The LiGHT trial - improving treatments for glaucoma
3 July 2022
Glaucoma is an eye condition, in which the damage to the optic nerve leads to sight loss. This is usually caused by the pressure inside the eye rising too high. A revolutionary clinical trial, the LiGHT trial, has explored new ways of treating glaucoma patients. We’re investing in an extension of this trial to maximise outcomes.
If left untreated, glaucoma can lead to vision loss. The only known way to manage glaucoma is to lower the pressure within the eye. This can be done using eye drops, laser treatment or surgery. These treatments may not be as effective on some patients as others and eye drops can cause irritation.
The LiGHT trial (Laser in Glaucoma and Ocular Hypertension Trial) has brought about changes in clinical guidelines on treatments for glaucoma patients.
What is glaucoma?
Glaucoma is an eye condition where damage to the optic nerve causes sight loss. It is usually caused by the pressure inside your eye rising too high.
Your eye is full of fluid, which helps it to keep its shape and function properly. If too much fluid builds up inside the eye, the pressure rises and squeezes the optic nerve at the back of the eye.
This can cause damage to your optic nerve - a bundle of over a million nerve fibres that carry signals between your eye and your brain.
Pressure might build up in the eye when:
- fluid is stopped from draining away
- extra fluid is produced after an eye injury or infection - this is called ‘secondary glaucoma’
- there is an abnormality in the shape of the eye in children - this is called ‘congenital glaucoma’
Glaucoma tends to develop slowly over many years. As there is currently no cure for glaucoma, treatment focuses on early diagnosis, careful monitoring and regular treatment to help prevent further sight loss.
9 in 10
diagnosed with glaucoma today who get the treatment they need will retain useful sight for the rest of their lives
It is not currently possible to repair the optic nerve once it has been damaged, so any vision lost to glaucoma cannot be recovered. If left untreated, glaucoma can lead to blindness.
There are usually no symptoms of a rising pressure in the eye until sight loss occurs, so regular eye tests are the best way to help spot the condition early.
people over age 40 in the UK have high eye pressure
people have chronic open-angle glaucoma
Trial outcomes changing practice
The LiGHT trial is led by Professor Gus Gazzard, director of the glaucoma service at Moorfields Eye Hospital, and professor in ophthalmology, glaucoma studies at UCL London.
The trial compared laser treatment to eye drops in newly diagnosed patients. This pivotal study led to the change in the National Institute for Health and Care Excellence (NICE) guidelines.
NICE now recommends selective laser trabeculoplasty (SLT) as the first line of treatment for newly diagnosed ocular hypertension and open-angle glaucoma patients.
Maximising impact of the LiGHT trial
Glaucoma is a chronic disease. Monitoring participants from the LiGHT trial for an extended period of time will help add great depth and breadth to the research.
We’ve funded an additional three years of extended monitoring of trial participants, which has provided more data and information on the use of laser treatment to control ocular pressure.
The charity also funded a blood biobank, a resource to collect and store blood samples from participants from the LiGHT trial. This will help further research into the genetics of glaucoma and how it affects disease progression and responses to treatments.
Looking beyond the UK, the charity has funded Professor Gazzard to lead a sister LiGHT trial in China where the three year data is now being analysed.
We’re very pleased to have this long-term data on SLT effectiveness in controlling glaucoma and ocular hypertension. It will be used by clinicians to support treatment decisions. It shows the advantages of SLT over eye drops for long term care with reduced sight deterioration and less likelihood of surgery.
Professor Gus Gazzard
Optometrists lead the way
Moorfields Eye Charity also funded a study looking at attitudes towards optometrists delivering SLT treatment for glaucoma patients.
The researchers gathered the views of ophthalmologists, optometrists and patients, and the findings were published and presented at medical conferences. This study supports delivery of SLT by an optometrist provided it is within an NHS clinical setting and the professional receives suitable training.
Due to the high number of optometrists involved, we’re in a perfect position to deliver this service and care efficiently. With robust training protocols and governance - there is the potential for a shift in service delivery.
Dr Evgenia Konstantakopoulou, Research optometrist, Moorfields Eye Hospital
Moorfields Eye Charity is facilitating these studies with a number of other organisations, including the National Institute for Health Research Health and Technology Assessment Programme (NIHR HTA) and UCL.
The charity is proud to support research which is having widespread impact on the treatment of glaucoma.
Robert Dufton, Chief executive of Moorfields Eye Charity