Clinical UM Guideline

This document addresses the use of laser trabeculoplasty and laser peripheral iridotomy.

Note: For information about other proposed treatments of glaucoma see:

• CG-SURG-40 Cataract Removal Surgery for Adults
• CG-SURG-114 Ophthalmic use of Nd:YAG Laser for Posterior Capsulotomy
• CG-SURG-118 Intraocular Anterior Segment Aqueous Drainage Devices (without extraocular reservoir)
• CG-SURG-124 Viscocanalostomy
• CG-SURG-125 Canaloplasty

Note: For a high-level overview of this document, please see “Summary for Members and Families” below.

Medically Necessary:

Laser trabeculoplasty is considered medically necessary for glaucoma in the following situations:

1. As initial treatment of newly diagnosed glaucoma; or
2. As treatment for medically refractory glaucoma; or
3. As treatment for individuals who are at high risk for nonadherence to medical therapy (for example, those who cannot tolerate medications or who are noncompliant with medications due to memory problems or have difficulty with instillation).

Laser peripheral iridotomy is considered medically necessary in the following situations:

1. Primary angle-closure; or
2. Primary angle-closure glaucoma.

Not Medically Necessary:

Laser trabeculoplasty is considered not medically necessary when the above criteria are not met and for all other indications.

Laser peripheral iridotomy is considered not medically necessary when the above criteria are not met and for all other indications.

This document describes clinical studies and expert recommendations, and explains when laser peripheral iridotomy or laser trabeculoplasty is clinically appropriate. The following summary does not replace the medical necessity criteria or other information in this document. The summary may not contain all of the relevant criteria or information. This summary is not medical advice. Please check with your healthcare provider for any advice about your health.

Key Information

This document discusses two types of laser treatment used for some types of glaucoma, a group of eye diseases that can damage the optic nerve and lead to vision loss. Laser trabeculoplasty helps fluid drain from the eye by improving the function of the eye’s drainage system. Laser peripheral iridotomy (LPI) creates a small opening in the colored part of the eye (iris) to improve fluid flow. Both treatments aim to lower pressure inside the eye. Studies show that these procedures can help certain people with glaucoma. Each treatment has advantages and disadvantages. Possible risks can include temporary eye discomfort, inflammation, changes in eye pressure, or other eye-related side effects. Some people may still need eye drops or other treatments after laser treatment.

What the Studies Show

Laser trabeculoplasty is used to lower pressure inside the eye in people with certain forms of glaucoma. Studies found that it can work as well as glaucoma eye drops for many people and may reduce the need for long-term medication. Several studies found that laser trabeculoplasty lowered eye pressure safely in people with newly diagnosed glaucoma. Some people were able to control their eye pressure without eye drops for several years after treatment.

Laser peripheral iridotomy is used to treat certain forms of angle-closure disease by creating a small opening in the iris. This can improve fluid drainage and help prevent sudden increases in eye pressure. Studies found that laser peripheral iridotomy can reduce the risk of disease progression in people with primary angle closure or primary angle-closure glaucoma. Studies of people who were primary angle-closure suspects found that progression to more serious disease was uncommon. Observation with regular follow-up was found to be a reasonable option for many of these people.

What is Clinically Appropriate?

What is Not Clinically Appropriate?

The following have not been proven appropriate under this document and are not considered clinically appropriate:

• Laser trabeculoplasty for situations other than those listed above.
• Laser peripheral iridotomy for situations other than those listed above.

For people who are primary angle-closure suspects, studies found that progression to primary angle closure or glaucoma was uncommon. Although laser peripheral iridotomy reduced some signs of disease progression, long-term studies showed that observation with regular follow-up was often a reasonable alternative. Better studies are needed to know if routine treatment of all primary angle-closure suspects improves health.

Laser trabeculoplasty and laser peripheral iridotomy are not clinically appropriate in scenarios other than those listed above.

(Return to Description)

The following codes for treatments and procedures applicable to this guideline are included below for informational purposes. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.

Laser Trabeculoplasty
When services may be Medically Necessary when criteria are met:

When services are Not Medically Necessary:
For the procedure and diagnosis codes listed above when criteria are not met or for all other diagnoses not listed.

Laser peripheral iridotomy
When services may be Medically Necessary when criteria are met:

When services are Not Medically Necessary:
For the procedure and diagnosis codes listed above when criteria are not met or for all other diagnoses not listed.

