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23 November 2021

NICE consultation on first line glaucoma treatment now open

The National Institute for Health and Care Excellence (NICE) manages which treatments are offered on the NHS in England, Wales and Northern Ireland. They decide which treatments provide the best outcome for patients, within the available resources of the NHS. As treatments for diseases are being developed all the time, NICE regularly reviews the processes they recommend.

NICE has now opened a consultation on guidelines for the diagnosis and management of glaucoma. For years, the most common treatment for glaucoma has been eye drops in a first instance, followed by laser if required. However, research has identified that SLT is cheaper and just as effective as eye drops as an initial treatment. NICE is therefore proposing that selective laser trabeculoplasty (SLT) should be the initial treatment offered to people when diagnosed. They would like feedback on whether to make SLT the first line of treatment for open angle glaucoma and ocular hypertension, followed by eye drops if needed.

What would this change this mean for glaucoma care in England, Wales and Northern Ireland?

  • Care for established glaucoma patients will not change. Neither will care for people with advanced glaucoma, or angle closure glaucoma.
  • People who are newly diagnosed with mild-moderate chronic open angle glaucoma (except for pigment dispersion glaucoma) and ocular hypertension will be offered SLT as the first treatment for their glaucoma. If they don’t want laser, or laser isn’t suitable for them, they will be offered eye drops.
  • The result is that people may have three to six years without eye drops, where their glaucoma is managed through laser. Once they’ve received several laser treatments, they may be put on eye drops.
  •  In Scotland, they have SIGN (Scottish Intercollegiate Guidelines Network), not NICE. It’s probable that SIGN guidelines will follow suit in due course.

The consultation is open to any adults with chronic open angle glaucoma or ocular hypertension, or who are at risk of developing glaucoma, their families and carers.

If you would like to offer your thoughts on the proposal, please email these to our helpline manager, Helen Doe, at by 3.00pm on Wednesday 1 December.

The full consultation documents are available to view on the NICE website.