What are the current NICE guidelines for the pharmacological management of primary open-angle glaucoma?

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 ¹.

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 ¹.

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 ¹.

In cases where IOP cannot be sufficiently controlled with SLT or pharmacological treatment, referral to a consultant ophthalmologist is recommended to discuss further options ¹.