Summary

Laser trabeculoplasty is a procedure proposed for the remodeling of parts of the eye to improve aqueous humor outflow to reduce intraocular pressure (IOP). Similarly, laser peripheral iridotomy (LPI) is a procedure in which a hole is made in the iris to improve aqueous humor outflow to reduce IOP. Both procedures have been used to manage glaucoma.

Clinical evidence supports the medical necessity of laser trabeculoplasty and LPI for appropriate glaucoma cases. Randomized controlled trials (RCTs) show that selective laser trabeculoplasty effectively lowers IOP in individuals with newly diagnosed primary open-angle glaucoma (POAG) and ocular hypertension, often reducing or eliminating the need for medications. Selective laser trabeculoplasty is also effective for individuals with refractory glaucoma or those unable to adhere to medical therapy. For individuals with primary angle closure or angle-closure glaucoma, LPI is effective in relieving pupillary block and preventing acute angle-closure, with long-term studies confirming its role in reducing disease progression and associated complications. However, LPI is not considered medically necessary for individuals classified as primary angle closure suspects (PACS). Long-term studies indicate that the progression from PACS to primary angle-closure glaucoma is infrequent, and observation without intervention is a reasonable and safe alternative in this population.

Discussion

Glaucoma is a group of diseases that can cause damage to the eye's optic nerve and result in vision loss or blindness. According to the American Academy of Ophthalmology (AAO) 2026 Preferred Practice Pattern^® (PPP) on primary glaucoma, it is the second leading cause of blindness. Glaucoma is typically not associated with pain or discomfort but leads to gradual visual field loss. In the United States, an estimated 2% of people over 40 have POAG (also known as just open-angle glaucoma), the most common type of glaucoma, accounting for approximately 70-90% of all glaucoma cases. Angle closure glaucoma, also called primary angle-closure glaucoma or narrow-angle glaucoma, accounts for approximately 10-25% of the glaucoma cases. Angle closure glaucoma is responsible for a disproportionate amount of glaucoma induced blindness. Primary angle closure is defined as an eye with an anatomic narrow angle and elevated IOP or peripheral anterior synechiae, but no damage to the optic nerve. In contrast, there is an anatomically narrow angle in primary angle closure suspect, but no elevated IOP or peripheral anterior synechiae.

Glaucoma is diagnosed through a combination of clinical evaluation, imaging, and functional testing. Key components include measurement of IOP, typically using applanation tonometry, and assessment of the optic nerve head through fundoscopic examination to detect signs like an enlarged cup-to-disc ratio (CDR). Optical coherence tomography (OCT) is used to visualize and quantify thinning of the retinal nerve fiber layer, often preceding visible visual field loss. Functional vision is assessed through automated perimetry (visual field testing), which helps identify characteristic glaucomatous defects. Gonioscopy or anterior segment optical coherence tomography (AS-OCT) is performed to evaluate the drainage angle, helping to differentiate open-angle from angle-closure glaucoma. For angle-closure suspects, additional predictors like shallow anterior chamber depth and smaller angle dimensions on AS-OCT help estimate long-term progression risk. However, standardized diagnostic criteria and risk-based referral models remain essential for early detection and efficient use of resources (Frediani, 2025; Michels, 2023). Michels (2023) outlines the clinical characteristics associated with POAG:

The initial diagnosis of POAG is presumptive, and observations over years are a more accurate indicator of the disease. Persistent or worsening findings of a 0.3 or greater cup-to-disc ratio, increasing IOP greater than 21 mm Hg, nerve fiber layer defects verified with optical coherence tomography, and reproducible visual field defects all substantiate the diagnosis.

Glaucoma is a progressive optic neuropathy characterized by increased IOP and resulting optic nerve damage and loss of retinal ganglion cells and their axons. The increased IOP in POAG is thought to be caused by an increased resistance to aqueous outflow through the trabecular meshwork. Treatment is aimed at slowing progression by decreasing IOP and can include medications or surgery.

In contrast, the increased IOP in closed-angle glaucoma is related to obstruction in the aqueous outflow. Apposition of the iris results in an anatomically closed angle (Weinreb, 2014). Treatment is directed at widening the angle and preventing further angle closure. If the angle is suddenly obstructed, IOP can increase rapidly. This condition is referred to as acute angle-closure crisis or acute primary angle closure. This is an urgent situation that can lead to permanent vision loss or blindness without prompt treatment. LPI uses a laser to cut into the iris thereby creating a hole through which aqueous humor can reach the angle and drain from the eye.

