RecommendationOffer alternative pharmacological treatment (a prostaglandin analogue, beta-blocker, carbonic anhydrase inhibitor or sympathomimetic) to people with OHT or suspected COAG and high IOP who are intolerant of the current medication.
Relative values of different outcomesThe surrogate outcome is IOP reduction which in turn reduces the risk of future conversion to COAG in people with elevated IOP. Intolerance to one medication may require use of an alternative provided costs are broadly similar.
Trade off between clinical benefits and harmsSide effects of topical glaucoma medications may cause significant morbidity for patients. Intolerance to medications is likely to lead to poor persistence.
Economic considerationsBeta-blockers are cost-effective for patients with IOP 21–32 mmHg, CCT <555 μm who cannot be treated with PGA. PGA are cost-effective for patients with IOP 25 – 32 mmHg, CCT 555 – 590 μm who cannot be treated with BB only up to the age of 60.
Quality of evidenceThere is no direct clinical evidence.
The economic evidence has minor limitations and direct applicability.
Other considerationsNone

From: 7, Treatment of ocular hypertension and suspected chronic open angle glaucoma

Cover of Glaucoma
Glaucoma: Diagnosis and Management of Chronic Open Angle Glaucoma and Ocular Hypertension.
NICE Clinical Guidelines, No. 85.
National Collaborating Centre for Acute Care (UK).
Copyright © 2009, National Collaborating Centre for Acute Care.

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