Oculoplastic and ocular surface morbidity after medication-first therapy versus selective laser trabeculoplasty: A 6-year analysis of the LiGHT trial

PurposeLong-term topical glaucoma medication may contribute to ocular surface and oculoplastic morbidity. This study compared ocular morbidity after medication-first versus selective laser trabeculoplasty (SLT)-first therapy over six years in the LiGHT Trial.MethodsThis post hoc secondary analysis used adverse-event and quality-of-life data from the 6-year LiGHT Trial extension cohort. Patients were grouped by randomised strategy (SLT-first or medication-first); the SLT-first arm was subdivided into those who later received medication and those who remained medication-free. Adverse events were categorised as ocular surface disease, oculoplastic changes, or surgical intervention, compared by logistic regression adjusted for age and sex. Quality-of-life change was assessed with mixed-effects models.ResultsA total of 633 patients were included: 313 SLT-first and 320 medication-first. Ocular surface disease was more frequent in the medication-first arm than in the SLT-first arm (65.3% vs 51.8%; OR 1.75, 95% CI 1.27-2.41; p = 0.001), as were oculoplastic changes (33.4% vs 17.9%; OR 2.30, 95% CI 1.59-3.35; p < 0.001). Surgical intervention rates were similar. Within the SLT-first arm, patients who later required medication had higher morbidity than those who remained medication-free.ConclusionsMedication-first therapy was associated with greater ocular surface and oculoplastic morbidity than SLT-first therapy. Findings should be interpreted as treatment-strategy effects rather than isolated prostaglandin-specific effects.