Purpose

To compare visual field outcomes of ocular hypertensive and glaucoma patients treated first with medical therapy with those treated first with selective laser trabeculoplasty (SLT).

Design

Secondary analysis of patients from the Laser in Glaucoma and Ocular Hypertension study, a multicenter randomized controlled trial.

Participants

Three hundred forty-four patients (588 eyes) treated first with medical therapy and 344 patients (590 eyes) treated first with SLT.

Methods

Visual fields (VFs) were measured using standard automated perimetry and arranged in series (median length and duration, 9 VFs over 48 months). Hierarchical linear models were used to estimate pointwise VF progression rates, which were then averaged to produce a global progression estimate for each eye. Proportions of points and patients in each treatment group with fast (<–1 dB/year) or moderate (<–0.5 dB/year) progression were compared using log-binomial regression.

Main Outcome Measures

Pointwise and global progression rates of total deviation (TD) and pattern deviation (PD).

Results

A greater proportion of eyes underwent moderate or fast TD progression in the medical therapy group compared with the SLT group (26.2% vs. 16.9%; risk ratio [RR], 1.55; 95% confidence interval [CI], 1.23–1.93; P < 0.001). A similar pattern was observed for pointwise rates (medical therapy, 26.1% vs. SLT, 19.0%; RR, 1.37; 95% CI, 1.33–1.42; P < 0.001). A greater proportion of pointwise PD rates were categorized as moderate or fast in the medical therapy group (medical therapy, 11.5% vs. SLT, 8.3%; RR, 1.39; 95% CI, 1.32–1.46; P < 0.001). No statistical difference was found in the proportion of eyes that underwent moderate or fast PD progression (medical therapy, 9.9% vs. SLT, 7.1%; RR, 1.39; 95% CI, 0.95, 2.03; P = 0.0928).

Conclusions

A slightly larger proportion of ocular hypertensive and glaucoma patients treated first with medical therapy underwent rapid VF progression compared with those treated first with SLT.

中文翻译：

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青光眼和高眼压试验（LiGHT）中多中心随机控制激光的视野结果。

目的

为了比较先接受药物治疗的眼部高血压和青光眼患者与先接受选择性激光小梁成形术（SLT）的患者的视野结局。

设计

青光眼和高眼压症患者的激光研究的二级分析，一项多中心随机对照试验。

参加者

首先接受药物治疗的34例患者（588眼）和首先接受SLT治疗的344例患者（590眼）。

方法

使用标准自动视野检查法测量视野（VF），并进行连续排列（中位长度和持续时间，48个月内9个VF）。使用分层线性模型来估计逐点VF进度，然后将其平均以生成每只眼睛的整体进度估计。使用对数二项回归分析比较每个治疗组中进展快（<–1 dB /年）或中等（<–0.5 dB /年）的点数和患者的比例。

主要观察指标

总偏差（TD）和模式偏差（PD）的逐点和全局进度。

结果

与SLT组相比，药物治疗组中有较大比例的眼睛经历了中度或快速TD进展（26.2％比16.9％；风险比[RR]为1.55； 95％置信区间[CI]为1.23–1.93；P <0.001）。逐点发病率观察到相似的模式（药物治疗，26.1％vs. SLT，19.0％； RR，1.37； 95％CI，1.33–1.42；P <0.001）。在药物治疗组中，较大比例的逐点PD率被分类为中度或快速（药物治疗，11.5％vs. SLT，8.3％； RR，1.39； 95％CI，1.32–1.46；P <0.001）。PD中度或快速进展的眼睛比例无统计学差异（药物治疗，9.9％vs. SLT，7.1％; RR，1.39; 95％CI，0.95，2.03 ; P = 0.0928）。

结论

与先行SLT治疗的患者相比，首先接受药物治疗的眼部高血压和青光眼患者的VF进展迅速。