Predictors of Initial Glaucoma Therapy: Laser Trabeculoplasty Versus Medication

Background: Glaucoma is the most common cause of blindness in the world. If not recognized and treated early enough, open-angle glaucoma can be a severe ocular illness that can lead to blindness. A gradual loss of ganglion cells leads to the optic nerve head cupping, which is the pathogenic process. Objective: The main aim of this study was to determine if selective laser trabeculoplasty (SLT) is superior to topical medication as the first-line treatment for open-angle glaucoma.Material & Methods:This prospective comparative study was conducted in 225 patients (450 eyes) at Deen Mohd. Eye Hospital & Research Center from July 2019 to July 2021.The patients were randomly divided into two groups; Selective laser trabeculoplasty (SLT group)and medical therapy group.Results:The study was conducted between 25 to 85 years of patients where the majority were between 46 to 65 years age group;58% patientswere male, and 42% were female. The mean intraocular pressure (IOP) was 18.2mm Hg for the SLT group and 17.6mm Hg for the medical therapy group. Overall, mean pressures and IOP lowering were not statistically different between the two treatment groups.Conclusions:In the last follow-up, 11% of the eyes had been stepped to additional SLT in the SLT arm, and 27% of the eyes in the medical arm required more medications to reach the target IOP range. The main risk factor is high intraocular pressure; however additional potential risk factors include optic nerve vascular insufficiency, neuronal degeneration, and hereditary factors. More research and prospective trials on intraocular pressure control and disease progression are needed to understand the long-term implications.