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102. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial

Author

Gazzard, Gus, primary, Konstantakopoulou, Evgenia, additional, Garway-Heath, David, additional, Garg, Anurag, additional, Vickerstaff, Victoria, additional, Hunter, Rachael, additional, Ambler, Gareth, additional, Bunce, Catey, additional, Wormald, Richard, additional, Nathwani, Neil, additional, Barton, Keith, additional, Rubin, Gary, additional, Buszewicz, Marta, additional, Bourne, Rupert, additional, Broadway, David, additional, Davis, Amanda, additional, Gazzard, Gus, additional, Jayaram, Hari, additional, Jiang, Yuzhen, additional, Lim, Sheng, additional, Liput, Joanna, additional, Manners, Timothy, additional, Morris, Stephen, additional, Strouthidis, Nicholas, additional, Wilson, Sarah, additional, and Zhu, Haogang, additional

Published
2019
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105. Primary Selective Laser Trabeculoplasty for Open-Angle Glaucoma and Ocular Hypertension: Clinical Outcomes, Predictors of Success, and Safety from the Laser in Glaucoma and Ocular Hypertension Trial

Author

Garg, Anurag, Vickerstaff, Victoria, Nathwani, Neil, Garway-Heath, David, Konstantakopoulou, Evgenia, Ambler, Gareth, Bunce, Catey, Wormald, Richard, Barton, Keith, Gazzard, Gus, Laser In Glaucoma And Ocular Hypertension Trial Study Group, Konstantakopoulou, Evgenia [0000-0001-8215-2689], and Apollo - University of Cambridge Repository

Subjects
Male, genetic structures, Trabeculectomy, Lasers, Solid-State, Middle Aged, eye diseases, Treatment Outcome, Trabecular Meshwork, Humans, Female, Ocular Hypertension, sense organs, Laser Therapy, Prospective Studies, Antihypertensive Agents, Glaucoma, Open-Angle, Intraocular Pressure, Aged
Abstract

PURPOSE: To report clinical efficacy, predictors of success, and safety of primary selective laser trabeculoplasty (SLT) used in treatment-naive patients with open-angle glaucoma (OAG) or ocular hypertension (OHT). DESIGN: Post hoc analysis of a multicenter, prospective, randomized, controlled trial. PARTICIPANTS: Treatment-naive patients with OAG or OHT. METHODS: Patients randomized to SLT or topical medication and treated to predefined target intraocular pressures (IOPs) requiring ≥20% IOP reduction from baseline for all disease severity levels. OUTCOME MEASURES: Initial (early) absolute IOP-lowering at 2 months. Achievement of drop-free disease-control: meeting target IOP without disease progression or need for additional topical medication over 36 months after SLT. Predictors of early absolute IOP-lowering and drop-free disease-control after single initial SLT. Frequency of laser-related complications. RESULTS: A total of 611 eyes (195 OHT and 416 OAG) of 355 patients received SLT, and 622 eyes (185 OHT and 437 OAG) of 362 patients received topical medication at baseline. Early absolute IOP-lowering after SLT was no different between OHT and OAG eyes (adjusted mean difference = -0.05 mmHg; 95% confidence interval [CI], -0.6 to 0.5 mmHg; P = 0.85). No difference was noted in early absolute IOP-lowering between topical medication and primary SLT (adjusted mean difference = -0.1 mmHg; 95% CI, -0.6 to 0.4 mmHg; P = 0.67). Early absolute IOP-lowering with primary SLT was positively associated with baseline IOP (coefficient 0.58; 95% CI, 0.53-0.63; P < 0.001) and negatively with female gender (coefficient -0.63; 95% CI, -1.23 to -0.02; P = 0.04). At 36 months, 536 eyes (87.7% of 611 eyes) of 314 patients (88.5% of 355 patients) were available for analysis. Some 74.6% of eyes (400 eyes) treated with primary SLT achieved drop-free disease-control at 36 months; 58.2% (312 eyes) after single SLT. Total SLT power and 2-month IOP were predictors of drop-free disease-control at 36 months after single SLT. Six eyes of 6 patients experienced immediate post-laser IOP spike (>5 mmHg from pretreatment IOP) with 1 eye requiring treatment. CONCLUSIONS: Primary SLT achieved comparable early absolute IOP-lowering in OHT versus OAG eyes. Drop-free disease-control was achieved in approximately 75% eyes at 36 months after 1 or 2 SLTs, the majority of these after single SLT. These analyses are exploratory but support primary SLT to be effective and safe in treatment-naive OAG and OHT eyes.

