Real-world outcomes of selective laser trabeculoplasty and medical treatment in primary open-angle glaucoma and ocular hypertension.

Objective: Report effectiveness of selective laser trabeculoplasty (SLT) and topical medical therapy for treatment initiation and escalation.

Design: Multicentre, retrospective cohort study covering an observation period of 10 years.

Participants: Patients with ocular hypertension or primary open-angle glaucoma initiating intraocular pressure (IOP)-lowering therapy, or escalating from a single topical agent.

Main outcome measures: Kaplan-Meier estimate for duration of treatment success, defined by the time between treatment event to treatment failure, defined as meeting one of the following: a <20% reduction in IOP in comparison to baseline at two consecutive clinic visits; IOP >21 mm Hg at 2 consecutive clinic visits; or subsequent intensification of glaucoma treatment (subsequent increase in medical drops, SLT (re-)treatment, incisional glaucoma therapy).

Results: A total of 4564 eyes (mean baseline IOP 21.8 SD 7.0 mm Hg) of 2708 patients were included. The median time to treatment failure (ie, duration for which treatment success can be expected for 50% of patients) was 1.72 years (95% CI 1.63 to 1.79) following initiation of a topical agent and 1.35 (95% CI 1.13 to 1.73) years after initial SLT.Following escalation in those already on a single topical agent, the median treatment failure time was 1.32 years (95% CI 1.23 to 1.44) for 2 topical agents and 1.53 years (95% CI 1.35 to 2.03) for a single topical agent and SLT.

Conclusion: This retrospective analysis reports the real-world effect of SLT and topical medical therapy on IOP and treatment success following the most common treatment scenarios: initiation of IOP-lowering treatment and intensification from a single topical drop. Due to the non-randomised nature of this study, it is not possible to draw firm conclusions regarding the comparative effectiveness of drop and SLT.