LASER TRABECULOPLASTY: A POTENTIAL ALTERNATIVE TO MEDICATION IN GLAUCOMA TREATMENT-A LITERATURE REVIEW.

Background: Glaucoma causes global blindness and impaired vision, with treatment aiming to reduce intraocular pressure (IOP) to preserve the visual field. Selective laser trabeculoplasty (SLT) is a non-invasive laser procedure improving eye fluid drainage. Objective: The aim of this review is to evaluate the potential benefits of SLT in comparison with current medication. This therapy can provide longer-lasting reduction in IOP and may be more cost-effective in the long term. Material and methods: This review selected articles included in the PubMed database that compared laser trabeculoplasty and medication from different perspectives: therapeutical and financial. The phrases used in the search were,,laser trabeculoplasty",,medication" and,,comparison". Included articles were mainly randomized clinical trials (RCT) but there was one cross-sectional and one retrospective study. The clinical trials included evaluated therapeutical success, which was defined by lowering the IOP (and therefore the risk of needing medication or even trabeculectomy) or by health-related quality of life. Studies comparing different types of laser trabeculoplasty were not included. Bias risk was not assessed and data were extracted using a standardized abstraction form. Results : A total of 1435 patients were identified in 13 studies, of which 2 are still ongoing. Gazzard et al (2023) observed a significant reduction in disease progression for SLT: 26.8% of patients treated with medication exhibited disease progression, compared to 19.6% of patients treated with SLT (p=0.006). Trabeculectomy was required in 32 eyes in the eye drops group, compared to 13 eyes in the SLT group (p<0.001). Also, SLT proved to be more cost-effective: patients ended up saving about 500£ in a threeyear span. Lee et al (2014) also concluded that patients treated with SLT had a lower IOP (p=0.03) and required fewer medications. Ang et al (2020) reported a significant improvement in the patient's quality of life regarding social well-being. On the other side, Narayanaswamy et al (2015) reported complete success in fewer eyes treated with SLT (60%) compared to prostaglandin analog (PGA-84%), with statistical significance (p=0.008). Also, additional medications were required in 22% of the patients treated with SLT, compared to 8% treated with PGA (p=0.05). Conclusions: Although some studies prove otherwise, in most of the studies laser trabeculoplasty appears to provide better outcomes for patients with glaucoma, both from a therapeutical and a financial standpoint. However, each study had a different definition of therapeutical success, which made it difficult to compare the results and further investigation is still needed. [ABSTRACT FROM AUTHOR]