NICE guidelines raise concern for COAG care

Hospital eye departments will be overwhelmed by a mass of referrals if the National Institute for Health and Clinical Excellence's draft guidance for the management of glaucoma and ocular hypertension are implemented unchecked.

NICE published the draft for consultation Glaucoma: diagnosis and management of chronic open-angle glaucoma and ocular hypertension late last year. This suggests only those with the College of Optometrists' Diploma in Glaucoma should manage COAG or ocular hypertension above 21mm Hg.

The optical bodies have welcomed the clarity of the guidelines, saying it would provide a universal structure for referral and monitoring between the primary and secondary sectors. However, they added that if the large number of patients with intraocular pressure above 21mm Hg, but with no other signs, were put into the hospital system for gonioscopy it would overwhelm the system with false-positive patients.