Game-Changers in Glaucoma: Roclanda and Selective Laser Trabeculoplasty Lead the Non-Surgical Revolution

Glaucoma continues to be a leading cause of irreversible blindness, affecting over 80 million people globally. As clinicians and researchers strive to preserve vision and improve quality of life, the spotlight is shifting toward non-surgical glaucoma treatments that offer efficacy, safety, and convenience.

Traditionally, glaucoma was treated with eyed drops and then surgery if these failed.

Two more recent standouts are redefining the treatment paradigm: Roclanda, a dual-action eye drop, and Selective Laser Trabeculoplasty (SLT), a laser-based therapy now recommended as first-line treatment as well as additional treatment for patients already taking eye drops.

This article explores how these therapies are transforming glaucoma management, with a focus on their mechanisms, clinical outcomes, and practical advantages for patients and clinicians alike.

Roclanda eye drops is the first new class of glaucoma drops to become available in Europe for 25 years. It offers a powerful dual-action approach to lowering intraocular pressure (IOP) in patients with glaucoma and ocular hypertension. This innovative treatment combines netarsudil, a Rho kinase inhibitor, with latanoprost, a prostaglandin analog, to target two key drainage pathways in the eye. Netarsudil works by increasing fluid outflow through the trabecular meshwork and reducing episcleral venous pressure, while latanoprost enhances uveoscleral outflow. Together, these mechanisms help reduce IOP more effectively than either agent alone, making Roclanda an ideal option for patients who need stronger pressure control without surgery. With once-daily dosing and proven efficacy, Roclanda is a leading choice in non-surgical glaucoma treatment and is increasingly recommended for patients seeking advanced, drop-based therapy. The recent Mercury-3 trial highlights the a number of benefits.

Key Benefits of Roclanda:

• Once-daily dosing improves adherence.
• Effective even at low baseline IOP, making it suitable for normal-tension glaucoma.
• Complementary mechanism of action enhances efficacy across diverse patient profiles.
• Mild side effect profile, with conjunctival redness being the most common.

Selective Laser Trabeculoplasty (SLT):

Once considered a secnd-line option, Selective Laser Trabeculoplasty (SLT) is now recommended by NICE as a first-line treatment for primary open-angle glaucoma and ocular hypertension. SLT uses low-energy laser pulses to stimulate the trabecular meshwork, enhancing aqueous outflow and lowering IOP—without damaging surrounding tissue.

Clinical Evidence:

The LIGHT trial, a landmark study, showed that:

• 74.2% of SLT-treated patients remained medication- and surgery-free at 3 years.
• 69.8% maintained target IOP at 6 years with just one or two SLT sessions.
• SLT patients had lower rates of disease progression, trabeculectomy, and cataract surgery compared to those on drops.

Advantages of SLT:

• Non-invasive and repeatable, with minimal downtime.
• Reduces or eliminates the need for daily drops, improving adherence.
• Safe profile, with transient side effects like mild discomfort or photophobia.

SLT is particularly valuable for patients struggling with drop compliance, those with ocular surface disease, or those seeking a proactive approach to glaucoma management.

Combining eye drops and SLT: A Strategic Approach

For many patients, eye drops and SLT are not mutually exclusive—they can be used synergistically. SLT may be offered as first-line therapy, with Roclanda introduced if additional pressure reduction is needed or if SLT effects diminish over time. Conversely, eye drops may be used initially, with SLT added to reduce medication burden or delay surgical intervention.

This layered approach allows clinicians to tailor treatment plans based on disease severity, patient preferences, and response to therapy.

Looking Ahead: A New Standard for Non-Surgical Glaucoma Care

The rise of Roclanda and SLT signals a shift toward personalized, non-invasive glaucoma management. These therapies offer robust IOP control, improved adherence, and reduced reliance on surgery—aligning with modern goals of preserving vision while enhancing patient quality of life.

Mr Modi remains committed to staying at the forefront of ophthalmic innovation and offers amongst the widest range of treatments for glaucoma available in the UK.

Whether you're a patient exploring treatment options or a clinician refining your protocol, understanding these advancements is key to delivering optimal care.