Innovation in glaucoma care

There is considerable interest in the development of surgical techniques to improve the drainage of aqueous without the need for external filtration by establishing a direct connection between the anterior chamber and Schlemm’s canal, bypassing the trabecular meshwork.   None of these has so far displaced trabeculectomy as the most frequently performed drainage procedure. Some of these procedures involve novel implantable devices.

NICE has reviewed the following procedures:

IPGG397 (Trabeculectomy ab interno for open angle glaucoma 2011). It concludes that there is sufficient evidence of safety and efficacy to support its use providing that normal arrangements are in place for clinical governance, consent and audit.

IPG260 (Canaloplasty for primary open angle glaucoma 2008). It concludes that there is not yet sufficient evidence of safety and efficacy to recommend its routine use and that  it should only be used in the context of research of formal prospective data collection.

A number of glaucoma services have changed the way in which care is delivered to involve a wider range of health care professionals, such as nurses and optometrists, with the consultant taking a more managerial role. In some services, the consultant in charge of the service may undertake remote reviews of patient care based on measurements taken by technicians.