Closed-angle glaucoma is one of several classifications which fall under primary angle closure disease. The AAO PPP (2026) for primary angle closure disease includes the following classifications:

• Primary angle closure suspect (PACS): 180 degrees or greater iridotrabecular contact without IOP elevation, peripheral anterior synechiae or glaucomatous optic neuropathy
• Primary angle closure (PAC): 180 degrees or greater iridotrabecular contact with IOP elevation and/or peripheral anterior synechiae but no glaucomatous optic neuropathy
• Primary angle closure glaucoma (PACG): 180 degrees or greater iridotrabecular contact with IOP elevation and/or peripheral anterior synechiae and the presence of glaucomatous optic neuropathy

Laser Trabeculoplasty

In the management of POAG, the goal is to reduce the IOP to slow the development of optic nerve damage. The IOP can be reduced by medical treatment or surgery (alone or in combination). Surgical procedures may be indicated in individuals with glaucoma when the target IOP cannot be reached pharmacologically. One option is laser trabeculoplasty, a procedure that can lead to tissue remodeling and improved aqueous humor outflow to reduce IOP.

In a 2019 RCT by Gazzard, the authors reported on laser therapy to treat individuals with newly diagnosed untreated open-angle glaucoma or ocular hypertension (Laser in Glaucoma and Ocular Hypertension Trial [LIGHT]). Participants were randomized in a 1:1 fashion to receive either eye drops or laser trabeculoplasty. Participants had visual acuity of 6/36 or better with no previous history of intraocular surgery. Individuals were monitored for 36 months. The primary outcome was health-related quality of life (QOL) using the EuroQol EQ-5D 5 Levels (EQ-5D-5L). Secondary outcomes were disease-specific health-related QOL (assessed by the Glaucoma Utility Index, Glaucoma Symptom Scale, Glaucoma QOL-15 questionnaire), clinical effectiveness (proportion of visits at target IOP and the number of treatment escalations), visual function (visual acuity and fields), and safety. There were 718 participants enrolled with 356 in the selective laser trabeculoplasty group and 362 in the eye drops group. At 36 months, 652 participants returned the primary outcome questionnaire. The average EQ-5D score was 0.89 in the surgery group versus 0.90 in the eye drops group. At 36 months, 74.2% of participants in the surgery group did not require eye drops to maintain target IOP. The participants in the surgery group were within target IOP at more visits (93%) versus the eye drops group (91.3%). The groups had similar Glaucoma Utility Index scores, Glaucoma Symptom Scale scores, endpoint visual acuity, IOP, and visual field loss mean deviation. Serious adverse events were also similar between the two groups. While the scores were similar after 36 months, the questionnaires suggested better health-related quality-of-life outcomes for the surgery group.

The 6-year results of the LIGHT trial reported the clinical effectiveness of the selective laser trabeculoplasty compared to the IOP-lowering eye drops (Gazzard, 2023). A total of 524 individuals (82.8% of those enrolled in the extension phase) reported improved long-term disease control compared to eye drop therapy. There were significantly fewer eyes in the surgery group that demonstrated progression from ocular hypertension to open-angle glaucoma or deterioration of open-angle glaucoma, compared to those treated with eye drops (19.6% compared to 26.8%; p=0.006). At 72 months, 69.8% of eyes treated with selective laser trabeculoplasty achieved drop-free IOP control without incisional surgery compared to 18.0% of eyes initially treated with eye-drop therapy. The authors concluded that the positive long-term results and the safety profile of selective laser trabeculoplasty support its use as a first-line therapy along with IOP drops in the United States.

Yang (2024) published a post hoc analysis of the LiGHT China trial assessing whether repeat selective laser trabeculoplasty could effectively reduce IOP in individuals with open-angle glaucoma and ocular hypertension, regardless of their initial response to selective laser trabeculoplasty. While repeat selective laser trabeculoplasty resulted in a slightly lower average IOP reduction than the initial treatment (3.3 mm Hg versus 4.5 mm Hg at 2 months), its effect lasted significantly longer (median duration of 1043 versus 419 days). Importantly, most eyes (85%) responded to at least one selective laser trabeculoplasty treatment. The authors concluded that repeat selective laser trabeculoplasty remains a viable treatment escalation option regardless of initial response. While the authors reported positive findings, reported outcomes were limited to 2-month IOP readings. Longer-term results are needed to more adequately assess appropriate treatment outcomes. Selective laser trabeculoplasty has been shown to be an effective treatment for lowering IOP in  individuals with OAG and OHT; however, it should not be viewed as a universal replacement for medication, as individuals may still require eye drops for long-term control (Kanter, 2024; Quigley, 2025).