Published
2019

107. School grades and myopia

Author

Saw, Seang-Mei, Cheng, Angela, Fong, Allan, Gazzard, Gus, Tan, Donald T. H., and Morgan, Ian

Published
2007

118. Primary Selective Laser Trabeculoplasty for Open-Angle Glaucoma and Ocular Hypertension

Author

Garg, Anurag, primary, Vickerstaff, Victoria, additional, Nathwani, Neil, additional, Garway-Heath, David, additional, Konstantakopoulou, Evgenia, additional, Ambler, Gareth, additional, Bunce, Catey, additional, Wormald, Richard, additional, Barton, Keith, additional, Gazzard, Gus, additional, Bourne, Rupert, additional, Broadway, David, additional, Buszewicz, Marta, additional, Davis, Amanda, additional, Garg, Anurag, additional, Hunter, Rachael, additional, Jayaram, Hari, additional, Jiang, Yuzhen, additional, Lim, Sheng, additional, Liput, Joanna, additional, Manners, Timothy, additional, Morris, Stephen, additional, Rubin, Gary, additional, Strouthidis, Nicholas, additional, Wilson, Sarah, additional, and Zhu, Haogang, additional

Published
2019
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119. Selective laser trabeculoplasty versus drops for newly diagnosed ocular hypertension and glaucoma: the LiGHT RCT

Author

Gazzard, Gus, primary, Konstantakopoulou, Evgenia, additional, Garway-Heath, David, additional, Garg, Anurag, additional, Vickerstaff, Victoria, additional, Hunter, Rachael, additional, Ambler, Gareth, additional, Bunce, Catey, additional, Wormald, Richard, additional, Nathwani, Neil, additional, Barton, Keith, additional, Rubin, Gary, additional, Morris, Stephen, additional, and Buszewicz, Marta, additional

Published
2019
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121. Global causes of blindness and distance vision impairment 1990–2020: a systematic review and meta-analysis

Author

Flaxman, Seth R., Bourne, Rupert R. A., Resnikoff, Serge, Ackland, Peter, Braithwaite, Tasanee, Cicinelli, Maria V., Das, Aditi, Jonas, Jost B., Keeffe, Jill, Kempen, John H., Leasher, Janet, Limburg, Hans, Naidoo, Kovin, Pesudovs, Konrad, Silvester, Alex, Stevens, Gretchen A., Tahhan, Nina, Wong, Tien Y., Taylor, Hugh R., Arditi, Aries, Barkana, Yaniv, Bozkurt, Banu, Bron, Alain M., Budenz, Donald, Cai, Feng, Casson, Robert, Chakravarthy, Usha, Choi, Jaewan, Congdon, Nathan, Dana, Reza, Dandona, Rakhi, Dandona, Lalit, Dekaris, Iva, Del Monte, Monte, Deva, Jenny, Dreer, Laura, Ellwein, Leon, Frazier, Marcela, Frick, Kevin, Friedman, David, Furtado, Joao, Gao, Hua, Gazzard, Gus, George, Ronnie, Gichuhi, Stephen, Gonzalez, Victor, Hammond, Billy, Hartnett, Mary E., He, Minguang, Hejtmancik, James, Hirai, Flavio, Huang, John, Ingram, April, Javitt, Jonathan, Joslin, Charlotte, Khairallah, Moncef, Khanna, Rohit, Kim, Judy, Lambrou, George, Lansingh, Van Charles, Lanzetta, Paolo, Lim, Jennifer, Mansouri, Kaweh, Mathew, Anu, Morse, Alan, Munoz, Beatriz, Musch, David, Nangia, Vinay, Palaiou, Maria, Parodi, Maurizio B., Pena, Fernando Y., Peto, Tunde, Quigley, Harry, Raju, Murugesan, Ramulu, Pradeep, Rankin, Zane, Reza, Dana, Robin, Alan, Rossetti, Luca, Saaddine, Jinan, Sandar, Mya, Serle, Janet, Shen, Tueng, Shetty, Rajesh, Sieving, Pamela C., Silva, Juan C., Sitorus, Rita S., Stambolian, Dwight, Tejedor, Jaime, Tielsch, James, Tsilimbaris, Miltiadis, van Meurs, Jan, Varma, Rohit, Virgili, Gianni, Wang, Ya Xing, Wang, Ning-Li, West, Sheila, Wiedemann, Peter, Wormald, Richard, and Zheng, Yingfeng

