The COAST trial seeks to compare the efficacy and safety of standard versus low energy primary SLT in eyes with mild-moderate open-angle glaucoma or high-risk ocular hypertension and to determine the optimal interval and energy for repeat SLT.
This randomized clinical trial will enroll approximately 635 treatment-naïve patients at up to 20 sites. Patients will receive either standard or low energy SLT, and 12-month success rates will be compared. At 12 months, patients will undergo repeat SLT either annually at low energy or as needed at initially assigned energy, and 48-month success rates will be compared.
If we validate an SLT treatment strategy that extends the duration of medication-free disease control, we move one step closer to the possibility of a drop-free lifetime for our patients. Delaying the need for medications by 3, or 5, or 7 years not only confers all the benefits of medication-freedom during this period—which will be all that many patients would need in their lifetimes—it also allows time for the development of safer and more effective drugs dosed infrequently via sustained-release delivery systems, as well as better surgical options, for patients whose lifespans exceed SLT responsiveness.
Thus, a new treatment paradigm consisting of SLT, then sustained-release medications, then surgery, could offer the majority of glaucoma patients the very real possibility of a drop-free lifetime of therapy.