NICE clinical guidelines
Issued: April 2009
CG85

Glaucoma: Diagnosis and management of chronic open angle glaucoma and ocular hypertension

This is an extract from the guidance. The complete guidance is available at guidance.nice.org.uk/cg85

Introduction

Chronic open angle glaucoma (COAG) is a common and potentially blinding condition. It is usually asymptomatic until advanced and many people will be unaware there is a problem with their eyes until severe visual damage has occurred. Ocular hypertension (OHT) is a major risk factor for developing COAG, although COAG can occur with or without raised eye pressure.

Approximately 10% of UK blindness registrations are attributed to glaucoma. Around 2% of people older than 40 years have COAG, rising to almost 10% in people older than 75 years in white Europeans. The prevalence may be higher in people of black African or black Caribbean descent or who have a family history of glaucoma. With changes in population demographics the number of individuals affected is expected to rise. Based on these estimates 480,000 people are currently affected by COAG in England. There are over a million glaucoma-related outpatient visits in the hospital eye service annually.

Once diagnosed, people with COAG need lifelong monitoring so that any progression of visual damage can be detected. Once lost, sight cannot be restored, and controlling the condition, together with prevention, or at least minimisation of ongoing damage, is crucial to maintaining a sighted lifetime.

Because uncertainty and variation exist in clinical practice this guideline seeks to give clear recommendations on testing for and diagnosing COAG and OHT, and on effective monitoring and treatment to prevent these conditions progressing. By implementing this guideline more people will be prevented from going blind.

The guideline will assume that prescribers will use a drug's summary of product characteristics to inform their decisions for individual patients.