In a 2006 prospective, nonrandomized trial by McIlraith, 61 participants (100 eyes) with newly diagnosed open-angle glaucoma or ocular hypertension were assigned to the laser trabeculoplasty treatment group (74 eyes) or the control group (26 eyes) which received latanoprost. Follow-up visits were done at 1, 3, 6, and 12 months. In the surgery treatment group, the average post-treatment IOP was 17.8 mm Hg, the average absolute reduction in IOP was 8.3 mm Hg, and the average percent reduction in IOP was 31.0%. In the control group, the average post-treatment IOP was 16.9 mm Hg, the average absolute reduction in IOP was 7.7 mm Hg, and the average percent reduction in IOP was 30.6%. There were no significant complications among the surgery group. With similar outcomes between the two groups, surgery appears to be as efficacious as latanoprost for individuals with newly diagnosed glaucoma.

In a 2012 randomized prospective trial by Katz, the authors sought to compare the outcomes of laser trabeculoplasty with medical treatment as initial therapy in participants with glaucoma. There were 67 eyes (38 participants) in the laser trabeculoplasty group and 60 eyes (31 participants) in the medication group. Follow-up continued for 12 months with 54 eyes in the surgery group (30 participants) and 48 eyes (24 participants) in the medication group available for evaluation at the 9 to 12 months follow-up window. At the last visit in the surgery group, mean IOP was 18.2 mm Hg (a 6.3 mm Hg reduction) and 17.7 mm Hg (a 7.0 mm Hg reduction) in the medication group. Compared to baseline, the surgery group had an IOP reduction of 26.4% while the medication group had a 27.8% IOP reduction. With no statistically significant differences between the surgery group and the medication group, the study shows laser trabeculoplasty to be as efficacious as medical therapy for treatment of glaucoma.

In 2020, Ang reported on an RCT in which participants with treatment naïve mild-to-moderate primary open-angle or exfoliation glaucoma received either selective laser trabeculoplasty (n=83) or eye drops (n=84). Primary outcome for QOL was assessed using the Glaucoma Outcomes Assessment Tool (GOAT). Secondary outcomes included IOP reduction of greater than 25% from baseline and presence of ocular surface disease. There were 75 selective laser trabeculoplasty and 70 medication-treated participants available at 24-month follow-up. The participants in the selective laser trabeculoplasty group reported a 0.27 ± 0.81 logit mean improvement in ‘social well-being’ scores at 24 months compared to a −0.01 ± 0.74 mean logit reduction in the medication group. IOP reduction of greater than 25% was achieved by 62.3% of participants in the medication group and 45.5% of participants in the trabeculoplasty group at 12 months. At 24 months, 72.1% of participants in the medication group had a reduction in IOP compared to 53.4% in the surgery group. At 12 months, ocular surface disease was found in 8/67 participants in the medication group and 10/74 participants in the surgery group. The 24-month visit found 8/62 participants with ocular surface disease in the medication group and 12/69 participants in the surgery group. The authors note that selective laser trabeculoplasty was not superior to medication in improving QOL and not superior in reducing IOP, however a greater percentage of participants in the medication group had ocular surface disease. Study limitations include not meeting the target sample size, lack of documentation of medication side effects, and a lack of standardization as surgery was performed by different clinicians using different instruments. While this study did not show superiority of surgery over medication in improving glaucoma-specific QOL, it did show superiority over medication in ocular surface disease.

Chi (2020) reported on a systematic review and meta-analysis of RCTs that compared the effectiveness of selective laser trabeculoplasty and medication-only treatments for open angle glaucoma. Included were 8 RCTs encompassing 1229 participants. Follow-up periods ranged from 5 months to 5 years. IOP reduction was reported in 7 of the randomized trials with no significant differences reported between the surgery and medication-only groups. Three of the trials reported data regarding the mean number of medications needed and noted that the surgery groups had a lower mean number of medications. Improvement of QOL outcomes was reported by three studies. Two of the studies showed higher QOL in the surgery group with one study showing no significant changes in QOL between surgery and medication groups. The three studies used different ways to assess QOL. Adverse events were reported by two studies and found that the medication-only groups had more ocular adverse events caused by glaucoma eye drops. With varying assessment tools and lack of reporting of medication compliance it was difficult to ascertain the outcomes of QOL and adverse events. Further high-quality trials are necessary. However, the trials do show that surgery decreases the number of medications needed and is observed to be safe with fewer adverse events reported when compared to medication only.

