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The LiGHT randomized trial compared initial selective laser trabeculoplasty (SLT) with eye drops in treatment-naive patients with open-angle glaucoma or ocular hypertension. More than 700 participants were followed for three years, with an emphasis on disease control, quality of life, cost-effectiveness, and safety. The trial found similar health-related quality-of-life outcomes, while a large proportion of patients initially treated with SLT maintained target intraocular pressure without topical drops at 36 months. The laser-first pathway also avoided glaucoma surgery in the reported trial population and was highly cost-effective from the study's health-system perspective. The practical relevance is substantial: SLT can reduce dependence on daily topical therapy, avoid adherence problems, and provide a non-incisional treatment option early in the disease course. For glaucoma clinics, the decision still depends on angle anatomy, disease severity, access to laser, clinician expertise, and patient preference. The evidence supports presenting SLT as a legitimate first-line treatment rather than reserving it only for patients who fail drops. It also highlights the importance of discussing treatment burden alongside intraocular pressure when designing long-term glaucoma care.
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The LiGHT randomized trial compared initial selective laser trabeculoplasty (SLT) with eye drops in treatment-naive patients with open-angle glaucoma or ocular hypertension. More than 700 participants were followed for three years, with an emphasis on disease control, quality of life, cost-effectiveness, and safety. The trial found similar health-related quality-of-life outcomes, while a large proportion of patients initially treated with SLT maintained target intraocular pressure without topical drops at 36 months. The laser-first pathway also avoided glaucoma surgery in the reported trial population and was highly cost-effective from the study's health-system perspective. The practical relevance is substantial: SLT can reduce dependence on daily topical therapy, avoid adherence problems, and provide a non-incisional treatment option early in the disease course. For glaucoma clinics, the decision still depends on angle anatomy, disease severity, access to laser, clinician expertise, and patient preference. The evidence supports presenting SLT as a legitimate first-line treatment rather than reserving it only for patients who fail drops. It also highlights the importance of discussing treatment burden alongside intraocular pressure when designing long-term glaucoma care.
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