Part 2 – SLT versus eye drops Direct comparison: efficacy, adherence, and quality of life

Glaucoma is a chronic and progressive disease, and reduction of intraocular pressure remains the only confirmed strategy for slowing the progression of optic nerve damage. Traditionally, initial treatment is based on the continuous use of hypotensive eye drops; however, this approach relies heavily on patient compliance and is associated with adverse effects, namely on the ocular surface, and thus, ultimately impairing the quality of life. Considering this background, selective laser trabeculoplasty has emerged as an effective and safe alternative and does not require daily medication use. Current evidence, especially from the LiGHT multicenter randomized clinical trial, indicates that selective laser trabeculoplasty has a sustained hypotensive efficacy comparable to treatment with medications while being associated with less treatment intensification, less disease progression, and less demand for filtering surgery during follow-up. Although the overall quality of life scores are similar between the two strategies, initiating treatment with selective laser trabeculoplasty is associated with a lower treatment burden, greater autonomy, and greater patient satisfaction. Despite the solid scientific basis, the use of selective laser trabeculoplasty is limited due to challenges in training of ophthalmologists, doctor–patient communication, and availability of equipment. Thus, the choice between selective laser trabeculoplasty and eye drops must address efficacy, compliance, and quality of life using an individualized and patient-centered approach.