NICE has updated NICE Guideline (NG) 81 on Glaucoma: diagnosis and management, originally NICE Clinical Guideline 85, and updated Quality Standard (QS) 7 on Glaucoma in adults.

Chronic open angle glaucoma (COAG) is a common condition that can cause blindness, but is usually asymptomatic until it has reached an advanced stage. Approximately 10% of blindness registrations in the UK are attributed to glaucoma and the condition accounts for over one million hospital eye service visits annually.

The scope of the guidance on diagnosing and managing open angle glaucoma has been expanded to include what tests should be carried out by primary eye care professionals to determine if referral to a specialist is necessary.

The update has provided an opportunity to re-evaluate the clinical and cost effectiveness, and indications for treating ocular hypertension (OHT). Changes in the costs of pharmacological treatments, acknowledgement of short- and long-term variations in intraocular pressure, and the uneven relationship between rising pressure and increased risk have allowed a simplification of the indications for OHT treatment. Control of intraocular pressure remains a key objective of the therapeutic approach.

Areas covered by the recommendations in NG81 include:

  • case-finding
  • diagnosis
  • standard practice for all assessments
  • reassessment
  • treatment
  • organisation of care
  • providing information.

In addition, QS7 has been updated with the latest guidance on commissioning and co-ordinating integrated services across primary, secondary, and social care. To reflect changes to the guidance on glaucoma management made by NG81, sections on definitions and source guidance were updated, as well three of the QS7 quality statements:

  • people with suspected COAG or with OHT are managed based on estimated risk of conversion to COAG and progression to visual impairment using IOP, in accordance with NICE guidance (quality statement 6)
  • people with COAG who are progressing to loss of vision despite treatment or who present with advanced visual loss are offered surgery with pharmacological augmentation (MMC) as indicated and information on the risks and benefits associated with surgery (quality statement 10)
  • people with suspected COAG or with OHT who are not recommended for treatment are discharged from formal monitoring with a patient-held management plan and their discharge summary is sent to their GP and primary eye care professional (quality statement 12).