The 2026 AAO PPP for POAG states that medical therapy is the most common initial intervention. Laser trabeculoplasty can be considered as initial or adjunctive treatment.

Current literature shows laser trabeculoplasty to be safe and efficacious for individuals with newly diagnosed glaucoma and as an alternative for those who are refractory to medication or those who cannot tolerate medications or are noncompliant with medications.

LPI

Individuals for whom half the outflow channels appear obstructed are considered to be at high risk for primary angle-closure glaucoma and are referred to as primary angle closure suspects. Many primary angle closure suspects do not ever develop glaucoma. Over a 5-year period, more than 90% of individuals with untreated ocular hypertension did not progress to glaucoma (AAO, 2026).

In a study by He (2019), the authors reported on the efficacy of LPI in preventing the development of primary angle-closure or acute angle closure in a Chinese cohort with primary angle closure suspects in the Zhongshan Angle-Closure Prevention Study. The natural history of primary angle closure suspects was possible by observation of the untreated eye. In this single-center, interventional RCT of primary angle-closure suspects, 889 participants received LPI in one randomly selected eye with the contralateral eye left untreated. Participants completed follow-up visits after 2 weeks, 6 months, 18 months, 36 months, 54 months, and 72 months with the mean follow-up of 61.1 months. The primary outcome was the incidence of primary angle closure at 72 months. In this study, primary angle closure was defined as IOP measurement above 24 mm Hg on two separate occasions, the development of at least one clock hour of peripheral anterior synechia in any quadrant, and an episode of acute angle closure. During the follow-up, there were 19 eyes treated with LPI which reached the primary study endpoint with a corresponding cumulative incidence of 4.19 per 1000 eye-years (95% confidence interval [CI], 2.67-6.57) and 36 control eyes that reached the primary study endpoint with a corresponding cumulative incidence of 7.97 per 1000 eye-years (95% CI, 5.75-11.0). There were no serious adverse events observed during the follow-up period. This study may not be generalizable with cohorts of other ethnicities. With the low rate of progression from primary angle closure suspects to primary angle-closure, the authors would not recommend LPI in primary angle closure suspects.

Extended follow-up (14 years) of the participants in the Zhongshan Angle-Closure Prevention Study were reported on by Yuan (2023). Follow-up evaluation was completed in 56.13% (499 eyes) in the treatment group and 56.36% (501 eyes) in the control group. During the 14 years, 33 eyes in the treatment group and 105 eyes in the control group reached the primary end point; within this group 1 eye in the treatment group and 5 eyes in the control group progressed to acute angle closure. Primary angle-closure glaucoma was identified in 2 eyes in the treatment group and 4 eyes in the control group. The occurrence of primary angle closure in the treatment group was decreased by two-thirds compared to the control group. Over the course of 14 years, the number-needed-to-treat was 12.35 (95% CI, 9.42-17.67) to prevent 1 primary angle closure occurrence. While the study did provide some long-term data, it was limited by a 45% dropout rate. In general, participants lost to follow-up were older and had a higher baseline IOP. Individuals in both groups received cataract surgery (70 eyes in the treatment group and 54 eyes in the control group). The effect of cataract surgery in the management of individuals with PACS has not yet been adequately investigated. The generalizability of the study results is limited due to the homogeneous makeup of the study group. The authors concluded:

In summary, the 14-year ZAP Study demonstrated that LPI significantly reduced the risk of PAC occurrence in PACS eyes by two thirds over the long term, which further confirmed previous 6-year results and supported the suggestion that LPI-free observation is an alternative response to PACS.

