The NICE guidelines recommend offering 360° selective laser trabeculoplasty (SLT) as initial treatment for people with newly diagnosed chronic open-angle glaucoma (COAG), excluding cases associated with pigment dispersion syndrome, to delay the need for eye drops and reduce IOP, with information provided about its effects and side effects NICE NG81.
If SLT is not suitable, not effective, or the patient prefers, a generic prostaglandin analogue (PGA) should be offered to people with COAG or ocular hypertension (OHT) with IOP of 24 mmHg or more, demonstrating correct eye drop technique and scheduling reassessment NICE NG81.
For people who cannot tolerate PGAs, an alternative medication such as a beta-blocker may be offered, and if tolerated, treatment should be continued unless there is progression of optic nerve damage, visual field loss, or intolerance NICE NG81.
In cases where IOP cannot be sufficiently controlled with SLT or pharmacological treatment, referral to a consultant ophthalmologist is recommended to discuss further options NICE NG81.