Six-Year Rate of Visual Field Progression in the Laser in Glaucoma and Ocular Hypertension Trial

Purpose: To compare the 6-year rate of visual field (VF) progression in the 2 arms of the Laser in Ocular Hypertension and Glaucoma Trial (LiGHT), comparing selective laser trabeculoplasty (SLT) and drops as first treatment in ocular hypertension (OHT) and open-angle glaucoma (OAG).

Design:Post hoc analysis of data from randomized clinical trial.

Participants: Patients with newly diagnosed OHT/OAG recruited in the LiGHT trial.

Methods: In each patient, we selected the better (baseline mean deviation [MD]) eligible eye with at least 3 reliable VFs (false-positive errors < 15%) over at least 6 months. We estimated the rate of MD progression using a published hierarchical linear mixed effect model (LMM), designed to increase precision by minimizing the effect of perimetric learning and test-retest noise. Secondary analyses were performed to assess the differences in rate across baseline severity groups (OHT, mild OAG, and moderate/severe OAG); the effect of glaucoma surgery and switch to SLT in the drops-first arm, by truncating the VF series; and the effect of cataract and cataract surgery, by using the mean pattern deviation (MPD) instead of the MD.

Main Outcome Measures: Mean difference in the rate of VF MD progression between patients in the SLT-first arm and drops-first arm.

Results: Data from 710 eyes (482 with OAG and 354 in the SLT-first arm) were analyzed. The 2 arms had similar baseline MD (P = 0.7). The average intraocular pressure (IOP) during follow-up was 16.1 [14.2—18.2] for the drops-first arm and 16.8 [14.6—18.6] in the SLT-first arm (median [interquartile range], P = 0.057). The mean [95% credible interval] MD rate was —0.37 [—0.43 to —0.31] decibels (dB)/year in the drops-first arm and —0.26 [—0.31 to —0.21] dB/ year in the SLT-first arm (P = 0.007). When stratified by severity, this difference was significant only in mild OAG (P = 0.035, the largest sub-group). The secondary analyses largely confirmed the main results. The difference in MPD rate was also significantly slower in the SLT-first arm (P < 0.001).

Conclusions: First-line SLT was more effective than drops at preserving VF. Selective laser trabeculoplasty should be preferred as the first line of treatment in newly diagnosed OHT and OAG eyes.

Authors: Giovanni Montesano, David P. Crabb, David F. Garway-Heath, David M. Wright, Evgenia Konstantakopoulou, Neil Nathwani, Giovanni Ometto, Gus Gazzard.

Link: https://www.aaojournal.org/article/S0161-6420(25)00610-4/fulltext

Doi: 10.1016/j.ophtha.2025.09.023

NGP Papers Manager: Carlo Cutolo