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Glaucoma is still a significant cause of sight loss (maintained at around 10 to 12 per cent) in the UK. The benefits of screening, diagnosis and effective intervention cannot be argued with.

Much of the new NICE guidelines simply echo what is already in place. Suspicious disc changes and repeatable field loss require referral to a specialist. It is perhaps the referral or monitoring of ocular hypertension (OHT) that is the most controversial. The guidelines define this as an intraocular pressure (IOP) of over 21mmHg.

In the original consultation of the proposed guidelines, one of several comments put forward by ABDO, AOP and FODO representation stated: 'Currently a very large number of patients with IOP greater than 21mmHg, but with no other signs of glaucoma, are being successfully monitored by optometrists in the community with no evidence of visual loss occurring as a result.'