Laser trabeculoplasty for open-angle glaucoma and ocular hypertension

Area of Science:

• Ophthalmology
• Glaucoma Research
• Laser Therapy

Background:

• Open-angle glaucoma (OAG) is a leading cause of global blindness.
• The optimal position of laser trabeculoplasty within OAG treatment sequences remains unclear.
• Comparing laser trabeculoplasty with other interventions is crucial for treatment guidelines.

Purpose of the Study:

• To evaluate laser trabeculoplasty's efficacy against medication, surgery, or no intervention for OAG and ocular hypertension (OHT).
• To compare the effectiveness of different laser trabeculoplasty technologies.
• To assess outcomes including intraocular pressure (IOP) control, visual field progression, and adverse effects.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) comparing laser trabeculoplasty with control groups (no intervention, medication, surgery).
• Included trials comparing different laser trabeculoplasty technologies.
• Primary outcomes assessed at 24 months: IOP control failure, visual field/optic neuropathy progression, adverse events, quality of life, and costs. Certainty of evidence graded using GRADE.

Main Results:

• Forty studies (4028 participants) were included; most had a high risk of bias.
• Laser trabeculoplasty showed variable results compared to medication for IOP control (low-certainty evidence).
• Evidence suggests laser trabeculoplasty may reduce visual field progression compared to medication (moderate-certainty evidence) and is cost-effective. Newer selective laser trabeculoplasty had fewer adverse events like IOP spikes.

Conclusions:

• Laser trabeculoplasty may be more effective than topical medication in slowing visual field loss in OAG.
• It may be comparable to modern eye drops for IOP control and is more cost-effective.
• Selective laser trabeculoplasty is associated with fewer serious adverse effects.