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Aim: To characterise clinical outcomes following selective laser trabeculoplasty (SLT) in eyes of Afro-Caribbean patients with open-angle glaucoma (OAG) at high risk for progression., Methods: In a prospective interventional case series, patients meeting high-risk criteria (advanced disease, unilateral glaucoma blindness, inadequate intraocular pressure (IOP) on > 2 medications, recent progression on medications, inability to administer, afford or tolerate medications) underwent bilateral 360° SLT and managed based on their subsequent clinical course. Patient-specific indications for SLT-IOP reduction (IOP group) or reduced reliance on medical therapy (MED group)-were recorded before treatment. IOP and medication use were recorded every 3-4 months through up to 24 months of follow-up. Outcomes were analysed separately in the IOP and MED groups., Results: Among 33 right eyes (left eye outcomes were similar) in the IOP group, mean (SD) IOP was significantly reduced from 21.7 (7.5) mm Hg to 16.2-17.1 mm Hg over follow-up (p < 0.0177); medication use remained unchanged (p>0.05) at all time points. Among 36 right eyes in the MED group, mean medication use was 1.9 (0.9) at baseline and ranged from 1.2 to 1.4 medications per eye through follow-up (p < 0.0033), and mean IOP was significantly reduced at months 1-6 (to 13.1 (2.3) mm Hg, p=0.0013), months 13-18 (to 14.3 (2.8), p=0.0136) and unchanged at other time points. No vision-threatening adverse events occurred., Conclusions: Afro-Caribbean patients with OAG at risk for progression can achieve clinically and statistically significant reductions in IOP or medications through up to 24 months following a single 360° SLT treatment., Trial Registration Number: NCT02375009., Competing Interests: Competing interests: TR: Personal fees from Aerie, Allergan, Asclepix, iStar Medical, New World Medical, Nicox, Notal, Ocular Therapeutix and Sight Sciences. GKB: Personal fees from New World Medical., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To characterize long-term clinical outcomes of monotherapy selective laser trabeculoplasty (SLT) in Afro-Caribbean patients with open-angle glaucoma (OAG)., Design: This was a post hoc analysis of nearly 8 years (median, 3.2; interquartile range, 2.1-7.1) of pooled data from the West Indies Glaucoma Laser Study and its preliminary study., Methods: Setting: Three eye care practices in Saint Lucia and Dominica., Participants: Afro-Caribbean adults with mild-moderate OAG treated with ≤2 medications (61 in preliminary study, 72 in West Indies Glaucoma Laser Study)., Intervention: Participants underwent medication washout, baseline intraocular pressure (IOP) determination, and bilateral 360-degree SLT. Participants were followed for up to 94 months. Repeat SLT was performed according to prespecified criteria., Main Outcome Measures: The primary outcome was mean IOP reduction from baseline. The secondary outcome was medication-free survival with SLT repeated as needed., Results: The pooled data set included 265 eyes of 133 Afro-Caribbean participants. The mean (standard deviation) baseline IOP was 21.2 (3.4) and 21.2 (3.9) mmHg in right and left eyes, respectively. Over 8 years, the mean IOP ranged from 12.8 to 15.7 mm Hg and from 13.1 to 15.8 mm Hg, respectively (P < .0001 for every comparison with baseline). The median medication-free survival time for initial SLT was 85.4 months in both eyes. The 94-month medication-free survival of SLT repeated as needed was 71.2% and 71.7%, respectively., Conclusions: Monotherapy SLT, repeated as needed, safely provides significant IOP reductions in most Afro-Caribbean adults with primary OAG through nearly 8 years of follow-up and has significant potential to delay or prevent glaucoma-related vision loss in black patients in low-resource regions., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Precis: In the absence of prophylactic anti-inflammatory therapy, anterior chamber inflammation (characterized by cells and less commonly flare) is minimal and transient after selective laser trabeculoplasty in Afro-Caribbean glaucoma patients., Purpose: The purpose of this study was to characterize the prevalence, severity, and duration of anterior chamber inflammation (cells and flare) following selective laser trabeculoplasty (SLT) in Afro-Caribbean eyes with primary open-angle glaucoma (POAG)., Methods: In total 144 eyes of 72 POAG patients underwent first-time 360-degree SLT treatment following washout of all topical medications in the prospective West Indies Glaucoma Laser Study. No anti-inflammatory therapy was used post-SLT. Anterior chamber cells and flare were characterized pre-SLT after medication washout, and 1 week, 6 weeks, and 3, 6, 9 and 12 months post-SLT using the standardized methodology described by the Society for Uveitis Nomenclature (SUN) in which cells and flare are each graded on a scale of 0-4+ using specific slit-lamp settings., Results: Mean cell scores in both right and left eyes rose significantly (P<0.0001) from baseline to week 1 after SLT before returning to baseline values at all subsequent time points. Mean flare scores in right eyes (P=0.0185) but not left eyes (P=0.1816) rose from baseline to week 1 after SLT before returning to baseline values at all subsequent time points. Cells appeared in 40.3% of eyes and flare appeared in 9.7% of eyes after SLT. One subject developed bilateral symptomatic anterior iritis one day postoperatively and reported a previously undisclosed history of recurrent iritis; the iritis resolved with topical steroid therapy., Conclusions: SLT in Afro-Caribbean people with POAG is associated with mild, short-lived and self-limited anterior chamber inflammation. Routine anti-inflammatory therapy to suppress posttreatment inflammation after SLT is unnecessary in this population.

Purpose: To identify factors associated with intraocular pressure (IOP) reduction following selective laser trabeculoplasty (SLT) in Afro-Caribbean people with primary open-angle glaucoma (POAG)., Design: This was a prospective stepped-wedge study., Methods: Data were drawn from 72 Afro-Caribbean subjects with POAG participating in the ongoing West Indies Glaucoma Laser Study. Multivariable mixed-model analysis was utilized to develop a predictive model for percent IOP reduction 12 months following SLT. Putative factors (age, sex, site, baseline IOP, prior use of prostaglandin therapy, number of prewashout IOP-lowering medications, central corneal thickness, severity of glaucoma, duration of follow-up, and signs of acute postoperative inflammation) were evaluated in bivariate analysis. Factors significant at P≤0.2 were included in the final model. Right and left eye data were modeled separately., Results: At month 12 following SLT, mean IOP reductions in the West Indies Glaucoma Laser Study were 6.2 to 6.5 mm Hg (29.7% to 31.0%) in right and left eyes. The only factor significant in both eyes (P=0.0005 in right eyes and P<0.0001 in left eyes) was time, with IOP reductions being greatest at month 3 and declining slightly over time through month 12. Vertical cup-disc ratio (P=0.006) and prior prostaglandin therapy (P=0.004) were significant only in right eyes, and central corneal thickness (P=0.014) was significant only in left eyes. Factors significant only unilaterally did not approach significance in fellow eyes, suggesting the possibility that these represent type 1 errors. Site (St. Lucia vs. Dominica) was not a significant factor, establishing generalizability of these treatment outcomes to a broader population of African-derived people., Conclusions: This analysis did not identify any subject-specific factors consistently predictive of therapeutic response to SLT. Of note, no factors predicted a suboptimal response. These findings favorably position SLT for broad application as primary therapy in African-derived people with POAG.