SLT More Commonly Being Used As First-Line Glaucoma Therapy

Selective laser trabeculoplasty and prostaglandin analogues are the top first line methods for managing glaucoma in Ontario.

Selective laser trabeculoplasty (SLT) has become the most common first-line glaucoma therapy (FLGT) for Ontario residents 66 years of age or older, and prostaglandin analogue (PGAs) remain the most frequently prescribed glaucoma medication, according to findings published in the Canadian Ophthalmological Society.

Researchers conducted a retrospective population-based study to evaluate the long-term evolution of FLGT initiated by ophthalmologists and optometrists. Validated provincial health care databases were used for analysis, and 194,759 Ontario residents who received FLGT between 2007 and 2018 were included. Rates of first-line medical treatment (PGA, beta-blocker, alpha-2-agonist, and carbonic anhydrase inhibitor) and SLT were calculated. 

The study shows that 60.2% of enrolled participants who received FLGT initially received medical treatment, 39.8% underwent SLT, and approximately 94.6% were treated by ophthalmologists. The most common therapy prior to 2010 was PGA therapy, and subsequently, SLT has become the most common FLGT, the researchers explain. SLT exceeded the total of all medications as FLGT by 2015. Between 2011 and 2018, the annual rate of initial medication prescriptions by optometrists rose to 101.4 per 100,000 population. PGA and non-PGA prescription rates by ophthalmologists were 2.6 and 5.0 times higher, respectively, than prescription rates by ophthalmologists in 2018.

Our appraisal of temporal trends in FLGT may help foster efficient models of care to improve outcomes for patients with glaucoma.

While ophthalmologists continue to provide the majority of FLGT, optometrists have provided a small but growing fraction of FLGTs following the introduction of glaucoma medication prescribing privileges. 

“Our appraisal of temporal trends in FLGT may help foster efficient models of care to improve outcomes for patients with glaucoma,” according to the researchers..

Study limitations include the researchers’ lack of knowledge of detailed baseline patient characteristics or risk factors; and possible confounding due to information about comorbid medical conditions or allergies.


Doliszny K, Quinn MP, El-Defrawy SR, et al. Evolution of first-line glaucoma therapy, 2007-2018: a population-based analysis. Can J Ophthalmol. Published online December 6, 2022. doi:10.1016/j.jcjo.2022.22.008