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

J. Galvez-Olortegui,Rachid Bouchikh El Jarroudi,I. Silva-Ocas,Susan Bernales-Urbina,Rosmery Mollo-Bautista,C. Burgueño-Montañes,T. Galvez-Olortegui

Published 2025 in Journal of glaucoma

ABSTRACT

PRCIS 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. TOPIC To assess the methodological quality of Clinical Practice Guidelines for the diagnosis and management of open angle glaucoma (OAG). CLINICAL RELEVANCE An assessment of the methodological quality of Clinical Practice Guidelines for the diagnosis and management of open angle glaucoma (OAG) is reported. METHODS 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 seven 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. Additionally, a meta-synthesis of the recommendations for the most relevant outcomes of each guideline was performed. RESULTS 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 four 'clarity of presentation'. British (92%), Peruvian (77%) and Spanish (75%) guidelines presented the best score in domain three '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). CONCLUSIONS British, Peruvian and Spanish guidelines for the diagnosis and management of OAG have a high methodological quality, and high scores in applicability. On the other hand, European guideline have high scores in applicability and moderate quality.

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