Significant change as NICE guidelines recommend use of laser treatment for glaucoma

The National Institute for Health and Care Excellence (NICE) has issued new guidelines for the treatment of thousands of patients with glaucoma in England. For the first time, it is recommending the use of SLT (selective laser trabeculoplasty) as the primary treatment option to lower internal eye pressure (intraocular pressure), replacing the previous standard treatment of eye drops. Previously, SLT was advised as a second choice, and was generally only considered if there was issue with the patient taking drops.

The change was made in large part due to the findings of the LiGHT Study, led by Gus Gazzard, and ophthalmology consultant at Moorfields Eye Hospital and professor of Glaucoma Studies at the UCL Institute of Ophthalmology.

It is very rare for trials to have such a profound impact on clinical guidelines. The fact that results from the LiGHT trial have influenced not only NICE, but many other medical bodies around the world, shows how robust the study is considered to be. Other bodes that have updated their guidelines as a result of the LiGHT Study include the American Academy of Ophthalmology’s Preferred Practice Pattern and the European Glaucoma Society.

The LiGHT study compared the current standard treatment using medicine (daily eye drops) with laser surgery (SLT) followed by drops where necessary. The LiGHT Study, which stands for ‘Laser in Glaucoma and Ocular Hypertension’, was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and began in 2012.

Glaucoma is the largest cause of irreversible blindness in the UK, affecting around 2.5% of people aged over 40, and around 9% of people aged over 80^[1], with a higher prevalence among people of black African and Caribbean descent. It comes in various forms, the most common being primary open angle glaucoma. In the previous NICE guidelines, eye drops were generally recommended as the first-line treatment to lower intraocular pressure, while SLT was rarely used.

The LiGHT Trial measured a number of factors, including patients’ quality of life and ongoing visual acuity, and was able to show conclusively that laser treatment was not only more effective in terms of visual outcomes, but also safer, and more cost effective in the long-term due to the reduced need for drops and hospital visits.

Eye drops are associated with a number of problems, including high cost, lack of patient compliance and they can have side effects. This new NICE guidelines (issued in January 2022) is likely to have a major positive impact on the lives of patients, as well as on the provision of glaucoma services across the NHS.

Commenting on the new NICE guidelines, Professor Gus Gazzard said: “It’s unusual for a trial such as the LiGHT Study to have such a profound impact, and fantastic that NICE have considered our results to be so robust that they have relied on them for a major shift in guidelines. It’s an excellent example of how bench-to-bedside research, funded by the NIHR, can make a real difference to patients’ lives.”