In March, glaucoma therapy took a giant leap forward when Gazzard et al published the results of the 3-year LiGHT study.¹ In this randomized, prospective study comparing SLT laser to medications, SLT was the winner in terms of cost, efficacy, and quality of life. The implications of this study in terms of glaucoma therapy are straightforward but paradigm changing: glaucoma therapy should be initiated with SLT in cases of open-angle glaucoma. Currently, we are not doing enough SLT, with only 140,000 procedures being performed annually,² whereas more than 30 million prescriptions are written for glaucoma drops every year in the United States.³ Most of those SLT treatments are not for primary therapy but rather for patients on one or more eyedrops. Even more interesting is that there were 11 patients in the medical therapy group of the LiGHT study that went on to require glaucoma surgery compared to 0 patients in the SLT group, a finding that suggests SLT could be disease modifying rather than palliative like eye drops.

In a sense, SLT is our first standalone therapy. If our field is to move into the interventional arena, we would do well to embrace the findings of the LiGHT trial. In this issue of Glaucoma Physician, we will look at glaucoma from a variety of perspectives. We delve into the applications of optical coherence tomography angiography for glaucoma, technique for ab-interno canaloplasty, the importance of contrast sensitivity in testing, new drugs coming to the market for glaucoma, and risk management for your practice. As you read about these trends in glaucoma, we hope to shed light on emerging themes in glaucoma diagnosis and treatment that will help you move confidently toward your best future treatment paradigms. GP

References

1. Gazzard G, Konstantakopoulou E, Garway-Heath D, et al. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial. The Lancet. 2019;393(10181):P1505-P1516.
2. Arora KS, Robin AL, Corcoran KJ, Corcoran SL, Ramulu PY. Use of various glaucoma surgeries and procedures in Medicare beneficiaries from 1994 to 2012. Ophthalmology. 2015;122(8):1615-1624.
3. Ianchulev S. In search of the best glaucoma drop. Glaucoma Phys. 2019;3(1):20,23,24. Available at: https://www.glaucomaphysician.net/issues/2019/march-2019/in-search-of-the-best-glaucoma-drop

On the cover: Postoperative image 1 month after ab-interno canaloplasty with iTrack microcatheter (Ellex).Image courtesy of Ellex.

Dr. Radcliffe is Clinical Assistant Professor in the Department of Ophthalmology at the NYU Langone Medical Center and a surgeon at the New York Eye Surgery Center.