Visual Field Outcomes from the Multicenter, Randomized Controlled Laser in Glaucoma and Ocular Hypertension Trial

Author(s): David M.Wright (1,2), Evgenia Konstantakopoulou (3,4,5), Giovanni Montesano (6), Neil Nathwani (3), Anurag Garg (3), David Garway-Heath (3,4), David P.Crabb (6), Gus Gazzard (3,4) on behalf of the LiGHT Trial Study Group

1 Centre for Public Health, Queen’s University Belfast, Belfast, UK
2 Health Data Research UK
3 NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, London, UK
4 Institute of Ophthalmology, University College London, UK
5 Division of Optics and Optometry, University of West Attica, Greece
6 Optometry and Visual Science, School of Health Science, City, University of London, London, UK

PURPOSE: To compare visual field outcomes of ocular hypertensive and glaucoma patients treated first with medical therapy with those treated first with selective laser trabeculoplasty (SLT).

DESIGN: Secondary analysis of patients from the Laser in Glaucoma and Ocular Hypertension study, a multicenter randomized controlled trial.

PARTICIPANTS: Three hundred forty-four patients (588 eyes) treated first with medical therapy and 344 patients (590 eyes) treated first with SLT.

METHODS: Visual fields (VFs) were measured using standard automated perimetry and arranged in series (median length and duration, 9 VFs over 48 months). Hierarchical linear models were used to estimate pointwise VF progression rates, which were then averaged to produce a global progression estimate for each eye. Proportions of points and patients in each treatment group with fast (<–1 dB/year) or moderate (<–0.5 dB/year) progression were compared using log-binomial regression.

MAIN OUTCOME MEASURES: Pointwise and global progression rates of total deviation (TD) and pattern deviation (PD).

RESULTS: A greater proportion of eyes underwent moderate or fast TD progression in the medical therapy group compared with the SLT group (26.2% vs. 16.9%; risk ratio http://RR, 1.55; 95% confidence interval http://CI, 1.23–1.93; P < 0.001). A similar pattern was observed for pointwise rates (medical therapy, 26.1% vs. SLT, 19.0%; RR, 1.37; 95% CI, 1.33–1.42; P < 0.001). A greater proportion of pointwise PD rates were categorized as moderate or fast in the medical therapy group (medical therapy, 11.5% vs. SLT, 8.3%; RR, 1.39; 95% CI, 1.32–1.46; P < 0.001). No statistical difference was found in the proportion of eyes that underwent moderate or fast PD progression (medical therapy, 9.9% vs. SLT, 7.1%; RR, 1.39; 95% CI, 0.95, 2.03; P = 0.0928).

CONCLUSIONS: A slightly larger proportion of ocular hypertensive and glaucoma patients treated first with medical therapy underwent rapid VF progression compared with those treated first with SLT.

PMID: 32402553

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