title: Racial Differences in Selective Laser Trabeculoplasty Efficacy.
abstract: OBJECTIVE
  Sub-Saharan Africa has a population of 1 billion, with one ophthalmologist per million people. Basic ophthalmic support services are virtually absent for all but a few urban populations. Minimally invasive laser treatment may help. This study reports our initial experience using selective laser trabeculoplasty (SLT) in a mixed-racial population of adult glaucoma patients in Durban, South Africa.
  
  
  METHODS
  Institution Review Board approved the 5-year chart review.
  
  
  METHODS
  Consecutive glaucomatous adults underwent SLT (Lumenis Selecta) on one or both eyes applying 360° treatment of 120 to 140 closely spaced burns (400 urn spot size for 3 ns; range 1.1-1.4 mJ). Significance of change in intraocuar pressure (IOP) from baseline at 1, 3, 6, and 12 months was assessed by two-tailed paired t-test.
  
  
  RESULTS
  Among 148 eyes of 84 patients (60 African, 21 Indian, 3 Caucasian), 69 had already undergone glaucoma therapy, and 15 untreated(de novo).Among all eyes, mean IOP was reduced by >32% with mean IOP < 15 mm Hg from baseline at all four study intervals (p < 0.0001). A 20% reduction in IOP was sustained at 12 months in 90% of African eyes but in only 50% of Indian eyes.
  
  
  CONCLUSIONS
  Selective laser trabeculoplasty was effective in producing clinically significant IOP reduction among South African adults with or without prior medical or surgical anti-glaucoma therapy. Socioeconomically comparable individuals of Indian ancestry showed good therapeutic responses, but significantly less efficacious than those observed among Black subjects. Programs to provide first-line SLT management of glaucoma in Africa, where 90% of patients are unable to sustain prescribed medical therapy, appear to be a very appropriate option.
  Goosen E, Coleman K, Visser L, Sponsel WE. Racial Differences in Selective Laser Trabeculoplasty Efficacy. J Curr Glaucoma Pract 2017;11(1):22-27.
authors.affiliation: Surgeon, Department of Ophthalmology, Port Elizabeth, Eastern Cape South Africa.
authors.forename: Emil
authors.initials: E
authors.lastname: Goosen
authors.affiliation: Consultant, Department of Ophthalmology, Blackrock Clinic, Dublin, Ireland.
authors.forename: Kate
authors.initials: K
authors.lastname: Coleman
authors.affiliation: Head, Department of Ophthalmology, Nelson Mandela Medical School, Durban, South Africa.
authors.forename: Linda
authors.initials: L
authors.lastname: Visser
authors.affiliation: Professor, Department of Vision Sciences, University of the Incarnate Word, San Antonio, Texas, USA; Department of Biomedical Engineering, University of Texas, San Antonio, Texas, USA.
authors.forename: William E
authors.initials: WE
authors.lastname: Sponsel
keywords: Ethnicity; Glaucoma; Intraocular pressure; Selective laser trabeculoplasty.