Professor Realini's team report long-term (8-year) follow up data on a large series of Afro- Caribbean subjects (265 eyes; 133 patients) treated with selective laser trabeculoplasty. They report IOP reductions and the numbers of subjects who remain drop-free. The most striking finding is the long median medication-free survival time after SLT of 85.4 months, and that over 71% of patients remaining medication-free at 94 months when SLT was repeated as needed. It is also of note that this study confirms the LiGHT findings that a repeated SLT provides a longer duration of treatment effect.
The major strengths of this study are the use of washout pressure measurements, the longterm follow-up and its focus on an important, high-risk group. The study was limited by the lack of a control group (handled in the original WIGGLES trial by a stepped-wedge design) and a moderate but significant attrition rate.
The major strengths of this study are the use of washout pressure measurements, the long-term follow-up and its focus on an important, high-risk group
Nonetheless, this deserves to have a major impact on practice. Its findings support two other recent major trials ('LiGHT' trial, Lancet 2019 and SLT vs Timolol in Tanzania, Philippin, Lancet Glob Health 2021) that have also showed SLT to have profound and lasting effects when used as monotherapy. We now have data from a predominantly European (LiGHT), East African (Tanzania) and West-African-derived populations all showing similar robust results. While Realini et al. do not look at cost-effectiveness in this paper, other earlier findings have shown cost-effectiveness in both high and low resource settings, which makes early SLT an important paradigm shift in glaucoma management across the world.