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Pearls from the EGS Guidelines
Pearls from the EGS Guidelines
Drops or SLT as First Line Treatment? – Implications of the LiGHT Trial

Publishing date: June 2021

Pearls Manager: Hari Jayaram

Newly diagnosed patients with Ocular Hypertension or Open Angle Glaucoma were randomised to one of two treatment pathways – “Laser First” or “Drops First”. Target IOPs were generated by computer based algorithms based upon severity and pre-treatment IOPs, with treatment escalation defined by objective criteria.

After 3 years, 74% of the “Laser First” group remained within target without the need for medication, required fewer trabeculectomies and showed reduced disease progression compared to the “Drops First” arm. SLT was safe and cost-effective compared with eyedrops and is a safe and effective initial treatment that can be offered to newly diagnosed patients.

EGS Guidelines, 5th Edition, Page 46


1. Gazzard G, Konstantakopoulou E, Garway-Heath D, Garg A, Vickerstaff V, Hunter R, Ambler G, Bunce C, Wormald R, Nathwani N, Barton K, Rubin G, Buszewicz M; LiGHT Trial Study Group. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial. Lancet. 2019 Apr 13;393(10180):1505-1516.

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