Racial Differences in Selective Laser Trabeculoplasty Efficacy

Abstract

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.

West Indies Glaucoma Laser Study (WIGLS): 1. 12-Month Efficacy of Selective Laser Trabeculoplasty in Afro-Caribbeans With Glaucoma

“…Our current and previous data, 18 coupled with the data from Goosen and colleagues, 21 suggest that a laser-first glaucoma care process could reduce glaucoma-related blindness in resource-limited regions populated by people of African descent (ie, Africa and the Caribbean). In all three of these studies, SLT lowered IOP by approximately 30–40%, an effect size that would reasonably be expected to favorably alter the natural history of glaucoma.…”

“…More recently, Goosen and colleagues reported the response to SLT in African subjects with glaucoma in South Africa. 21 In their study, mean IOP reductions of 42% were seen, with 90% of treated subjects achieving and maintaining a minimum 20% IOP reduction from baseline through 12 months of follow-up. The magnitude of IOP reduction seen in these studies of patients of African descent exceeds the reported treatment effect in largely Caucasian study samples.…”

<p>Short-Term Efficacy of Selective Laser Trabeculoplasty in Omani Eyes with Glaucoma: A Single Institutional Study</p>

“…This general reported pattern of gradual nature of response and decrease rate of decline with time was documented in several other studies and in majority of eyes even in different races such as in Romanian and Indian eyes. 10 , 12 , 25 A distinct difference in pattern of response to treatment with SLT in Blacks versus those of Indian heritage in a South African study was noted. Although both races exhibited a good IOP response, Indian eyes showed more of a gradual response pattern whereas Blacks showed a more uniform response pattern fully manifest within 1 month of treatment and sustained throughout a 1-year interval.…”

“… 9 A more recent study found that SLT was effective in producing clinically significant IOP reduction among South African adults and good therapeutic responses but significantly less efficacious with a different pattern of response in socioeconomic comparable patients of Indian ancestry. 10 It should be interesting to investigate how Omani eyes respond to this intervention and whether it resembles the pattern of response exhibited by African or Indian eyes. This study looks at the short-term efficacy of SLT in Omani eyes with OAG and ocular hypertension (OHTN).…”

Selective Laser Trabeculoplasty Versus Brimonidine Tartrate 0.2%/Timolol Maleate 0.5% As Adjunct Therapy in Primary Open Angle Glaucoma: A Randomized Prospective Trial

“…Although the pressure reduction was slightly greater in the Saint Lucia study, again SLT was used as primary therapy as opposed to adjunct treatment. 14 Additionally, the racial disparity of the population bases may further contribute to the difference in SLT 17. Gazzard et al in the LiGHT trial also compared SLT to eye drops for first line treatment and found that drops lowered IOP from baseline by 33.2% at 36 months while SLT lowered IOP by 32.2%.…”