Baskaran (2022) reported on the results of a prospective RCT which examined the efficacy of LPI in individuals with PACS. A total of 480 participants with bilateral asymptomatic primary angle-closure suspect underwent LPI in one eye; the other eye was used as a control. Participants were followed yearly for 5 years for the development of primary angle closure (peripheral anterior synechiae, IOP of > 21 mm Hg, or both), acute angle closure, or primary angle-closure glaucoma. There was a significantly lower incidence rate in the LPI eyes compared to the control eyes at the end of the 5 years (11.65 per 1000 eye-years vs. 21.84 per 1000 eye-years, respectively). The primary benefit of treatment was a reduction in the development of peripheral anterior synechiae. The development of peripheral anterior synechiae signals mild damage to the angle structure but is not necessarily associated with vision loss (Han, 2022). The other endpoints, progression to primary angle-closure glaucoma, an IOP of greater than 21 or acute angle closure were uncommon in both groups. There was no significant difference in the development of primary angle-closure glaucoma between the groups. The authors summarized their findings as supporting the findings of He (2019) that “observation without LPI is a reasonable option for PACS.”

According to the AAO 2026 PPP for Primary Angle Closure Disease, most affected individuals will not progress to primary angle closure or glaucoma; however, LPI may be considered to reduce the risk of acute angle-closure attacks and progression to primary angle closure. The decision to perform prophylactic LPI should be individualized based on risk factors (such as a history of angle closure in the fellow eye, family history, symptoms suggestive of intermittent angle closure, medication use, or difficulty obtaining urgent eye care), while observation with regular follow-up is also an acceptable option because the overall rate of progression is relatively low and LPI carries potential risks and side effects.

Angle closure: An event in which a blockage of the trabecular meshwork closes the anterior-chamber angle causing elevated IOP. Angle closure can be acute or chronic.

Aqueous humor (vitreous humor/fluid): A transparent fluid with low protein content secreted by the ciliary body. The fluid circulates through the pupil to the anterior chamber where it is resorbed through the trabecular meshwork into the canal of Schlemm and then into the episcleral veins. The aqueous humor provides nutrition to the anterior vitreous, lens, posterior cornea, and trabecular meshwork. It also maintains IOP and provides a route for immunoglobulins to enter the anterior segment.

Glaucoma: A grouping of diseases that damage the optic nerve and result in vision loss and blindness. The damage is usually caused by abnormally high IOP. Progressive vision loss can develop slowly (i.e., open angle glaucoma) or suddenly (i.e., angle-closure glaucoma).

Glaucoma suspect: Condition characterized by elevated IOP with a normal optic nerve, retinal nerve fiber layer, and visual fields, or by isolated abnormalities in these structures (i.e., cup-to-disc ratio > 0.3) without elevated pressure. Affected individuals are at an increased risk of developing glaucoma.

Intraocular pressure (IOP): A fluid pressure within the eye; a measurement of the balance between the production and drainage of aqueous humor. An IOP above 21 mm Hg is considered to be ocular hypertension. An elevated IOP is a risk factor for glaucoma.

Iridotomy: A surgical procedure in which a hole is made in the iris.

Laser trabeculoplasty: A surgical procedure in which a laser is used to improve drainage through the trabecular meshwork.

Trabeculectomy: A surgical filtration procedure in which a portion of the trabecular meshwork is surgically removed through a superficial flap of sclera to lower the IOP by creating an alternate pathway for the aqueous fluid to flow from the anterior chamber to a bleb created in the subconjunctival space.

Peer Reviewed Publications:

