NICE increases IOP threshold for glaucoma referral

NICE has published a new guideline (NG81) on the diagnosis and management of glaucoma in adults. It includes updated recommendations for primary eye care professionals on case finding before referral for chronic open angle glaucoma (COAG; the most common type of glaucoma) and ocular hypertension, as well as guidance on diagnosis and treatment. The new guidance replaces the 2009 clinical guideline (CG85) and also forms the basis for an updated set of quality standard statements (QS7) for glaucoma.

In order to target the population at greatest risk of going on to develop COAG, the new guidance has increased the intraocular pressure (IOP) threshold for referral and treatment from 21mmHg to 24mmHg. Gold-standard equipment (Goldmann-type applanation tonometry) should be used to measure IOP and primary eye care professionals should consider repeat testing of both IOP and visual field assessments before referral. A generic prostaglandin analogue is the treatment of first choice for people with IOP of 24mmHg or more, if they are at risk of visual impairment within their lifetime. Patients with an IOP below 24mmHg should continue to visit their primary eye care professional for regular assessments.

NICE explained that the recommendations had been changed because approximately 1.8 million people in the UK have an IOP of 22 or 23mmHg, and therefore increasing the treatment threshold to 24mmHg should lead to fewer patients being referred unnecessarily and reduce costs without compromising patient safety.

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