Primary Open-Angle Glaucoma Preferred Practice Pattern

Publication Date: November 11, 2020
Last Updated: March 14, 2022

Primary Open-Angle Glaucoma Preferred Practice Pattern

Adherence interventions are left to the judgment of the treating ophthalmologist. (I-, In - Insufficient quality, S - Strong recommendation)
569
In consultation with the individual patient, treating ophthalmologists should use perioperative medications if temporary IOP elevations are a concern. (I+, M - Moderate quality, S - Strong recommendation)
569
A 2005 Cochrane Systematic Review concluded that antifibrotic agents may be used intraoperatively and postoperatively to reduce the subconjunctival scarring after trabeculectomy that can result in failure of the operation, and therefore intraoperative MMC should be used. (I+, M - Moderate quality, S - Strong recommendation)
569
The routine administration of postoperative 5-FU is not recommended, but should be based on individualized considerations for the patient. (I++, M - Moderate quality, S - Strong recommendation)
569
The selection of aqueous shunts or trabeculectomy should be left to the discretion of the treating ophthalmologist, in consultation with the individual patient. (I-, In - Insufficient quality, S - Strong recommendation)
569
A 2005 Cochrane Systematic Review concluded that MMC may be used intraoperatively to reduce the subconjunctival scarring after trabeculectomy that can result in failure of the operation, but found no evidence on the use of MMC in combined cataract and glaucoma surgery. (I+, M - Moderate quality, S - Strong recommendation)
569
The selection of a combined surgery or cataract surgery alone can be left to the discretion of the treating ophthalmologist in consultation with the individual patient. (I-, In - Insufficient quality, S - Strong recommendation)
569
The selection of viscocanalostomy and deep sclerectomy over trabeculectomy should be left to the discretion of the treating ophthalmologist, in consultation with the individual patient. (I-, In - Insufficient quality, S - Strong recommendation)
569
The selection of iStent or medications should be left to the discretion of the treating ophthalmologist, in consultation with the individual patient. (I-, In - Insufficient quality, S - Strong recommendation)
569
A 2020 Cochrane Systematic Review found moderate evidence that the Hydrus microstent in the short term is more effective when compared to iStent for lowering IOP in patients with OAG. (I+, M - Moderate quality, S - Strong recommendation)
569
The selection of the Xen gel stent should be left to the discretion of the treating ophthalmologist, in consultation with the individual patient. (I-, In - Insufficient quality, D - Discretionary recommendation)
569
The selection of cyclophotocoagulation over other procedures should be left to the discretion of the treating ophthalmologist, in consultation with the individual patient. (I-, In - Insufficient quality, D - Discretionary recommendation)
569

Recommendation Grading

Overview

Title

Primary Open-Angle Glaucoma Preferred Practice Pattern

Authoring Organization

American Academy of Ophthalmology

Publication Month/Year

November 11, 2020

Last Updated Month/Year

April 1, 2024

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adult, Older adult

Health Care Settings

Ambulatory, Hospital, Long term care

Intended Users

Optometrist, optician, nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Diagnosis, Management

Diseases/Conditions (MeSH)

D005902 - Glaucoma, Open-Angle

Keywords

open-angle glaucoma, intraocular pressure, stereoscopic photography, progressive optic neuropathy

Supplemental Methodology Resources

Data Supplement