Laser or Drops for Initial Glaucoma Treatment

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Eyedrops that lower intraocular pressure are the most common treatment for open-angle glaucoma and ocular hypertension. But remembering to use the drops as directed can be challenging. And many people with elevated intraocular pressure eventually go on to require glaucoma surgery.

Research findings published last year in The Lancet suggest that a better initial treatment for many people may be selective laser trabeculoplasty (SLT), a painless outpatient surgical procedure that increases the outflow of fluid from inside the eye, thereby decreasing pressure.

In a randomized controlled study, researchers compared 314 people who received SLT with 312 people who received eyedrops. Thirty-six months into the study, glaucoma had progressed in 36 people receiving eyedrops (5.8 percent), compared with 23 who had SLT (2.3 percent). Patients in the SLT group met their target intraocular pressure at more visits than those in the eyedrop group. Eleven patients in the eyedrop group required glaucoma surgery (trabeculectomy) to lower pressure, compared to none in the SLT group. Laser treatment allowed almost three-quarters of the participants to control their intraocular pressure without needing to start the use of eyedrops for at least three years. What’s more, SLT proved to be more cost-effective than eyedrops over time.

The researchers’ conclusion: SLT should be offered as a first-line treatment for open-angle glaucoma and ocular hypertension. Be sure to discuss your options with your doctor.