monitoring intervals for people with ocular hypertension (OHT), chronic open angle glaucoma (COAG) or suspected COAG who are recommended to receive medication

Last edited 02/2022 and last reviewed 06/2022

• techniques to monitor in COAG and OHT
  • at each assessment, offer the following tests to people with COAG, people suspected of having COAG and people with OHT:
    • Goldmann applanation tonometry (slit lamp mounted) anterior segment slit lamp examination
    • with van Herick peripheral anterior chamber depth assessment when clinically indicated
      
      
  • when clinically indicated
    • repeat gonioscopy, for example, where a previous examination has been inconclusive or where there is suspicion of a change in clinical status of the anterior chamber angle
      
      
  • when clinically indicated
    • repeat visual field testing using standard automated perimetry (central thresholding test) for people with COAG and those suspected of having visual field defects who are being investigated for possible COAG
      
      
  • when clinically indicated
    • repeat visual field testing using either a central thresholding test or a supra-threshold test for people with OHT and those suspected of having COAG whose visual fields have previously been documented by standard threshold automated perimetry (central thresholding test) as being normal
      
      
  • when a visual field defect has previously been detected
    • use the same measurement strategy for each visual field assessment
      
      
  • when clinically indicated, repeat assessment of the optic nerve head (for example, stereoscopic slit lamp biomicroscopy or imaging)
    
    
  • when a change in optic nerve head status is detected by stereoscopic slit lamp biomicroscopy
    • obtain a new optic nerve head image for the person's records to provide a fresh benchmark for future assessments
      
      
  • when an adequate view of the optic nerve head and surrounding area is unavailable at reassessment
    • people should have their pupils dilated before stereoscopic slit lamp biomicroscopy or optic nerve head imaging is repeated
      
      

• Time to next assessment for people being treated for OHT

  Conversion from OHT to COAG	Control of IOP	Time to next assessment*
  Not detected or uncertain conversion**	No	Review management plan and reassess between 1 and 4 months
  Uncertain conversion**	Yes	Reassess between 6 and 12 months
  No conversion detected	Yes	Reassess between 18 and 24 months
  Conversion	No or Yes	as per diagnosis and reassessment of COAG

  Time to next assessment for people with suspected COAG

  Conversion to COAG	Control of IOP	Time to next assessment*
  Not detected or uncertain conversion**	No	Review management plan and reassess between 1 and 4 months
  Uncertain conversion**	Yes	Reassess between 6 and 12 months
  No conversion detected	Yes	Reassess between 12 and 18 months
  Conversion	No or yes	as per diagnosis and reassessment of COAG

  Time to next assessment for people with COAG

  Progression of COAG	Control of IOP	Time to next assessment *
  Not detected	No	Review treatment plan and reassess between 1 and 4 months
  Uncertain progression** or progression	No	Review treatment plan and reassess between 1 and 2 months
  No progression detected and low clinical risk	Yes	Reassess between 12 and 18 months
  No progression detected and high clinical risk	Yes	Reassess between 6 and 12 months
  Uncertain progression** or progression	Yes	Review treatment plan and reassess between 2 and 6 months

  * Use clinical judgement to decide when the next appointment should take place within the recommended interval.

  **Uncertain progression includes having insufficient accurate information (perhaps because the person was unable to participate in the assessment).

Reference:

• 1. NICE (January 2022). Glaucoma: diagnosis and management of chronic open angle glaucoma and ocular hypertension