The GLAUrious trial was a multicentre, randomised, controlled study comparing Direct Selective Laser Trabeculoplasty (DSLT) with conventional Selective Laser Trabeculoplasty (SLT) for treating open-angle glaucoma (OAG)[5]. Key results of the trial include:

1. Intraocular Pressure (IOP) Reduction:

- At 6 months, DSLT reduced unmedicated IOP by 5.46 ± 0.51 mmHg, while SLT reduced it by 6.16 ± 0.53 mmHg[5].

- The difference between the two treatments was not statistically significant (-0.70 mmHg, 95% CI -2.15 to 0.76; p=0.091)[5].

2. Long-term Efficacy:

- At 12 months, DSLT reduced non-washed out IOP by 3.20 ± 0.38 mmHg, similar to SLT's reduction of 3.28 ± 0.40 mmHg[5].

3. Medication Use:

- Both groups showed approximately 50% reduction in medication use at 12 months[5].

- Over half of the patients were medication-free at 12 months (61.7% for DSLT, 59.5% for SLT)[5].

4. Safety:

- No safety concerns were identified for either treatment[5].

The study concluded that DSLT is safe and effective in providing a meaningful IOP reduction sustained up to 12 months, comparable to SLT[5]. This suggests that DSLT could serve as an alternative to SLT in glaucoma care, potentially increasing the availability of laser trabeculoplasty as a first-line treatment option.

  • DescCitations:

    [1] https://discovery.ucl.ac.uk/id/eprint/10135837/1/Gazzard_Direct%20selective%20laser%20trabeculoplasty%20in%20open%20angle%20glaucoma%20study%20design-%20a%20multicentre,%20randomised,%20controlled,%20investigator-masked%20trial%20(GLAUrious)_AOP.pdf

    [2] https://www.glaucomaphysician.net/issues/2024/november/an-update-on-slt-clinical-trials/

    [3] https://pubmed.ncbi.nlm.nih.gov/34433548/

    [4] https://www.tctmd.com/news/glorious-neither-exenatide-nor-restrictive-oxygenation-boost-cv-surgery-outcomes

    [5] https://iovs.arvojournals.org/article.aspx?articleid=2789245

    [6] https://www.isrctn.com/ISRCTN14033075?q=glaurious&offset=1&totalResults=1&page=1&pageSize=10&searchType=basic-search

    [7] https://www.isrctn.com/ISRCTN96782911

    [8] https://www.researchgate.net/publication/354139364_Direct_selective_laser_trabeculoplasty_in_open_angle_glaucoma_study_design_a_multicentre_randomised_controlled_investigator-masked_trial_GLAUriousription text goes here

Video Explainer

Click on the video for a conceptual explanation

In 2019, significant data highlighted the effectiveness of selective laser trabeculoplasty (SLT) as a primary treatment for mild glaucoma and ocular hypertension. The LIGHT trial demonstrated that SLT was successful in 75% of cases, reducing the need for surgery and slowing visual field progression. These outcomes suggest SLT could replace topical therapies, which have adverse effects like red eyes and dry eye disease.

From a practical standpoint, all patients with primary open-angle glaucoma can consider it.

Current laser systems can be uncomfortable and occasionally awkward as SLT involves a gonioscopy contact lens application which some patients find , and it can result in blurred vision and discomfort for a short time afterwards.

Additionally, the procedure requires laser energy to cross the anterior chamber in the front of the eye to reach the trabecular meshwork (TM), potentially affecting the cornea and causing intraocular inflammation or pressure spikes.

To address these issues, Belkin Vision has developed a new laser platform called the Eagle. This direct SLT (DSLT) laser idelivers energy directly to the TM through the peripheral cornea and limbus, eliminating the need for a gonioscopic contact lens.

The Eagle administers pulses in a circular pattern, enhancing treatment ease through automation that standardises and predicts outcomes. The Eagle allows treatments while patients are seated or standing, accommodating various body types. Eye-tracking technology ensures precision in targeting the treatment area.

The Glaurious study* concluded that DSLT is safe and effective in providing a meaningful IOP reduction sustained up to 12 months, comparable to SLT

This suggests that DSLT can serve as an more convenient alternative to SLT in glaucoma care, potentially increasing the availability of laser trabeculoplasty as a first-line treatment option