Low-energy Selective Laser Trabeculoplasty Repeated Annually: Rationale for the COAST Trial

Area of Science:

• Ophthalmology
• Medical Technology

Background:

• The historical medication-first approach for glaucoma has limitations, notably poor patient adherence to therapy.
• Selective laser trabeculoplasty (SLT) has been available for 20 years and is performed using a standard energy titration method.
• Recent data suggests lower energy SLT, used annually as primary therapy, may improve medication-free survival compared to standard energy SLT used as needed.

Purpose of the Study:

• To provide an evidence-based rationale for using low-energy SLT.
• To support the use of low-energy SLT repeated annually as primary therapy for specific glaucoma types.
• To explore preliminary findings on the efficacy of different SLT protocols.

Main Methods:

• A new study, Clarifying the Optimal Application of SLT Therapy, has been initiated.
• The study involves a pair of consecutive randomized trials.
• The research will investigate the preliminary finding of longer medication-free survival with lower energy SLT.

Main Results:

• A recent dataset indicated that lower energy SLT, applied annually as primary therapy, yielded longer medication-free survival.
• This contrasts with standard energy SLT repeated only when needed (pro re nata).
• The preliminary findings suggest a potential benefit of a proactive, lower-energy laser approach.

Conclusions:

• Low-energy SLT repeated annually is proposed as a primary therapy for mild to moderate primary open-angle glaucoma.
• This approach is also suggested for high-risk ocular hypertension.
• The findings support a paradigm shift towards a laser-first strategy in glaucoma management.