Subjects
genetic structures, eye diseases
Abstract

Background: Contemporary data on causes of vision impairment and blindness form an important basis for recommendations in public health policies. Refreshment of the Global Vision Database with recently published data sources permitted modeling of cause of vision loss data from 1990 to 2015, further disaggregation by cause, and forecasts to 2020.\ud Methods: Published and unpublished population-based data on the causes of vision impairment and blindness from 1980 to 2015 were systematically analysed. A series of regression models were fit to estimate the proportion of moderate and severe vision impairment (MSVI; defined as presenting visual acuity

Published
2017

127. Laser in Glaucoma and Ocular Hypertension (LiGHT) trial. A multicentre, randomised controlled trial: design and methodology

Author

Gazzard, Gus, primary, Konstantakopoulou, Evgenia, additional, Garway-Heath, David, additional, Barton, Keith, additional, Wormald, Richard, additional, Morris, Stephen, additional, Hunter, Rachael, additional, Rubin, Gary, additional, Buszewicz, Marta, additional, Ambler, Gareth, additional, and Bunce, Catey, additional

Published
2017
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130. Statistical analysis plan for the Laser-1st versus Drops-1st for Glaucoma and Ocular Hypertension Trial (LiGHT): a multi-centre randomised controlled trial

Author

Vickerstaff, Victoria, Ambler, Gareth, Bunce, Catey, Xing, Wen, and Gazzard, Gus

Subjects
randomised clinical trial, Ophthalmology, genetic structures, Medicine (miscellaneous), open-angle glaucoma, ocular hypertension, statistical analysis plan, Pharmacology (medical), eye diseases, Update
Abstract

Background The LiGHT trial (Laser-1st versus Drops-1st for Glaucoma and Ocular Hypertension Trial) is a multicentre randomised controlled trial of two treatment pathways for patients who are newly diagnosed with open-angle glaucoma (OAG) and ocular hypertension (OHT). The main hypothesis for the trial is that lowering intraocular pressure (IOP) with selective laser trabeculoplasty (SLT) as the primary treatment (‘Laser-1st’) leads to a better health-related quality of life than for those started on IOP-lowering drops as their primary treatment (‘Medicine-1st’) and that this is associated with reduced costs and improved tolerability of treatment. This paper describes the statistical analysis plan for the study. Methods/Design The LiGHT trial is an unmasked, multi-centre randomised controlled trial. A total of 718 patients (359 per arm) are being randomised to two groups: medicine-first or laser-first treatment. Outcomes are recorded at baseline and at 6-month intervals up to 36 months. The primary outcome measure is health-related quality of life (HRQL) at 36 months measured using the EQ-5D-5L. The main secondary outcome is the Glaucoma Utility Index. We plan to analyse the patient outcome data according to the group to which the patient was originally assigned. Methods of statistical analysis are described, including the handling of missing data, the covariates used in the adjusted analyses and the planned sensitivity analyses. Trial registration The trial was registered with the ISRCTN register on 23/07/2012, number ISRCTN32038223.

Published
2015

136. Laser in Glaucoma and Ocular Hypertension (LiGHT) trial. A multicentre, randomised controlled trial: design and methodology.

Author

Gazzard, Gus, Konstantakopoulou, Evgenia, Garway-Heath, David, Barton, Keith, Wormald, Richard, Morris, Stephen, Hunter, Rachael, Rubin, Gary, Buszewicz, Marta, Ambler, Gareth, and Bunce, Catey

Abstract

Purpose The Laser in Glaucoma and Ocular Hypertension (LiGHT) Trial aims to establish whether initial treatment with selective laser trabeculoplasty (SLT) is superior to initial treatment with topical medication for primary open-angle glaucoma (POAG) or ocular hypertension (OHT). Design The LiGHT Trial is a prospective, unmasked, multicentre, pragmatic, randomised controlled trial. 718 previously untreated patients with POAG or OHT were recruited at six collaborating centres in the UK between 2012 and 2014. The trial comprises two treatment arms: initial SLT followed by conventional medical therapy as required, and medical therapy without laser therapy. Randomisation was provided online by a web-based randomisation service. Participants will be monitored for 3 years, according to routine clinical practice. The target intraocular pressure (IOP) was set at baseline according to an algorithm, based on disease severity and lifetime risk of loss of vision at recruitment, and subsequently adjusted on the basis of IOP control, optic disc and visual field. The primary outcome measure is health-related quality of life (HRQL) (EQ-5D five-level). Secondary outcomes are treatment pathway cost and cost-effectiveness, Glaucoma Utility Index, Glaucoma Symptom Scale, Glaucoma Quality of Life, objective measures of pathway effectiveness, visual function and safety profiles and concordance. A single main analysis will be performed at the end of the trial on an intention-to-treat basis. Conclusions The LiGHT Trial is a multicentre, pragmatic, randomised clinical trial that will provide valuable data on the relative HRQL, clinical effectiveness and cost-effectiveness of SLT and topical IOP-lowering medication. Trial registration number ISRCTN32038223, Pre-results. [ABSTRACT FROM AUTHOR]

Published
2018
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137. The Laser in Glaucoma and Ocular Hypertension (LiGHT) trial. A multicentre randomised controlled trial: baseline patient characteristics.

