIHR HTA, alongside Moorfields Eye Charity, Fight for Sight, and the International Glaucoma Association, will provide more information on the long-term effects. This follow-up study is due to conclude in 2020.

*Gazzard G, Konstantakopoulou E, Garway-Heath D, et al. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial. The Lancet, March 09 2018, DOI: 10.1016/S0140-6736(18)32213-X


Editorial team, Wilmington Healthcare

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