Effectiveness of selective laser trabeculoplasty for glaucoma and ocular hypertension in a large real-world cohort in New Zealand.

Abstract

Aim: The Laser in Glaucoma and Ocular Hypertension (LiGHT) trial supports selective laser trabeculoplasty (SLT) as first-line glaucoma treatment; however, local real-world data are limited. We evaluated the real-world outcomes of SLT on intraocular pressure (IOP) and medication burden in a regional Aotearoa New Zealand hospital.

Methods: We conducted a retrospective clinical audit of all SLT procedures performed at Palmerston North Hospital between August 2022 and April 2025. The primary outcome was IOP at final follow-up. The secondary outcome was a change in medication burden. Sub-groups analysed included optimal treatment (360-degree laser, Goldmann applanation tonometry, ≥6 months follow-up) and treatment-naive eyes.

Results: A total of 236 eyes from 166 patients were included in the study. Most eyes (93.2%) were on established topical therapy at baseline. Mean IOP reduced from 18.3±5.2mmHg to 14.5±4.2mmHg, a mean reduction of 3.8mmHg (20.8%, p<0.001), with 93.6% achieving IOP ≤21mmHg at final follow-up. The medication burden remained statistically stable. In the optimal sub-group (n=62), 43.5% achieved clinical success (≥20% IOP reduction) with a 3.2mmHg mean drop. In treatment-naive eyes (n=16), mean IOP reduced by 5.3mmHg, with 93.8% remaining drop-free. Baseline IOP was the only significant predictor of clinical success.

Conclusion: SLT effectively lowers IOP in a real-world regional New Zealand setting, including in heavily medicated eyes. Stable medication burden reflects adjunctive use in this cohort rather than a procedural limitation. Treatment-naive outcomes support the growing evidence for SLT as a primary intervention.