Systematic review of clinical practice guidelines for the diagnosis and management of open angle glaucoma

Précis: Clinical Practice Guidelines(CPGs) for Open Angle Glaucoma(OAG) have evolved through the years and differ in their methodological quality. NICE, IETSI and SNSG have a high methodological quality, appraised with AGREE-II. Topic: To assess the methodological quality of Clinical Practice Guidelines (CPG) for the diagnosis and management of open angle glaucoma (OAG). Clinical relevance: An assessment of the methodological quality of Clinical Practice Guidelines (CPG) for the diagnosis and management of open angle glaucoma (OAG) is reported. Methods: A systematic review of CPGs for the diagnosis and management of OAG, published between January-2017 and November-2023, was carried out with a search in databases, metasearch engines, CPG development institutions, ophthalmology associations and CPG repositories. A search update was run in January 2024. Protocol was registered in the International Prospective Register of Systematic Reviews PROSPERO: CRD42024510656. Nine CPGs published in English/Spanish, between 2017 and 2024 were selected, and 5 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. Additionally, a meta-synthesis of the recommendations for the most relevant outcomes of each CPG was performed. Results: The lowest scores were in applicability and rigour of development (mean 47.9% and 48% respectively). The highest score (mean 72.1%) was for domain 4 ‘clarity of presentation’. NICE (92.1%), IETSI (77.5%) and SNSG (75.8%) presented the best score in domain 3 ‘Rigour of development’. When evaluating the overall quality of the CPGs analysed, only NICE, EGS-5-TGG, SNS and MaHTAS could be recommended with modifications. All the CPGs used GRADE approach for making recommendations. In the meta-synthesis, recommendations are similar between CPG, however variability was found in selective laser trabeculoplasty and minimally invasive glaucoma surgery indications (MIGS). Conclusions: NICE, IETSI and SNSG CPGs for the diagnosis and management of OAG, have a high methodological quality, appraised with AGREE-II. NICE, EGS-5-TGG, IETSI and SNSG have high scores in applicability.