Extracted assessment or intervention recommendations from eligible CPGs
| Assessment or intervention name | Recommendation | CPG | SoR | QoE | Remarks on recommendation |
| Screening to detect amblyopia or risk factors | The 2017 USPSTF report recommends vision screening for children aged 3–5 years of age to detect amblyopia or its risk factors | AAO | Strong | Good | |
| Examine individuals with first-degree relatives with glaucoma | …first-degree relatives of individuals diagnosed with glaucoma are considered at high risk of developing glaucoma themselves. It is recommended that they undergo a full ocular examination by a qualified healthcare provider, and receive ongoing monitoring for the development of glaucoma | NHMRC | Strong | Good | The following genetic syndromes have high associations with childhood glaucoma: Nail Patella syndrome with the LMX1B gene, Axenfeld Rieger syndrome/anterior segment dysgenesis with the PITX2 and FOXC1 genes and Aniridia with the PAX6 gene. Patients with these syndromes or mutations are usually followed closely for glaucoma. Congenital glaucoma is associated with Cyp1B1 mutations in 17% of Australian families. |
| Monitor long-term users of steroids for glaucoma | …long-term users of steroids by any route of administration are at increased risk of glaucoma, and thus require surveillance. | NHMRC | Intermediate | Moderate | There is no evidence from the secondary literature regarding the risk factors for, or progression of secondary glaucoma. |
| Comprehensive eye and vision examination of infants (6–12 months of age) | Infants should receive an in-person comprehensive eye and vision assessment between 6 and 12 months of age for the prevention and/or early diagnosis and treatment of sight-threatening eye conditions and to evaluate visual development | AOA | Strong | Moderate | |
| Comprehensive eye and vision examination of children (3–5 years of age) | Preschool age children should receive an in-person comprehensive eye and vision examination at least once between the ages of 3 and 5 years to prevent and/or diagnose and treat any eye or vision conditions that may affect visual development | AOA | Strong | Moderate | |
| Comprehensive eye and vision examination before beginning school | School-age children should receive an in-person comprehensive eye and vision examination before beginning school to diagnose, treat and manage any eye or vision conditions | AOA | Strong | Moderate | |
| Annual comprehensive eye and vision examination of school-age children | School-age children should receive an in-person comprehensive eye and vision examination annually to diagnose, treat and manage eye or vision problems | AOA | Not stated | Expert opinion | |
| Assess intraocular pressure | …assessment of intraocular pressure in all individuals with suspected glaucoma, as it is a significant risk factor for the development of all forms of glaucoma | NHMRC | Strong | Good | |
| Assess optic cup:disc ratio and cup:disc ratio symmetry | Evidence supports assessment of cup:disc ratio, and cup:disc ratio asymmetry, when assessing the risk of glaucomatous damage occurring… Evidence supports the value of validated optic disc comparison techniques (simultaneous stereo photograph comparison and confocal scanning laser tomography) in order to detect longitudinal changes in the optic nerve | NHMRC | Intermediate | Moderate | |
| Gonioscopy of both eyes | …gonioscopic examination of both eyes is required when making a diagnosis of glaucoma | NHMRC | Weak | Expert opinion | |
| Visual field testing | …visual field testing is invaluable to diagnose glaucoma…advancing age, visual acuity, patient capability, concurrent ocular conditions, oculo-facial anatomy and spectacle scotomata all impact on the results and interpretation of visual field testing | NHMRC | Weak | Expert opinion | |
| Assess target intraocular and reduce if glaucomatous progression identified | …assess target intraocular pressure at each ocular review, within the context of glaucomatous progression and quality of life. Evidence strongly supports a further 20% reduction in target intraocular pressure when glaucomatous progression is identified | NHMRC | Strong | Good | |
| Topical beta-blockers | Evidence supports using beta-blockers in infants and children where necessary | NHMRC | Intermediate | Low | To limit potential adverse effects, it is important to adhere to dosage times, use nasolacrimal system occlusion (if at all possible in small children) and use the minimum dose or limit the number of medications required. |
| Topical beta-blockers— precautions | Evidence suggests using beta-blockers with caution in premature and small infants, as bradycardia, bronchospasm and hypoglycaemia have been reported | NHMRC | Intermediate | Low | To limit potential adverse effects, it is important to adhere to dosage times, use nasolacrimal system occlusion (if at all possible in small children) and use the minimum dose or limit the number of medications required. |
| Carbonic anhydrase inhibitors | Evidence indicates caution when using topical and systemic carbonic anhydrase inhibitors in children, in situations where glaucoma is resistant to other treatment and/or prior to surgery | NHMRC | Intermediate | Low | To limit potential adverse effects, it is important to adhere to dosage times, use nasolacrimal system occlusion (if at all possible in small children) and use the minimum dose or limit the number of medications required. |
| Tube surgery |
| NHMRC | Strong | Moderate | Tube surgery should be considered for the primary procedure in patients in whom trabeculectomy is likely to fail, such situations include some severely traumatised eyes and secondary paediatric glaucomas. |
AAO, American Academy of Ophthalmology; AOA, American Optometric Association; CPG, clinical practice guideline; NHMRC, National Health and Medical Research Council; QoE, quality of evidence (good, moderate, low expert opinion); SoR, strength of recommendation (strong, intermediate, weak); USPSTF, United States Preventive Services Task Force.