Update information

Update information

November 2017: This guideline is an update of NICE guideline CG85 (published April 2009) and replaces it.

New recommendations have been added for case-finding, diagnosis, reassessment and treatment.

These are marked as: [2017].

Recommendations that have been changed

Amended recommendation wording (change to meaning):

  • In recommendation 1.2.4, clarification was added that this image may be acquired by a stereoscopic optic nerve head image (leaving it open to either biomicroscopy slit lamp examination or stereo photography) or OCT, whichever is more readily available at the time of diagnosis.

  • In recommendation 1.4.3, the original recommendation contained 2¬†separate instructions (1 for people with established COAG and those having initial investigation for possible COAG, and 1 for follow-up of people with an established diagnosis of suspected COAG or OHT). These 2¬†instructions have been separated into 2 recommendations to improve clarity.

  • In recommendation 1.4.4, as above, the original recommendation contained 2 separate instructions (1 for people with established COAG and those having initial investigation for possible COAG, and 1 for follow-up of people with an established diagnosis of suspected COAG or OHT). These 2 instructions have now been separated into 2 recommendations to improve clarity. The original recommendation was suggesting that for people with OHT and COAG suspects with normal visual fields, it would be acceptable to use the supra-threshold test as opposed to the superior central thresholding test (CTT) recommended for those with established COAG. However the committee wished to clarify that the CTT is also an option for this population if it is clinically available.

  • In recommendations 1.5.6, 1.5.16, 1.5.18, 1.5.19 and 1.5.20, clarification was added that the drug should be from another therapeutic class when switching to another monotherapy and when adding another drug. This clarification was considered important because committee members were aware of inappropriate switching through multiple examples of drugs from the same class (for example, multiple PGA switches).

  • In recommendation 1.5.8, high risk of conversion is no longer defined in the guideline by IOP and CCT so these parameters have been removed from the recommendation.

  • Treatment adherence may be significantly affected by both allergic and non-allergic reactions (preservative toxicity). Preservative toxicity is a particular problem for people with ocular surface diseases so this group was added to recommendations 1.5.8 and 1.5.18.

  • In recommendations 1.5.13, 1.5.16, 1.5.17 and 1.5.18, 5FU was deleted because it is no longer used as standard practice during surgical treatment and postoperative care.

  • In recommendation 1.5.14, generic PGAs are now recommended for first-line treatment.

  • Recommendation 1.7.1 was amended to indicate that people should have the opportunity to discuss referral, and discharge, and that patient information should also include:

    • reassurance that most people having treatment for COAG will have a good quality of life

    • reference to the eye clinic liaison officer (ECLO) as these are now available in many clinics

    • reference to support organisations.

ISBN: 978-1-4731-2713-5

  • National Institute for Health and Care Excellence (NICE)