NPC Archive Item: NICE publishes guidance on the management of glaucoma

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5th May 2009

NICE Clinical Guideline 85 provides recommendations for the diagnosis, treatment and care of glaucoma. The guidance covers adults with chronic open angle glaucoma and ocular hypertension as well as those at high risk of developing glaucoma.

This guideline will be useful for all healthcare professionals involved in the care of patients who either have glaucoma or who are at increased risk of developing it. We should familiarise ourselves with this guideline and use it as a basis for our management of this condition. The quick reference guide provides a summary of the recommendations and includes algorithms for diagnosis and monitoring.

NICE has also produced a summary of their guidance in plain English which may be useful for patients and/or families/carers or indeed anyone with an interest in these conditions.

What does the guideline cover?
The NICE guideline provides detailed recommendations for the diagnosis, monitoring, treatment, organisation of care and provision of information to people with ocular hypertension (OHT), and those with chronic open angle glaucoma (COAG) or suspected COAG.

What drug treatments are recommended?
People with ocular hypertension (OHT) or suspected COAG with high intraocular pressure (IOP) should be treated according to their estimated risk of conversion to COAG (based on their IOP, central corneal thickness and age). Depending on the level of risk, a topical beta-blocker or a prostaglandin analogue is the drug of first choice. A carbonic anhydrase inhibitor or a sympathomimetic can also be considered where other drugs are not tolerated, or where they do not decrease IOP sufficiently to reduce the risk of progression to sight loss. More than one agent may be necessary to achieve target IOP.

A preservative-free preparation should be offered to people with OHT or suspected COAG and an allergy to preservatives only if they are at high risk of conversion to COAG.

Referral to a consultant ophthalmologist will be necessary to consider further options if IOP cannot be reduced sufficiently.

Prostaglandin analogues should be prescribed for people newly diagnosed with early or moderate COAG who are at risk of significant visual loss in their lifetime. For people with advanced COAG, surgery is an option with augmentation with mitomycin C or 5-fluorouracil as indicated.

Details of how the recommendations were developed, and reviews of the evidence they were based on, can be found in the NICE Full Guideline.

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