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Aims To investigate the clinical efficacy of primary selective laser trabeculoplasty (SLT) as initial therapy in newly-diagnosed treatment-naïve open-angle-glaucoma (OAG)/ ocular hypertension (OHT) patients. To also investigate patient-reported outcome measures related to health-related quality of life (HRQL) between primary SLT and topical medication. Methods Pre-specified and post-hoc analyses performed using data derived from the Laser in Glaucoma and Ocular Hypertension ('LiGHT') Trial, a multi-centre randomised-controlled trial. Results 718 patients (1235 eyes) were randomised: 356 patients (613 eyes) were allocated to SLT (Laser-1st pathway) and 362 patients (622 eyes) to medical treatment (Medicine-1st pathway). Early absolute IOP-lowering following primary SLT was no different between OHT and OAG eyes (adjusted mean difference = -0.05mmHg; 95% confidence interval (CI) -0.6 to 0.5mmHg; p=0.85). No difference was noted in early absolute IOP-lowering between topical medication and primary SLT (adjusted mean difference = -0.1mmHg; 95% CI, -0.6 to 0.4mmHg; p=0.67). At 36-months, 536 eyes (87.7% of 611 eyes) of 314 patients (88.5% of 355 patients) were available for analysis in Laser-1st pathway. 74.6% of eyes (400 eyes) treated with primary SLT achieved drop-free "disease-control" at 36-months; 58.2% (312 eyes) following single SLT. 6 eyes of 6 patients experienced immediate post-laser IOP spike with 1 eye requiring treatment. 115 eyes of 90 patients received repeat SLT during the first 18 months of the trial. Repeat treatment maintained drop-free IOP control in 67% of these eyes for a subsequent 18 months, with no clinically-relevant adverse events. At 36-months, there was no significant difference in all HRQL measures between the treatment arms, including EQ-5D-5L (adjusted mean difference = 0.01; 95% CI, -0.01 to 0.03; p=0.23). Conclusions This work supports primary SLT to be a safe and clinically effective alternative to topical treatment that could be offered as a first-line IOP lowering treatment to patients with OAG or OHT.