SLT the number one choice for first-line treatment

Selective laser trabeculoplasty (SLT) is an effective method of long-term treatment for glaucoma, according to Madhu Nagar of the Clayton Eye Centre, UK.

Speaking at the Ellex symposium, Nagar presented results from a case study analysis of SLT procedures carried out between January 2000 and December 2005. 505 eyes were analysed in patients with primary open-angle glaucoma (POAG) and ocular hypertension (OHT). Out of these, 54% received SLT as a primary treatment while the remaining 46% received it as an adjunctive or replacement therapy.

In the primary group, intraocular pressure (IOP) fell from 27.8 mmHg to 19 mmHg after a follow-up period of 45 months. In the secondary group, a 33% reduction in IOP was recorded after 51 months. Nagar therefore concluded that SLT has positive long-term prospects.

She also found that SLT is a repeatable procedure. Out of 110 eyes, 56 were treated with SLT as an enhancement therapy (receiving 180º treatment) and the remaining 54 received SLT as retreatment (following previous treatment at 280º or 360º ). In the enhancement group, there was an IOP reduction of 23% after 24 months. At the start of treatment, there were 10 non-responders. Out of these, 40% were non-responders after 24 months. In the retreatment group, IOP fell from 27.5 mmHg to 18.6 mmHg. Nineteen eyes did not respond to the initial treatment, and 26% of these failed at six months.

In another randomised controlled trial, Nagar evaluated the effect of SLT in daytime tension curve in 40 patients, and compared the results with latanoprost (Xalatan; Pfizer). IOP recordings were taken at 8:00, 11:00, 14:00 and 18:00 prior to SLT treatment. After four months, IOP fell from 6.4 mmHg to 3.2 mmHg with SLT, and 2.1 mmHg with Xalatan. As a result, SLT is comparable to Xalatan at 360º treatment, and both lead to a flattening of daytime tension curve. "However, " she added, "much larger studies of 24-hour analysis need to be carried out to determine this."

"No treatment of glaucoma is 100%, not even SLT, " Nagar admitted. However, she believes that laser trabeculoplasty has a better risk-benefit ratio than any other method of treatment. For OHT patients in particular, it has been shown that SLT is the most effective treatment. "For me, SLT is now number one, " she concluded. "If I choose SLT as my first approach, I don't have to worry about compliance because I am the one in control, and I like that! "