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Controversies
February 1998

Initial Treatment for Open-Angle Glaucoma—Medical, Laser, or Surgical?Laser Trabeculoplasty Is the Treatment of Choice for Chronic Open-Angle Glaucoma

Arch Ophthalmol. 1998;116(2):240-241. doi:10.1001/archopht.116.2.240

LASER trabeculoplasty is the best initial treatment for most patients with chronic open-angle glaucoma. It is the preferred choice because it is as efficacious as medical treatment for newly diagnosed glaucoma, and is certainly safer than either medical or surgical treatment.

The criterion standard for the comparison of therapeutic interventions is the randomized clinical trial. The evidence supporting the efficacy of laser trabeculoplasty comes from the only large randomized clinical trial in the United States that has compared 2 different treatment modalities for newly diagnosed glaucoma. The Glaucoma Laser Trial randomized the eyes of 271 patients with newly diagnosed glaucoma so that one eye received topical medications and the other received laser trabeculoplasty. The Glaucoma Laser Trial Follow-up Study1 found that during the course of up to 9 years, the eyes that received laser trabeculoplasty first had intraocular pressures averaging 1.2 mm Hg lower and slightly better visual fields than the eyes that received medications first.

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