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Selective Laser Trabeculoplasty (SLT) versus Topical
Medications in Primary Open-Angle Glaucoma: A Meta-
analysis of Intraocular Pressure (IOP) Reduction and Visual Field
Progression with Subgroup Analysis by Follow-up Durations
Natchanon Champreeda*
Faculty of Medicine, Chulalongkorn University
*Corresponding Author E-mail: natchanon.c39@gmail.com
Background: Abstract
Primary open-angle glaucoma (POAG) is a leading cause of irreversible blindness
worldwide, primarily managed by lowering intraocular pressure (IOP). Selective laser
trabeculoplasty (SLT) and topical medications are first-line treatments, yet their long-term
efficacy and safety remain debated.
Methods: A systematic search of PubMed, MEDLINE, and Scopus (2019–2024) was conducted to
compare SLT and topical medications in POAG management. Outcomes included IOP
reduction (≥3-month follow-up), proportion of patients achieving target IOP (≤18 mmHg or
≥20% reduction), visual field progression, and ocular adverse events. Subgroup analyses
were performed based on follow-up duration.
Results: Six studies (4 RCTs, 2 observational; 1,624 patients) compared SLT with topical
medications for IOP control. No significant difference in IOP reduction was observed
between groups (Mean Difference [MD]: -0.25 [−0.88, 0.38]; p = 0.40), with consistent
results across follow-up durations (p = 0.70; I² = 0%). At 24 months, medications showed a
higher proportion of patients achieving target IOP (RR: 0.75 [0.59, 0.95]; p < 0.00001), while
SLT showed superiority at ≥36 months (Risk Ratio [RR]: 1.26 [1.18, 1.35]; p < 0.00001).
Visual field progression did not differ significantly (MD: -0.11 [−0.23, 0.01]; p = 0.06), nor
did adverse ocular events (RR: 0.90 [0.72, 1.13]; p = 0.29). Overall, SLT and medications
offer comparable efficacy and safety, with SLT showing long-term advantages in IOP
control.
Conclusion: SLT and topical medications offer comparable efficacy in reducing IOP and slowing visual
field progression in POAG, with no significant difference in ocular adverse events. Topical
medications show higher response rates in the medium term, but long-term effectiveness
may decline due to adherence issues. SLT offers sustained IOP control, potentially reducing
dependence on daily medications. Further studies are needed to assess patient-specific
factors, long-term cost-effectiveness, and quality-of-life outcomes.
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