Glaucoma NICE Guidelines

NICE Glaucoma Guidelines

The National Institute for Health and Clinical Excellence (NICE) has issued guidelines on the diagnosis and management of chronic open angle glaucoma and ocular hypertension. The AOP, ABDO and FODO strongly advise optometrists to take note of them when considering the referral of patients with signs of OHT. The AOP has issued separate advice for Scottish optometrists, backed by a legal opinion from an Edinburgh-based QC (see pdfs at the end of this page).

NICE lays out very clearly who is at risk of glaucoma and what tests these patients need to have. It identifies OHT as a risk factor and defines what OHT is – pressures over 21, measured repeatedly on separate occasions, using slit lamp mounted Goldmann tonometry, when the CCT (corneal central thickness) is greater than 590nm. It states clearly that OHTs should be offered a number of defined tests (including gonio and pachymetry) and should be monitored (also using a defined set of tests, which are well beyond the requirements of GOS).

English and Welsh PCTs and Health Boards may not have the resources to cope with the numbers of referrals – many of which, because they will have had their pressures taken using NCT, will be false positives. Nevertheless, in the absence of funding to repeat pressures using Goldmann, the AOP believes strongly that optometrists have no choice other than to refer a patient who has a sign of ocular hypertension – e.g. pressures measured at over 21 mmHg, using whatever tonometer they choose.

To identify a sign of OHT and then not to act on it could be considered to be unprofessional, especially when the correct course of action has been well researched, by a panel of experts in the field, using evidence-based methods, and has been officially published by NICE. Some PCTs are asking optometrists to continue to refer as they did before the publication of NICE. However, such a PCT is avoiding its own responsibility for treating these patients. But it will not be indemnifying the optometrist for his or her lack of action. It hopes that the optometrist will take the responsibility that is rightfully its own. PCTs do not have the power to insist that optometrists should not refer according to the NICE guidelines.

The full NICE Guidelines can be downloaded by clicking here.