1. Ang GS, Fenwick EK, Constantinou M, et al. Selective laser trabeculoplasty versus topical medication as initial glaucoma treatment: the glaucoma initial treatment study randomised clinical trial. Br J Ophthalmol. 2020; 104(6):813-821.
2. Baskaran M, Kumar RS, Friedman DS, et al. The Singapore asymptomatic narrow angles laser iridotomy study: five-year results of a randomized controlled trial. Ophthalmology. 2022; 129(2):147-158.
3. Chi SC, Kang YN, Hwang DK, Liu CJ. Selective laser trabeculoplasty versus medication for open-angle glaucoma: systematic review and meta-analysis of randomised clinical trials. Br J Ophthalmol. 2020; 104(11):1500-1507.
4. Frediani T, Yoo K, Cho A, et al. Outcomes of glaucoma referrals in adults aged 18 to 40 years. JAMA Netw Open. 2025; 8(2):e2457843.
5. Gazzard G, Konstantakopoulou E, Garway-Heath D, et al. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial. Lancet. 2019; 393(10180):1505-1516.
6. Gazzard G, Konstantakopoulou E, Garway-Heath D, et al; LiGHT Trial Study Group. Laser in Glaucoma and Ocular Hypertension (LiGHT) Trial: six-year results of primary selective laser trabeculoplasty versus eye drops for the treatment of glaucoma and ocular hypertension. Ophthalmology. 2023; 130(2):139-151.
7. Han Y. Evolution of management on primary angle-closure suspect: observation versus laser peripheral iridectomy. Ophthalmology. 2022; 129(2):159-160.
8. He M, Jiang Y, Huang S, et al. Laser peripheral iridotomy for the prevention of angle closure: a single-centre, randomised controlled trial. Lancet. 2019; 393(10181):1609-1618.
9. Kanter JA, Quigley HA. Repeat selective laser trabeculoplasty and open-angle glaucoma. JAMA Ophthalmol. 2024; 142(10):924-925.
10. Katz LJ, Steinmann WC, Kabir A, et al. Selective laser trabeculoplasty versus medical therapy as initial treatment of glaucoma: a prospective, randomized trial. J Glaucoma. 2012; 21(7):460-468.
11. McIlraith I, Strasfeld M, Colev G, Hutnik CM. Selective laser trabeculoplasty as initial and adjunctive treatment for open-angle glaucoma. J Glaucoma. 2006; 15(2):124-130.
12. Michels TC, Ivan O. Glaucoma: diagnosis and management. Am Fam Physician. 2023; 107(3):253-262.
13. Quigley HA. Shedding LiGHT on selective laser trabeculoplasty. JAMA Ophthalmol. 2025; 143(4):302-303.
14. Weinreb RN, Aung T, Medeiros FA. The pathophysiology and treatment of glaucoma: a review. JAMA. 2014; 311(18):1901-1911.
15. Yang Y, Xu K, Chen Z, et al.; LiGHT China Trial Study Group. Responsiveness to selective laser trabeculoplasty in open-angle glaucoma and ocular hypertension. JAMA Ophthalmol. 2024; 142(10):918-924.
16. Yuan Y, Wang W, Xiong R, et al. Fourteen-year outcome of angle-closure prevention with laser iridotomy in the zhongshan angle-closure prevention study: extended follow-up of a randomized controlled trial. Ophthalmology. 2023; 130(8):786-794.

Government Agency, Medical Society, and Other Authoritative Publications:

1. American Academy of Ophthalmology (AAO). Preferred Practice Pattern^®. For additional information, visit the AAO website: www.aao.org. Accessed on June 2, 2026.
   • Primary open angle glaucoma. 2026.
   • Primary open angle glaucoma suspect. 2026.
   • Primary angle-closure disease. 2026.
2. Bayliss JM, Ng WS, Waugh N, Azuara-Blanco A. Laser peripheral iridoplasty for chronic angle closure. Cochrane Database Syst Rev. 2021; 3(3):CD006746.
3. Chou R, Selph S, Blazina I, et al. Screening for glaucoma in adults: a systematic review for the U.S. preventive services task force. Rockville (MD): Agency for Healthcare Research and Quality (US); 2022 May. Report No.: 21-05286-EF-1.
4. Radhakrishnan S, Chen PP, Junk AK, et al. Laser peripheral iridotomy in primary angle closure: a report by the American Academy of Ophthalmology. Ophthalmology. 2018; 125(7):1110-1120.
5. Rolim-de-Moura CR, Paranhos A Jr, Loutfi M, et al. Laser trabeculoplasty for open-angle glaucoma and ocular hypertension. Cochrane Database Syst Rev. 2022; 8(8):CD003919.
6. Takusagawa HL, Hoguet A, Sit AJ, et al. Selective laser trabeculoplasty for the treatment of glaucoma: a report by the American Academy of Ophthalmology. Ophthalmology. 2024; 131(1):37-47.

1. American Academy of Ophthalmology. Glaucoma treatment. For additional information, visit the AAO website: https://www.aao.org/eye-health/diseases/glaucoma-treatment. Accessed on June 2, 2026.
2. National Eye Institute. Accessed on June 2, 2026.
   • Facts about glaucoma. Available at: https://www.nei.nih.gov/sites/default/files/2019-06/Facts-about-glaucoma.pdf.
   • Types of glaucoma. Last updated December 5, 2024. Available at: https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/glaucoma/types-glaucoma.

Glaucoma
Laser Peripheral Iridotomy
Laser Trabeculoplasty

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