European Glaucoma Society – Terminology and guidelines for glaucoma, 6th Edition

Abstract

Foreword We practice medicine in times of exponentially increasing medical knowledge. In 1950, it was estimated that the doubling time was 50 years; by 1980, it was 7 years and by 2010, 3.5 years. In 2020, it was projected to be just 73 days! To continue to practice evidence-based medicine and to provide the best possible care for our patients, clinicians need to adapt their strategies to keep their knowledge up to date. There will always be a role for critical appraisal of individual studies in the field of a clinician’s practice, but with such an increase in the volume of published research, it becomes impossible to appraise all relevant material. For this reason, sources of distilled knowledge, such as the EGS Guidelines, become essential references for best practice medicine. Rigorous methods for evidence synthesis, such as the systematic reviews overseen by Cochrane, provide a comprehensive summary of the current state of knowledge for important clinical questions. However, for many clinical uncertainties, there is little or no high-quality evidence, let alone an evidence synthesis. Where evidence is lacking, practice guidance needs to be built from expert opinion and consensus, while acknowledging the limitations of such an approach. Expert opinion, derived from sound medical knowledge and years of practice experience, also has an important role in understanding the relevance of lines of evidence and the nuances of implementing them in practice. Thus, the expert commentary around the evidence base given in these Guidelines is essential for proper implementation of published evidence. Importantly, the EGS Guidelines also include ‘Choosing wisely’ elements indicating actions which should be avoided due to insufficient evidence and/or unsubstantiated belief. Guidelines need regular updating to take account of new knowledge and aspects of clinical care that have not been given sufficient emphasis in the past. This 6th Edition of the EGS Guidelines includes an updated ‘evidence based’ section with new clinical questions and evidence-based answers. The section ‘What matters to patients’ has also been updated, recognising that, because Guidelines are typically written by clinicians for clinicians, there have been gaps in understanding the patient perspective. The updated section now has direct input from the Expert by Experience patient advisors in the EGS Patient Involvement Project and includes eight Tips for Doctors in their communication with patients. The Guidelines team, led by Drs Pazos, Traverso and Viswanathan, is to be congratulated for the 6th Edition of the Guidelines, updating and enhancing the previous edition, while maintaining the highly success format which gives a framework for glaucoma care, based on evidence synthesis and consensus expert opinion, and presented as a ‘How to’ manual for patient diagnosis and management. David (Ted) Garway-Heath Glaucoma UK Professor of Ophthalmology, UCL Introduction The European Glaucoma Society Guidelines are at the heart of our educational mission serving not only our members, but all involved in glaucoma care. Previous editions have been among the most widely accessed documents in the field, helping navigate the growing complexity of glaucoma research and clinical practice. This sixth edition reaffirms our commitment to evidence-based, patient-centred care. It builds on the solid foundations of past editions while embracing key innovations that reflect new scientific insights, emerging technologies, and evolving priorities in glaucoma care. For the first time, we collaborated closely with patient representatives through the Experts by Experience (EbE) group. Their contributions helped shape clinical questions and emphasized the importance of empathy, communication, and psychological support in managing glaucoma. The Guidelines maintain a dual purpose: to answer clinically relevant questions through a rigorous evidence-based approach, and to offer comprehensive, practical knowledge for daily use. We have updated existing recommendations and added new topics, including artificial intelligence, cost-effectiveness, adherence strategies, and paediatric glaucoma. A new “Choosing Wisely” section provides clear guidance to avoid low-value interventions. We extend our heartfelt thanks to all contributors and collaborators. This includes the many colleagues who authored and reviewed chapters with great care and expertise, the patient representatives who generously shared their lived experiences, and the team at the University of Genoa, who worked tirelessly to refine content and layout, ensuring clarity and consistency throughout. A very special word of thanks goes to the Editors Marta Pazos, Carlo Traverso, and Ananth Viswanathan, whose relentless dedication, critical oversight, and countless hours of work were instrumental in shaping the high quality and coherence of this edition. Their leadership and perseverance have been extraordinary. Together, these collective efforts have made this edition a cornerstone of our vision: to foster innovation, strengthen education, enhance communication, and promote best practices in glaucoma care across Europe and beyond. Ingeborg Stalmans and Luis Abegao Pinto www.eugs.org Editors Marta Pazos Carlo E. Traverso Ananth Viswanathan Evidence-Based Working Group Methodological oversight Augusto Azuara-Blanco Manuele Michelessi Leaders of evidence review Augusto Azuara-Blanco Manuele Michelessi ( EGS ) Marta Pazos ( EGS ) Riaz Qureshi ( US Cochrane Eyes and Vision Group ) Evidence review Augusto Azuara-Blanco João Barbosa Breda Carlo Alberto Cutolo Gerhard Garhöfer Manuele Michelessi Marta Pazos Verena Prokosh Andrew Tatham Evidence consensus panel Luís Abegão Pinto Augusto Azuara-Blanco Gauti Jóhannesson Marta Pazos Norbert Pfeiffer Ingeborg Stalmans Andrew Tatham Carlo E. Traverso Ananth Viswanathan Evidence patient’s feedback panel Stelios Georgoulas Marta Pazos Andrew Tatham The Guidelines Task Force Luís Abegão Pinto Eleftherios Anastasopoulos Florent Aptel Augusto Azuara-Blanco ( advisor ) João Barbosa Breda Luca Bagnasco Chiara Bonzano Rupert Bourne Carlo Alberto Cutolo Theodoros Filippopoulos Panayiota Founti

Topics & Concepts