Primary Open-Angle Glaucoma Preferred Practice Pattern
Publication Date: November 12, 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 12, 2020
Last Updated Month/Year
February 7, 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