Systematic review of clinical practice guidelines for the diagnosis and management of open angle glaucoma
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Background/Objectives : To assess the methodological quality of Clinical Practice Guidelines(CPG) for the diagnosis and management of open angle glaucoma(OAG). Methods : A systematic review of CPGs 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, CPG development institutions, ophthalmology associations and CPG repositories(PROSPERO:CRD42024510656). 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 was carried out. Results : The lowest mean scores were in applicability and rigour of development(mean 43.2% and 46.1% respectively). The highest score(mean 73.9%) 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’. Only NICE, EGS-5-TGG, SNS, and MaHTAS are recommended, the last two with modifications when evaluating the overall quality of the analyzed CPGs. Most of the CPGs used GRADE approach for making recommendations. In the meta-synthesis, the CPGs show similar recommendations, however, we found variability in indications for selective laser trabeculoplasty(SLT) and minimally invasive glaucoma surgery(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.
