NICE updated guideline on glaucoma diagnosis and management

NICE's updated guideline on glaucoma will mean fewer people need to be referred for further specialist investigation and possible treatment as it states that People at a low risk of developing glaucoma can avoid unnecessary referral.

This guideline covers diagnosing and managing glaucoma in people aged 18 and over. It includes recommendations on testing and referral for chronic open angle glaucoma and ocular hypertension, and on effective diagnosis, treatment and reassessment to stop these conditions progressing.This guideline includes recommendations on:

• case-finding


• diagnosis


• standard practice for all assessments


• reassessment


• treatment


• organization of care


• providing information

The new guideline now includes a section on what tests should be carried out by primary eye care professionals to determine if a referral to a specialist is necessary.

Glaucoma occurs when the nerve responsible for sight becomes damaged and is the cause of sight loss in around 10% of the 360,000 people registered as blind in the UK.There are several forms of glaucoma with chronic open angle glaucoma (COAG) being the most widespread, affecting around 480,000 people in England.

An increase in pressure within the eye (also called ocular hypertension) is a major risk factor for developing COAG. Controlling this inner eye pressure – usually with prostaglandin analogue (PGA) eye drops – is the main way of preventing COAG.

To better represent the population at greatest risk of going on to develop COAG, the updated guideline now recommends a higher inner eye pressure threshold of 24mm/Hg to prompt referral and treatment.

This is a change from the current practice of referring patients to an inner eye pressure of over 21mmHg. It is now recommended that people with an inner eye pressure below 24 mmHg should continue regular visits to their primary eye care professional so any future increase in pressure is detected.

Professor Mark Baker, Director of the center for guidelines at NICE, said: "Chronic open-angle glaucoma is a condition that should be taken seriously. People at risk of the condition should be carefully monitored so that it can be treated early.

"Approximately 1.8 million people in the UK have an inner eye pressure of 22 or 23 mmHg. That puts a huge demand on secondary care eye services for patients who don't need immediate treatment. Having a clear referral and treatment pathway to identify patients with ocular hypertension and suspected COAG ensures patients are assessed and treated in the most appropriate setting.

"Increasing the treatment threshold will not only lead to fewer patients being referred unnecessarily but it should reduce costs without compromising patient safety."

Other recommendations include using gold standard equipment to measure a patient's inner eye pressure and repeating tests before referral.