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
King's Ophthalmology Research Unit, King's College Hospital, London, UK.
Faculty of Life Sciences and Medicine, King's College London, London, UK.
BMJ Open Ophthalmol. 2024 Oct 2;9(1):e001870. doi: 10.1136/bmjophth-2024-001870.
Selective 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.
Adults 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.
207 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.
Outcomes 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.
选择性激光小梁成形术（SLT）是英国国家卫生与临床优化研究所推荐的开角型青光眼和高眼压症的一线治疗方法，越来越多的验光师开始实施该手术。这项回顾性多中心观察性研究评估了SLT的实际治疗效果，比较了验光师治疗的眼睛和眼科医生治疗的眼睛。
使用匿名的本地审计数据，对2018年8月1日至2021年8月1日期间在英国三个医院眼科单位（安特里、曼彻斯特、麦克尔斯菲尔德）接受首次SLT治疗的≥40岁成年人进行分析。观察指标包括眼压（IOP）、视力（VA）、眼药水使用负担、并发症（包括SLT术后眼压峰值）以及综合治疗失败情况（包括重复激光治疗或青光眼手术），每6个月评估一次，最长评估24个月。采用参数检验和非参数检验对两组进行比较，并考虑眼内相关性，同时使用综合治疗失败终点进行Kaplan-Meier生存分析。
共分析了207只眼睛（131例患者），其中验光师治疗的眼睛有84只（56例患者），眼科医生治疗的眼睛有123只（75例患者）。在所有时间点，验光师治疗的眼睛和眼科医生治疗的眼睛在SLT术前基线至术后VA、IOP或青光眼眼药水使用量的变化方面，均未发现统计学显著差异（p>0.05）。然而，在验光师治疗的眼睛中检测到更多白内障，但这并未影响VA差异或白内障手术频率。更多验光师治疗的眼睛接受了青光眼手术，不过，在18个月前，眼科医生治疗 的眼睛眼药水使用负担更高，综合治疗失败的可能性也更大。
验光师和眼科医生进行SLT治疗的效果在治疗后24个月内具有可比性。眼科医生治疗的眼睛可能接受了更积极的眼药水治疗，从而避免了手术的需要。
