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Glaucoma Physician

Article | 2025 American Glaucoma Society Meeting

Six-year LiGHT Data Reviewed at AGS

The landmark study found that early SLT provides effective pressure control with less disease progression and fewer surgeries.

Jim Gallagher, senior managing editor
Glaucoma Physician March 5, 2025

Six-year LiGHT Trial Data Support SLT as First-Line Glaucoma Treatment

Overview

The 6-year LiGHT trial data demonstrate that initial selective laser trabeculoplasty (SLT) effectively controls intraocular pressure (IOP) with less disease progression and fewer surgeries compared to medical therapy. Nearly 70% of patients in the SLT-first group achieved drop-free IOP control, with fewer cataract and glaucoma surgeries required.

Background

Selective laser trabeculoplasty (SLT) is increasingly recognized as a safe and effective first-line treatment for newly diagnosed open-angle glaucoma and ocular hypertension. The LiGHT trial, a randomized controlled study in the UK, enrolled 718 treatment-naïve patients to compare SLT versus initial medical therapy over six years. Outcomes included IOP control, disease progression, quality of life, and cost-effectiveness. The trial excluded patients with advanced or secondary glaucomas.

Data Highlights

OutcomeSLT-First GroupMedication-First Group
Drop-free IOP control~70%Not applicable
Disease progression (moderate/fast)1 in 6 eyes1 in 4 eyes
Trabeculectomy surgeriesFewerMore
Cataract surgeriesFewerMore
IOP rise >5 mmHg1% of eyesNot reported
Visual acuity and field preservationComparable between groupsComparable between groups

Key Findings

  • SLT-first treatment achieved effective IOP control with nearly 70% of eyes remaining drop-free at 6 years.
  • Disease progression was significantly lower in the SLT-first group, with fewer eyes showing moderate or fast visual field loss.
  • The SLT-first group required fewer incisional glaucoma surgeries (trabeculectomies) and cataract surgeries compared to the medication-first group.
  • Repeat SLT treatments were effective in eyes that initially failed, especially in patients with moderate to severe glaucoma.
  • Adverse events were minimal with SLT; medication-treated patients reported more side effects such as periocular pigmentation and ocular discomfort.
  • Economic analysis favored SLT as a cost-effective approach within the UK National Health Service.

Clinical Implications

SLT should be considered a first-line treatment option for patients with newly diagnosed open-angle glaucoma or ocular hypertension, offering effective IOP control with fewer medications and surgeries. Repeat SLT can be beneficial in cases of initial treatment failure. This approach may reduce the overall treatment burden and improve patient quality of life.

Conclusion

The LiGHT trial's 6-year data support SLT as a safe, effective, and cost-efficient initial therapy for glaucoma, with benefits extending beyond IOP control to reduced disease progression and surgical interventions. These findings have influenced clinical practice guidelines and healthcare policies.

References

  1. Bowden E. 2025 -- Six-year LiGHT Trial Data Reviewed at AGS