Visual field progression with medication vs. laser
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Secondary analysis of the LiGHT trial showed that patients treated first with medications were more likely to undergo rapid visual field progression than those treated first with selective laser trabeculoplasty.

The LiGHT trial showed that SLT provides better clinical effectiveness and lower treatment intensity among newly diagnosed glaucoma and ocular hypertension patients compared to IOP-lowering eye drops Because the trial has now achieved 6 years of follow-up, the authors decided to revisit the visual field (VF) outcomes using a more detailed and sensitive statistical approach than a simple comparison of means. A total of 1,178 VFs from 688 individuals were included. Hierarchical linear models were used to estimate pointwise VF progression rates, which were then averaged to produce a global progression estimate for each eye. Outcome measures were pointwise, and total deviation and pattern deviation of global progression were measured. The mean rates of progression were estimated for each treatment group, each eye and each location in each eye and then compared between groups.

There was no evidence of a difference in overall group means, in line with the results at 3 years. However, a comparison of the means does not tells the whole story. Approximately one in four eyes in the medicine first group had moderate or fast progression compared with approximately one in six in the laser first group, giving a risk ratio of 1.55 with strong statistical support. A similar pattern was observed for the location-specific or pointwise rates. A possible explanation for the better VF outcomes in the laser first group include avoidance of the low treatment adherence typically observed with eye drops and potentially greater diurnal stability in IOP after laser surgery.