AimSub-Saharan Africa has a population of 1 billion, with one ophthalmologist per million people. Basic ophthalmic support services are virtually absent for all but a few urban populations. Minimally invasive laser treatment may help. This study reports our initial experience using selective laser trabeculoplasty (SLT) in a mixed-racial population of adult glaucoma patients in Durban, South Africa.Study designInstitution Review Board approved the 5-year chart review.Materials and methodsConsecutive glaucomatous adults underwent SLT (Lumenis Selecta) on one or both eyes applying 360° treatment of 120 to 140 closely spaced burns (400 urn spot size for 3 ns; range 1.1-1.4 mJ). Significance of change in intraocuar pressure (IOP) from baseline at 1, 3, 6, and 12 months was assessed by two-tailed paired t-test.ResultsAmong 148 eyes of 84 patients (60 African, 21 Indian, 3 Caucasian), 69 had already undergone glaucoma therapy, and 15 untreated (de novo). Among all eyes, mean IOP was reduced by >32% with mean IOP < 15 mm Hg from baseline at all four study intervals (p < 0.0001). A 20% reduction in IOP was sustained at 12 months in 90% of African eyes but in only 50% of Indian eyes.ConclusionSelective laser trabeculoplasty was effective in producing clinically significant IOP reduction among South African adults with or without prior medical or surgical anti-glaucoma therapy. Socioeconomically comparable individuals of Indian ancestry showed good therapeutic responses, but significantly less efficacious than those observed among Black subjects. Programs to provide first-line SLT management of glaucoma in Africa, where 90% of patients are unable to sustain prescribed medical therapy, appear to be a very appropriate option.How to cite this articleGoosen E, Coleman K, Visser L, Sponsel WE. Racial Differences in Selective Laser Trabeculoplasty Efficacy. J Curr Glaucoma Pract 2017;11(1):22-27.
Objective: To compare the outcomes of selective laser trabeculoplasty (SLT) on treatmentnaive, primary open-angle glaucoma (POAG) patients with those of SLT on patients previously treated medically and/or surgically. Secondary objectives: To establish whether age, race or gender influenced SLT outcomes.Design: A retrospective chart review of patients who received SLT therapy for POAG between June 2011 and January 2015.Subjects: Group A: Treatment-naive patients (n = 15). Group B: Prior medical therapy and/or prior surgery (n = 69).Methods: Group A: Patients were treated with SLT therapy as first line, with medical treatment added as needed. Group B: Patients were treated with SLT therapy as additional therapy to medication and/or surgery. All patients were followed up for at least 1 year.Main outcome measures: A reduction in intraocular pressure (IOP) of at least 20% from baseline was considered significant.Results: The following percentage reduction in IOP was found in the different groups: Group A 50.7%, Group B 32.0%, Africans 52.2%, Indians 29.8% and Caucasians 28.87%.Conclusion: In our study patients, SLT achieved significant reductions in IOPs in treatmentnaive as well as previously surgically and medically treated eyes with POAG. Statistically significant higher reductions in IOP at 1 year after SLT was seen in treatment-naive eyes, patients older than 70 years when compared with younger patients, female patients (54%) when compared with male patients (30%) and in patients of African (52%) descent compared with Caucasians (30%).
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