Comparative outcomes of selective laser trabeculoplasty delivered by optometrists compared with ophthalmologists: a UK-based multicentre observational study

• Published in: BMJ open ophthalmology 2024-10, Vol.9 (1), p.e001870
• Main Authors: Lee, Chan Ning, Delaney, Alexander, Richardson, Jay A L, Freeman, Graham, Gunn, Patrick J G, Harthan, Stephen, Dubois, Vincent, Yau, Kenneth, Hemmerdinger, Christopher, Harper, Robert, Vallabh, Neeru A
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Female; Glaucoma; Glaucoma, Open-Angle - surgery; Hospitals; Humans; Hypertension; Intraocular pressure; Intraocular Pressure - physiology; Laser Therapy - methods; Lasers; Male; Medical personnel; Middle Aged; Ocular Hypertension; Ophthalmologists; Optometrists; Original Research; Patients; Retrospective Studies; Surgery; Survival analysis; Trabeculectomy - methods; Treatment Lasers; Treatment Outcome; United Kingdom; Visual Acuity - physiology
• ISSN: 2397-3269; 2397-3269
• DOI: 10.1136/bmjophth-2024-001870

BackgroundSelective laser trabeculoplasty (SLT), a National Institute for Care and Health Excellence recommended first-line treatment for open-angle glaucoma and ocular hypertension, is increasingly delivered by optometrists. This retrospective multicentre observational study evaluates real-world outcomes of SLT comparing optometrist-treated to ophthalmologist-treated eyes.MethodsAdults aged ≥40 years receiving first SLT treatment at three UK hospital eye units (Aintree, Manchester, Macclesfield) between 1 August 2018 and 1 August 2021 were analysed using anonymised local audit data. Outcomes included intraocular pressure (IOP), visual acuity (VA), drop burden, complications including post-SLT IOP spikes, and composite treatment failures including repeat laser or glaucoma surgery, evaluated at 6-monthly intervals up to 24 months. Groups were compared with parametric and non-parametric tests, accounting for intereye correlation, and Kaplan-Meier survival analysis using composite treatment failure endpoints was conducted.Results207 eyes (131 patients) were analysed, 84 (56 patients) optometrist-treated eyes compared with 123 ophthalmologist-treated eyes (75 patients). No statistically significant differences (p>0.05) were found in change in VA, IOP or glaucoma drops from pre-SLT baseline between optometrist and ophthalmologist-treated eyes, at all time points. More cataracts were detected in optometrist-treated eyes, however, this did not affect differences in VA or cataract surgery frequency. More optometrist-treated eyes underwent glaucoma surgery, however, ophthalmologist-treated eyes had higher drop burden and chance of composite treatment failure up to month 18.ConclusionOutcomes of SLT treatment by optometrists and ophthalmologists are comparable up to 24 months post-treatment. Ophthalmologist-treated eyes may have had more aggressive eye-drop treatment, preventing the need for surgery.