Glaucoma Laser Trial (GLT), Glaucoma Laser Trial Follow up Study (GLTFS)

Glaucoma Laser Trial (GLT), Glaucoma Laser Trial Follow up Study (GLTFS)

Purpose:

To compare efficacy of argon laser trabeculoplasty (ALT) vs. standard medical treatment for primary open-angle glaucoma (POAG)

Description:

. GLT was a randomized, controlled clinical trial, done to determine if ALT is

effective in patients with newly diagnosed POAG vs. standard topical

medication

. 271 patients were enrolled, with each eye randomly assigned to ALT or topical

medication

. GLTFS was a follow up study of 203 of initial 271 in GLT over median 7yrs

. Patients were followed every 3 months for a period of at least 2 yrs with VA &

IOP checks

. If IOP elevated, changed medication, added drops to laser eye and eventually

considered surgery or further laser treatment according to standardized  procedure.

Results:

- When compared with eyes initially treated with medication, eyes initially treated

with ALT had:

1) 1.2 mmHg greater reduction in intraocular pressure (p<0.001)

2) 0.6 dB greater improvement in the visual field from entry into the GLT

- The overall difference btw eyes with regard to change in cup to disc ratio area from

entry into the GLT was -0.01 (p=0.005) which indicated slightly more deterioration

for eyes initially treated with medication

- Overall, the eyes treated initially with ALT had lower IOP, better visual field and

optic disc status than their fellow eyes treated initially with topical medication

-  Noted a contralateral mean reduction in IOP of 0.5mmHg in the eye that received

ALT (how did they figure that it wasn’t the ALT)

Conclusion:

Initial treatment with ALT was at least as efficacious as initial treatment with topical medication

Teaching points:

Consider laser therapy as initial therapy vs. topical medication in POAG