NEI announces continuation of funding for multi-center glaucoma treatment study led by Professor Tony Realini

The West Virginia University School of Medicine received a notification of continued funding for a major multi-center study that aims to simplify glaucoma management for patients through the annual administration of a laser eye treatment known as selective laser trabeculoplasty (SLT).

The current award is a five-year renewal of the original five-year grant that was awarded by the National Eye Institute, National Institutes of Health, in 2020, which seeks to clarify the optimal energy level and repeat interval of SLT therapy for the treatment of open-angle glaucoma or ocular hypertension. The study is led by Professor and Glaucoma Specialist at the WVU Eye Institute and Department of Ophthalmology and Visual Sciences, Tony Realini, MD, MPH, who explained that SLT is a safe and painless alternative to topical glaucoma treatment.

“For more than 150 years, we have relied on topical medical therapy in the form of eye drops that patients must administer to themselves every day, often several times a day,” Dr. Realini explained. “Many patients can easily miss a dose or improperly administer the drops themselves. Every missed dose compromises treatment and increases the risk of glaucoma worsening, which can result in permanent loss of vision and potentially even blindness.

“SLT is a laser procedure that we can perform in the office,” he continued. “It’s safe, is not painful, takes only about 10 minutes to complete, and most importantly, most patients don’t need to use eye drop medications afterward. SLT wears off over time, generally after five years or more, and can be repeated when that occurs, but eventually, even repeated SLT can stop working.”

This is where the Clarifying the Optimal Application of SLT (COAST) trial comes in, which compares the current approach—waiting for SLT to wear off before repeating it—to  a novel approach where SLT is repeated each year at low-energy, even if it is still working properly. Realini explained that the hypothesis is that maintaining disease control with annual low-energy repeat SLT will be more effective in the long run than waiting for it to wear off and trying to regain control once vision has already suffered.

“We hope that this new approach will allow patients to manage their glaucoma through SLT without the need for topical medications for a longer period of time than the current method of waiting to repeat the procedure only after it wears off,” he said. “Think of it like a blood pressure pill. You take one every day to keep your blood pressure under control, rather than waiting until the pill wears off and blood pressure rises to take the next dose. We think this same approach makes sense with SLT.”

The COAST trial was originally conceived in 2019 and was subsequently funded by the National Eye Institute in the fall of 2020. The initial five-year award supported start-up of the major, multi-center study. This included the approval of the trial protocol, developing an operating plan, identifying, contracting and training 29 clinical centers across North America to participate in the study, empaneling a data and safety monitoring committee to provide independent oversight, and enrolling more than 500 patients into the study.

In 2025, Realini and his team submitted a renewal application for additional funds to support the continuation of this study. In those first five years, new data emerged that prompted the team to request that the follow-up period for the study be extended from four to six years to better show the differences between treatment groups. The request was granted, and a total of $1,953,173 in additional funding was awarded to the study in July 2026 for an additional five years.

Realini serves as the primary investigator for this study, which is supported by Co-Investigator Michael Kass, MD, who serves as a professor of ophthalmology at Washington University in St. Louis, Missouri. The University of Pittsburgh’s Epidemiology Data Center serves as the coordinating center for this study, which handles all administrative, logistic and data management functions.

“On behalf of the entire COAST team – including the teams here at WVU and at Washington University and the University of Pittsburgh, as well as the dozens of site investigators, research coordinators and other research staff members at our 29 clinical sites – we are grateful to the NIH and NEI for their ongoing support of this clinical study that will help us understand the best method to care for glaucoma patients in the future,” Realini said.

To learn more about SLT therapy and the COAST trial, visit coasttrial.org. To learn more about vision research at the WVU School of Medicine, visit medicine.hsc.wvu.edu/eye/research.