Systematic Review of Clinical Practice Guidelines for the Diagnosis and Management of Open Angle Glaucoma.

PRÉCIS: Clinical Practice Guidelines for Open Angle Glaucoma (OAG) have evolved through the years and differ in their methodological quality. British, Peruvian, and Spanish guidelines have a high methodological quality.

TOPIC: To assess the methodological quality of Clinical Practice Guidelines for the diagnosis and management of open angle glaucoma (OAG).

CLINICAL RELEVANCE: An assessment of the methodological quality of Clinical Practice Guidelines for the diagnosis and management of open angle glaucoma (OAG) is reported.

METHODS

A systematic review of Clinical Practice Guidelines for the diagnosis and management of OAG, published between January 2017 and November 2024, was carried out with a search in databases, meta-search engines, guidelines development institutions, ophthalmology associations and guidelines repositories (CRD42024510656). Guidelines were selected if they were published in English/Spanish during the last 7 years. Five authors evaluated them independently, using the Appraisal of Guidelines for Research and Evaluation (AGREE-II) instrument. An individual assessment by domain (AGREE-II), an overall assessment of the guide, and its use with or without modifications was performed. High-quality guideline was considered with at least 3/6 domains >60% including domain 3. In addition, a meta-synthesis of the recommendations for the most relevant outcomes of each guideline was performed.

RESULTS

Eleven guidelines (20% of the 55 guidelines retrieved) published in English/Spanish, between 2017 and 2024 were selected. The lowest mean scores were in applicability and rigour of development (mean 43% and 46%, respectively). The highest score (mean 73%) was for domain 4 "clarity of presentation." British (92%), Peruvian (77%), and Spanish (75%) guidelines presented the best score in domain 3 "Rigour of development." When applying AGREE-II criteria for the overall guideline assessment, British and Spanish guidelines have the highest overall quality (6 and 5 scores, respectively). Most of the guidelines used GRADE approach for making recommendations. In the meta-synthesis, the guidelines show similar recommendations; however, we found variability in indications for selective laser trabeculoplasty (SLT) and minimally invasive glaucoma surgery (MIGS).

CONCLUSIONS

British, Peruvian, and Spanish guidelines for the diagnosis and management of OAG have a high methodological quality, and high scores in applicability. In contrast, European guideline have high scores in applicability and moderate quality.