SLT for Improved Glaucoma Care in Africa

Article: Laser treatment could significantly improve glaucoma care in Africa
Source: London School of Hygiene & Tropical Medicine (U.K.)
Published: October 14, 2021 

Globally, glaucoma is the most frequent cause of irreversible blindness, with the highest prevalence and incidence in Africa, which also has the highest prevalence of blindness due to the disease. The only currently modifiable factor in the treatment of glaucoma is lowering intraocular pressure (IOP), which can be accomplished through eye drops, laser procedures, or surgery. Research conducted in Tanzania compared the use of beta-blocker timolol 0.5% eye drops and selective laser trabeculoplasty (SLT). Although the most affordable, and thus the most commonly used, glaucoma medication in lower income settings, timolol also comes with potential systemic and local side-effects and high long-term costs due to the need for daily life-long treatment of glaucoma. The study lead comments, “Glaucoma requires life-long treatment and follow-up to save a person’s sight, which can be very challenging in many settings. Currently, most people are treated with eye drops but many struggle with taking them regularly or accessing new bottles, for example due to cost or distance to the nearest clinic." An ophthalmologist at the hospital where the study was conducted adds, "[S]ome of the patients after sometime decide to ignore or just stop using eye drops. If we can establish an alternative effective means of arresting the disease, we would bring about a positive impact on the quality of life of these patients." The randomized controlled trial enrolled 201 patients (382 eligible eyes) with open-angle glaucoma and an IOP above 21 mm Hg, and did not have asthma or a history of glaucoma surgery or laser. Among the 101 patients assigned to the SLT group, 33 required two SLT procedures, while 66 were successfully treated with one SLT procedure. After one year, data from 339 eyes were analysed, showing that eye drop treatment was successful in 31.3% (55/176) of eyes, while SLT was successful in 60.7% (99/163) of eyes. The affordability of SLT was also considered, with the study suggesting that for hospitals that treat a high volume of glaucoma patients, SLT could be offered at a similar price as an annual supply of timolol eye drops. The researchers acknowledge that a longer follow-up period is needed to evaluate vision and quality of life; however, they stress that "studies such as these are crucial for identifying solutions that can tackle the challenge and improve the lives and livelihoods of those in Sub-Saharan Africa and beyond."

My rating of this study: ⭐⭐🌸

Philippin H, Matayan E, Knoll KM, et al. "Selective laser trabeculoplasty versus 0·5% timolol eye drops for the treatment of glaucoma in Tanzania: a randomised controlled trial." The Lancet Global Health.  13 October 2021. https://doi.org/10.1016/S2214-109X(21)00348-X