Visual Field Outcomes from the Multicenter, Randomized Controlled Laser in Glaucoma and Ocular Hypertension Trial (LiGHT)

Objective To compare visual field outcomes of ocular hypertensive and glaucoma patients treated with Medicine-1st against those treated with selective laser trabeculoplasty (SLT, Laser-1st). Design Secondary analysis of patients from Laser in Glaucoma and Ocular Hypertension (LiGHT), a multicentre randomised controlled trial. Participants and controls 344 patients (588 eyes) treated with Medicine-1st, 344 patients (590 eyes) treated with Laser-1st. 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/y) or moderate (< -0.5 dB/y) 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 Medicine-1st group compared with the Laser-1st group (26.2% vs. 16.9%; Risk Ratio, RR = 1.55 [1.23, 1.93], P < 0.001).A similar pattern was observed for pointwise rates (Medicine-1st 26.1% vs. Laser-1st 19.0%, RR = 1.37 [1.33, 1.42], P < 0.001). A greater proportion of pointwise PD rates were categorised as moderate or fast in the Medicine-1st group (Medicine-1st 11.5% vs. Laser-1st 8.3%, RR = 1.39 [1.32, 1.46], P < 0.001). There was no statistical difference in the proportion of eyes that underwent moderate or fast PD progression (Medicine-1st 9.9% vs. Laser-1st 7.1%, RR = 1.39 [0.95, 2.03], P = 0.0928). Conclusion A slightly larger proportion of ocular hypertensive and glaucoma patients treated with Medicine-1st underwent rapid VF progression compared with those treated with Laser-1st.