Selective Laser Trabeculoplasty for the Management of Open-Angle Glaucoma in St. Lucia

Realini, Tony

doi:10.1001/jamaophthalmol.2013.1706

Cited by 56 publications

(54 citation statements)

References 32 publications

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“…IOP spikes of >5 mm Hg 1 hour after laser were found in 3 subjects and were bilateral in 2 of these. 18 LT is performed as either first-line or adjunctive therapy for uncontrolled open-angle glaucoma. The high rate of bilateral same-day LT (40%) may suggest that this procedure is frequently performed as first-line therapy, considering the decreased likelihood of bilateral uncontrolled disease after initiating medical management.…”

Section: Discussionmentioning

confidence: 99%

Same-Day Bilateral Glaucoma Laser Treatments in Ontario

Szigiato

Trope²,

Jin³

et al. 2016

Journal of Glaucoma

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The increase in same-day bilateral trabeculoplasties coincided with the introduction of selective laser trabeculoplasty. The proportion of this practice remained constant for the last 3 years of the study period. In 2013, 56.7% of iridotomies and 38.5% of trabeculoplasties were performed as same-day bilateral procedures. We recommend comparison studies between same-day and sequential laser therapies to assess complication rates and patient satisfaction to provide an evidence-based treatment approach, as there are limited data to support this practice.

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Section: Discussionmentioning

confidence: 99%

Same-Day Bilateral Glaucoma Laser Treatments in Ontario

Szigiato

Trope²,

Jin³

et al. 2016

Journal of Glaucoma

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“…When evaluating patients with OAG or ocular hypertension (OHT) treated with SLT, Melamed et al (33) observed a ≥19.6% IOP reduction in 89% of the patients, while Mahdy (29) found an IOP-reduction ≥25% in 77.1% of the cases. Overall, in an attempt to summarize IOP data from the available studies, we found that average absolute IOP-reduction following SLT as first treatment ranges from 3 to 8 mmHg (percentage IOP reduction: 20% to 38%) (17,18,29,31,33,34) . Other studies compared SLT versus PGA as a primary therapy, with similar efficacy between the two treatment modalities (16)(17)(18) .…”

Section: Efficacy (Iop Reduction)mentioning

confidence: 98%

“…When the extension of the laser was considered, PGA showed better results than 90° and 180° SLT, but not 360° ( 18) . The efficacy of SLT was also evaluated in OAG eyes previously treated with glaucoma medication (monotherapy) (34) . After a 30-day medication washout, SLT reduced IOP significantly, and IOP remained stable without medical therapy for 12 months (34) .…”

Section: Efficacy (Iop Reduction)mentioning

confidence: 99%

“…The efficacy of SLT was also evaluated in OAG eyes previously treated with glaucoma medication (monotherapy) (34) . After a 30-day medication washout, SLT reduced IOP significantly, and IOP remained stable without medical therapy for 12 months (34) . In addition, another study also evaluated SLT results after topical medication washout, and SLT 360° was effective [mean IOP reduction of 2.9 mmHg (40%) at 3 months and 2.1 mmHg (29.2%) at 6 months after the laser) (35) .…”

Section: Efficacy (Iop Reduction)mentioning

confidence: 99%

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Selective laser trabeculoplasty as an initial treatment option for open-angle glaucoma

Freitas¹,

Ushida²,

Almeida³

et al. 2016

Arquivos Brasileiros De Oftalmologia

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Although eye drops are frequently used as an initial treatment option for open angle glaucoma (OAG), side effects, and poor adherence, among others, may compromise treatment efficacy. In this scenario, laser trabeculoplasty is an interesting therapeutic option for open angle glaucoma cases. Commonly used for many years as a last alternative prior to glaucoma incisional surgery, laser trabeculoplasty has been changing its indication after the advent of selective laser trabeculoplasty (SLT ). In the current review, we critically evaluated the published data regarding the use of laser trabeculoplasty as a first treatment option for open angle glaucoma patients. Studies using SLT as a first-line treatment have encouraging findings. One-year efficacy results are comparable to those obtained with prostaglandin analogues, with a good safety profile. Although the laser´s effect is known to be transitory, recent data suggest it can be successfully repeated in cases with good response to the first SLT treatment.

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“…Costs of procedures were from the 2016 Outpatient Prospective Payment System (OPPS) Limited Data Set (LDS) ( Table 3). Complication costs were $0 for both the iStent and SLT procedures based on published literature that demonstrated that complications risks with either were very low [14][15][16] . Complications costs with filtering surgeries were based on an analysis of the 2013 CMS Standard Analytical File.…”

Section: Direct Costsmentioning

confidence: 99%

Cost-comparison of two trabecular micro-bypass stents versus selective laser trabeculoplasty or medications only for intraocular pressure control for patients with open-angle glaucoma

Berdahl

Khatana

Katz

et al. 2017

Journal of Medical Economics

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Aim:Patients with open-angle glaucoma (OAG) whose intraocular pressure is not adequately controlled by one medication have several treatment options in the US. This analysis evaluated direct costs of unilateral eye treatment with two trabecular micro-bypass stents (two iStents) compared to selective laser trabeculoplasty (SLT) or medications only. Materials and methods: A population-based, annual state-transition, probabilistic, cost-of-care model was used to assess OAG-related costs over 5 years. Patients were modeled to initiate treatment in year zero with two iStents, SLT, or medications only. In years 1-5, patients could remain on initial treatment or move to another treatment option(s), or filtration surgery. Treatment strategy change probabilities were identified by a clinician panel. Direct costs were included for drugs, procedures, and complications. Results: The projected average cumulative cost at 5 years was lower in the two-stent treatment arm ($4,420) compared to the SLT arm ($4,730) or medications-only arm ($6,217). Initial year-zero costs were higher with two iStents ($2,810) than with SLT ($842) or medications only ($996). Average marginal annual costs in years 1-5 were $322 for two iStents, $777 for SLT, and $1,044 for medications only. The cumulative cost differences between two iStents vs SLT or medications only decreased over time, with breakeven by 5 or 3 years post-initiation, respectively. By year 5, cumulative savings with two iStents over SLT or medications only was $309 or $1,797, respectively. Limitations: This analysis relies on clinical expert panel opinion and would benefit from real-world evidence on use of multiple procedures and treatment switching after two-stent treatment, SLT, or polypharmaceutical initial approaches. Conclusions: Despite higher costs in year zero, annual costs thereafter were lowest in the two-stent treatment arm. Two-stent treatment may reduce OAG-related health resource use, leading to direct savings, especially over medications only or at longer time horizons.ARTICLE HISTORY

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Selective Laser Trabeculoplasty for the Management of Open-Angle Glaucoma in St. Lucia

Cited by 56 publications

References 32 publications

Same-Day Bilateral Glaucoma Laser Treatments in Ontario

Same-Day Bilateral Glaucoma Laser Treatments in Ontario

Selective laser trabeculoplasty as an initial treatment option for open-angle glaucoma

Cost-comparison of two trabecular micro-bypass stents versus selective laser trabeculoplasty or medications only for intraocular pressure control for patients with open-angle glaucoma

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