Clinical Practice Guideline for open-angle glaucoma in Spain

In mid-June, 2018, the Catalan Agency for Quality and Healthcare Evaluation, AQuAS, published the clinical practice guidelines for open-angle glaucoma.

The Spanish Ministry of Health, Social Services and Equality has issued the clinical practice guidelines for open-angle glaucoma. The guidelines were developed by the AQuAS under the agreement of collaboration with the Health Institute Carlos III within the framework of activities of the Spanish Network of Technology and Services Evaluation Agencies of the National Health System (REDETS).

Glaucoma is the second cause of irreversible blindness in the world after cataract and, specifically, the second most frequent cause among those over 40 years old in Western countries. In Spain, 2% of the population over 45 years old have the disease, with an annual increase of 1% starting at age 65, which could reach 10% if there is a family history. Open-angle glaucoma is the most common clinical form of this pathology in Europe.

This clinical guideline aims to serve as an instrument to reduce the uncertainty and variability in the detection, treatment and control of people with chronic open-angle glaucoma. Some of the recommendations provided in these guidelines are provided below.

Regarding the diagnosis of open-angle glaucoma:

• A complete history, tonometry, stereoscopic examination of the fundus, gonioscopy and visual field evaluation can be considered as the minimum tests for diagnosis of the patient with suspected open-angle glaucoma

Regarding the laser treatment of open-angle glaucoma:

• In patients with recent diagnosis of open-angle glaucoma, in those in which poor compliance of the pharmacological treatment is expected and/or the daily treatment with drugs is a burden, it is suggested to perform trabeculoplasty with an argon laser. The patient should be warned of the increased risk of adverse events with this intervention than with the pharmacological treatment
• In patients with open-angle glaucoma for whom treatment with laser trabeculoplasty is decided, it is suggested to start with any type of laser (diode, argon or selective laser)
• It is recommended not to perform laser trabeculoplasty associated with pharmacological treatment in patients with uncontrolled open-angle glaucoma (despite maximum doses of pharmacological treatment)
• In patients who do not respond to treatment with laser, it is suggested to offer surgery

For the surgical treatment of open-angle glaucoma:

• In patients with open-angle glaucoma, it is suggested to offer the surgical procedure to newly diagnosed patients in severe stages, poor control or progression with adequate pharmacological treatment
• In patients who undergo surgical treatment, trabeculectomy or non-penetrating deep sclerectomy are preferred, leaving other non-penetrating or microinvasive techniques to specific cases and experienced teams
• Implantation of drainage implants (Baerveldt implant) is an option for patients who have already received eye surgery (trabeculectomy or phacoectomy) not controlled with medical treatment or those cases with the risk of failure of filtering surgery.

For the follow-up of patients with open-angle glaucoma:

• Tonometry, stereoscopic examination with of the fundus, gonioscopy and the visual field evaluation can be considered as the minimum tests for the follow-up of the patients with open-angle glaucoma. The frequency of completion of each of these tests it will depend on the risk of progression and control of intraocular pressure

See the guideline in Spanish here.

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