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

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.

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

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

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.

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).

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.