Dall’Hawaiian Eye 2016 meeting vengono ulteriori conferme a quanto già da tempo è parte integrante della nostra attività clinica: il trattamento con SLT è un approccio valido, efficace e conveniente per iniziare a trattare la pressione oculare nei pazienti con nuova diagnosi di glaucoma.

Come specificato da Jay Katz, lo SLT garantisce una elevata sicurezza e garantisce che la pressione oculare sia sempre tenuta sotto controllo senza andare incontro ai rischi di una scarsa adesione alla terapia con i colliri.
Tutti i pazienti possono effettuare lo SLT: il 98% dei pazienti con prima diagnosi è risultata idonea al trattamento.
La pressione oculare è abbassata in una percentuale che va dal 30 al 39%.

Gli effetti collaterali, pur descritti saltuariamente, risultano essere scarsi e di poco significato. La procedura è definita “incredibilmente sicura”, soprattutto in considerazione che la lista degli eventi avversi provocati dai colliri è, invece, molto lunga.
Per questo il dottor Katz domanda alla platea: ma perché non facciamo sempre l’SLT come prima terapia?

Why aren’t we using laser trabeculoplasty as first-line therapy?

Katz J.

Presented at: Hawaiian Eye 2016; Jan. 16-22, 2016; Waikoloa, Hawaii.

Because it is as effective as primary glaucoma medications, and it is less expensive and safer than medications with no patient compliance issues, selective laser trabeculoplasty should be considered as a first line therapy for some glaucoma patients, according to a speaker here.
“In the majority of patients in the trabecular meshwork for Schlemm’s canal, there is a problem with outflow. All of the current drugs that we are using really don’t address that particular problem,” L. Jay Katz, MD, said at Hawaiian Eye. “There has been a fair amount of work done with laser trabeculoplasty showing that it seems to work in lowering IOP and improving trabecular or conventional outflow in the eye.”

In a study conducted by Brian A. Francis, MD, MS, 98% of patients were able to have at least one medication replaced with laser trabeculoplasty and three quarters of patients were able to replace two medications, he said.
In another study conducted by Anthony Realini, MD, MPH, IOP was reduced 30% to 39% with laser trabeculoplasty in both eyes, and in 93% of these patients who were on more than one medication, there was a better pressure reduction with laser trabeculoplasty, he said.
There are complications associated with laser trabeculoplasty, but it is a fairly safe procedure, he said.
“There are sometimes problems with selective laser trabeculoplasty. You can sometimes have a pressure spike and sometimes inflammation. By and large, it is an incredibly safe procedure and it is rare that anyone would have a lasting abnormality as a result of laser trabeculoplasty,” Katz said. Topical medication complications include cosmetic issues with hyperemia, intolerance because of irritation, blepharoconjunctivitis, as well as systemic concerns.

The cost of SLT over time is less than that of medications in the U.S., Canada and Australia, according to several publications. According to the Canadian Journal of Ophthalmology, 3-year savings of SLT vs. monotherapy is $580. In Current Medical Research and Opinion, researchers found that the 5-year cost of SLT was $4,838 compared to $6,571 for medication. In Ophthalmology, SLT cost savings were stated as $2.50 for every dollar spent.
“Laser trabeculoplasty has demonstrated to be equally effective to our best monotherapies whether it be timolol or prostaglandin. Safety, compliance and cost seem to be better in terms of laser trabeculoplasty. In terms of treatment paradigm, I would urge all of you to rethink how we treat our patients on a case by case basis,” Katz said.

Reference
Katz J. Why aren’t we using laser trabeculoplasty as first-line therapy? Presented at: Hawaiian Eye 2016; Jan. 16-22, 2016; Waikoloa, Hawaii.