Author

Konstantakopoulou, Evgenia, Gazzard, Gus, Vickerstaff, Victoria, Yuzhen Jiang, Nathwani, Neil, Hunter, Rachael, Ambler, Gareth, and Bunce, Catey

Abstract

Purpose The laser in glaucoma and ocular hypertension (LiGHT) trial aims to establish whether initial treatment with selective laser trabeculoplasty (SLT) is superior to initial treatment with topical medication for primary open angle glaucoma (POAG) or ocular hypertension (OHT). Design LiGHT is a prospective unmasked, multicentre, pragmatic, randomised controlled trial (RCT). Participants 718 previously untreated patients with POAG or OHT were recruited at 6 UK centres between 2012 and 2014. Methods Patients were randomised to initial SLT followed by medical therapy or medical therapy without laser. Participants will be monitored for 3 years, according to routine clinical practice. The primary outcome is EQ-5D-5L. Secondary outcomes are treatment pathway cost and cost-effectiveness, Glaucoma Utility Index (GUI), Glaucoma Symptom Scale, Glaucoma Quality of Life (GQL), pathway effectiveness, visual function, safety and concordance. Results A total of 555 patients had POAG and 163 OHT; 518 patients had both eyes eligible. The mean age for patients with POAG was 64 years and for OHT 58 years. 70% of all participants were white. Median IOP for OHT eyes was 26 mm Hg and 23 mm Hg for POAG eyes. Median baseline visual field mean deviation was -0.81 dB for OHT eyes and -2.82 dB for POAG eyes. There was no difference between patients with POAG and patients with OHT on the EQ-5D-5DL; the difference between OHT and POAG on the GUI was -0.02 and 1.23 on the GQL. Conclusions The LiGHT trial is the first RCT to compare the two treatment options in a real-world setting. The baseline characteristics of the LiGHT cohort compare well with other landmark glaucoma studies. Trial registration number ISRCTN32038223, Pre-results. [ABSTRACT FROM AUTHOR]

Published
2018
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144. Use of Surodex in Phacotrabeculectomy Surgery

Author

Seah, Steve K.L., Husain, Rahat, Gazzard, Gus, Lim, Marcus C.C., Hoh, Sek-Tien, Oen, Francis T.S., and Aung, Tin

Subjects
Drugs -- Vehicles, Surgery, Drug delivery systems, Dexamethasone, Health
Abstract

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajo.2004.10.052 Byline: Steve K.L. Seah (a), Rahat Husain (a)(b), Gus Gazzard (b), Marcus C.C. Lim (a), Sek-Tien Hoh (a), Francis T.S. Oen (a), Tin Aung (a)(c) Abstract: To evaluate the use of Surodex (Oculex Pharmaceuticals, Sunnyvale, California) a drug delivery system incorporating 60 micrograms of dexamethasone in a pellet, in phacotrabeculectomy surgery. Author Affiliation: (a) Singapore National Eye Center, Singapore (b) Institute of Ophthalmology, London, United Kingdom (c) National University of Singapore, Singapore Article History: Accepted 20 October 2004

Published
2005

145. The Singapore 5-Fluorouracil Trial

Author

Wong, Melissa H.Y., primary, Husain, Rahat, additional, Ang, Bryan C.H., additional, Gazzard, Gus, additional, Foster, Paul J., additional, Htoon, Hla M., additional, Wong, Tina T., additional, Oen, Francis T., additional, Khaw, Peng T., additional, Seah, Steve K., additional, and Aung, Tin, additional

Published
2013
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150. Initial Management of Acute Primary Angle Closure

Author

Husain, Rahat, primary, Gazzard, Gus, additional, Aung, Tin, additional, Chen, Yuming, additional, Padmanabhan, Vishwanath, additional, Oen, Francis T.S., additional, Seah, Steve K.L., additional, and Hoh, Sek-Tien, additional

Published
2012
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