Low-energy Selective Laser Trabeculoplasty Repeated Annually: Rationale for the COAST Trial

被引:17
作者
Realini, Tony [1 ]
Gazzard, Gus [2 ,3 ]
Latina, Mark [4 ]
Kass, Michael [4 ,5 ]
机构
[1] West Virginia Univ, Dept Ophthalmol & Visual Sci, Morgantown, WV 26506 USA
[2] Moorfields Eye Hosp NHS Fdn Trust, NIHR Biomed Res Ctr, London, England
[3] UCL, London, England
[4] Tufts Univ, Dept Ophthalmol, Boston, MA 02111 USA
[5] Washington Univ, Dept Ophthalmol & Visual Sci, St Louis, MO 63110 USA
基金
美国国家卫生研究院;
关键词
selective laser trabeculoplasty; glaucoma; COAST; low energy; OPEN-ANGLE GLAUCOMA; QUALITY-OF-LIFE; INTRAOCULAR-PRESSURE REDUCTION; MINIMALLY INVASIVE GLAUCOMA; TRABECULAR MESHWORK CELLS; MEDICATION ADHERENCE; OCULAR-HYPERTENSION; EDUCATIONAL INTERVENTIONS; AQUEOUS OUTFLOW; CORNEAL EDEMA;
D O I
10.1097/IJG.0000000000001788
中图分类号
R77 [眼科学];
学科分类号
100212 ;
摘要
The recent Laser in Glaucoma and Ocular Hypertension Trial provided the evidentiary basis for a paradigm shift away from the historical medication-first approach to glaucoma--which has numerous limitations, the most important of which is poor adherence to therapy --and toward a laser-first approach. Now 20 years after its commercialization, selective laser trabeculoplasty (SLT) is routinely performed consistently with its initial description, with energy titrated to the appearance of fine, champagne-like cavitation bubbles. A recent data set suggested that lower energy SLT, applied as primary therapy and repeated annually irrespective of intraocular pressure--rather than pro re nata when its effect wanes and irrespective of intraocular pressure rises --yields longer medication-free survival than standard energy SLT repeated pro re nata. A new study--Clarifying the Optimal Application of SLT Therapy --has been initiated to explore this preliminary finding in a pair of consecutive randomized trials. Herein, we provide an evidence-based rationale for the use of low-energy SLT repeated annually as primary therapy for mild to moderate primary open-angle glaucoma or high-risk ocular hypertension.
引用
收藏
页码:545 / 551
页数:7
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