Recommended changes in clinical practice will reduce the number of patients needing eye drops and save money for the NHS.
NICE’s latest guideline on the diagnosis and management of glaucoma looked at the treatment and organization of care for ocular hypertension (OHT) and chronic open-angle glaucoma (COAG).
Glaucoma is a group of eye conditions in which the optic nerve is damaged, causing loss of sight. It is one of the most common causes of blindness worldwide.
About 10% of people in the UK who go blind do so because of glaucoma.
Increased pressure in the eye, also called ocular hypertension, is a major risk factor for developing COAG. Controlling this internal eye pressure is the main way to prevent COAG.
In the UK, chronic open-angle glaucoma affects around 2% of people over the age of 40 and can reach almost 10% in people over the age of 75. Ocular hypertension affects 3-5% of people over 40 in the UK.
The change in treatment approach would lead to an increase in the routine use of selective laser therapy (SLT), a procedure in which a laser is applied through a contact lens to reduce intraocular pressure (IOP) in patients. Increased use of this treatment would reduce the use of eye drops and potentially decrease the need for some patients to undergo cataract or intraocular pressure surgery.
Reduced use of eye drops and cataract or intraocular lowering surgery would more than cover the costs of a wider introduction of SLT, including staff training and equipment purchase.
It is estimated that implementing this guideline for England over the next five years would result in savings of around £87,500 in 2021/22, rising to around £400,000 by 2025/26.
Healthcare professionals should refer people suitable for selective laser therapy to a consulting ophthalmologist and discuss the decision to offer speech therapy and how it will be performed. Healthcare professionals undertaking speech therapy should be supported by the responsible consultant ophthalmologist and have appropriate training.
Dr. Paul Chrisp, director of the Center for Guidelines at NICE, said: “Chronic open-angle glaucoma is a serious condition, and our updated guideline will ensure that people who have it, or who suffer from ocular hypertension, receive prompt, effective treatment to improve their quality of life.”
“Usually, eye drops are initially prescribed to lower the pressure in the eye. However, evidence has shown that first-line treatment with selective laser therapy is more cost-effective than eye drops.
“The guideline was developed following public consultation last year and we recommend that local health departments that perform laser therapy provide training on the treatment to their staff. It is crucial that healthcare professionals discuss the benefits and risks with patients, family members and caregivers to agree on a treatment plan for each person.
NICE also pointed out that there was a lack of long-term evidence on the progression of glaucoma and optic nerve damage and recommended that further research be conducted in this area.
Further information on the Glaucoma Guideline, including information for the public, is available on the NICE website.
The guideline aims to reduce health inequalities, it is recognized that the use of eye drops is more difficult for certain groups, including people with cognitive and physical impairments and people with learning disabilities.