Laser in Glaucoma and Ocular Hypertension (LiGHT)

Lead investigator Mr Gus Gazzard

Consultant Ophthalmic Surgeon at Moorfields Eye Hospital and reader in ophthalmology at UCL Institute of Ophthalmology

Glaucoma can be lifelong condition caused by an increase in eye pressure leading to damage to the optic nerve that sends messages from the eye to the brain.  The high pressure is caused by fluid build-up because channels in the eye become blocked and don’t allow the fluid to drain away efficiently.  While a rare congenital form occurs in very young children, glaucoma is common in adults and the majority of newly diagnosed cases are in people over the age of 40 to 45.  It is often unclear exactly what the causes are however some risk factors include the aging process and a family history. 

Current treatments

Surgery and laser treatments all aim to either open up the drainage channels by widening or removing blockages to allow the fluid in the eye to drain away more effectively and thus help reduce the damaging pressure increase.  Eye drops all work by reducing the pressure in the eye however they can cause irritation and cause unpleasant side effects which may not be suitable for long term use.

The LiGHT Trial

The LiGHT trial is a randomised controlled trial which aims to compare the quality of life of patients who start treatment with medicines (eye-drops) to those who are first treated with selective laser trabeculoplasty (SLT) and then receive drops later as necessary.  The purpose is to find out if initial treatment with SLT is superior to current standard initial treatments with topical medication alone in terms of quality of life for patients, tolerance of treatment and the subsequent need for topical medication. 

The study has recruited over 700 newly diagnosed patients who had received no previous treatment for glaucoma or ocular hypertension.  The participants have been asked to fill in quality of life questionnaires and their ocular pressure and eye drop use has been monitored regularly for the three year duration of the trial.  All the participants will have completed the three year monitoring by late 2017 so the initial results are expected in 2018.  Recommendations from the trial will provide clinicians with important information when advising patients diagnosed with glaucoma or ocular hypertension on their initial treatment options and long term care.

Taking this research to new levels

Mr Gus Gazzard who is leading the research team has successfully secured additional funding to extend the monitoring period for a further three years.  This will allow the researchers to monitor quality of life over a longer period which is more relevant for this condition and will ensure more robust data.  Extending the project will also strengthen the expertise within the glaucoma research community and generate collaborations to take glaucoma research further.  Already two new studies have started as a result of the LiGHT Trial they are the China LiGHT Trial and LiGHT Bio Bank.

Not everyone responds in the same way to different glaucoma treatments so as part of the LiGHT project Mr Gazzard and his team have also collected the DNA from some participants taking part in the trial.  Mr Gazzard said “We hope that this will contribute to helping us define the genes that determine why some people respond to certain treatments and others do not”.   The data collected as part of this trial will help underpin larger genetics studies which have the potential to inform clinicians and patients in the future of the best type of treatment specific to the patient.

Global reach and collaborations

Moorfield Eye Hospital has a global reputation for being at the forefront of eye health and research. Collaboration with another leading research centre at the Zhongshan Ophthalmic Centre in Guangzhou (a city to the north of Hong Kong) has led to The China LiGHT Trial.  This is a ‘sister trial’ to that being carried out in the UK so the results from each can inform each other.  The China LiGHT study also benefits from being located at a centre which receives approximately 25,000 new referrals for glaucoma each year. Mr Gazzard said “Our collaboration with the Zhongshan Ophthalmology Centre in China will be a tremendous contribution to our understanding of the differences in responses to glaucoma treatment.”

Find out more by following the links to:

LiGHT Trial project website https://www.ucl.ac.uk/ioo/research/light-study

Moorfields Eye Hospital Glaucoma Service http://www.moorfields.nhs.uk/service/glaucoma