A systematic review of clinical practice guidelines for childhood glaucoma

Author: Lingham G, Thakur S, Safi S, Gordon I, Evans JR, Keel S.

Geographical coverage: United States of America (USA) and Australia

Sector: Service delivery

Sub-sector: Quality of clinical practice guidelines

Equity focus: Not reported

Study population: Paediatric patients with glaucoma

Review type: Effectiveness review

Quantitative synthesis method: Narrative synthesis

Qualitative synthesis method: Not applicable

Background

Childhood glaucoma is a relatively rare cause of vision loss, affecting approximately 5.4 per 100,000 individuals in the United Kingdom, with higher rates reported in Asian populations. It accounts for 10% of childhood blindness in Africa and 3% in the United States. Although treatments are available, outcomes often remain suboptimal, impacting the quality of life of both patients and caregivers. As a result, the World Health Organization (WHO) has prioritised childhood glaucoma in its Package of Eye Care Interventions (PECI), aimed at improving global eye care services.

Objectives

To conduct a systematic review to identify and critically appraise clinical practice guidelines on the assessment, diagnosis, and management of childhood glaucoma.

Main findings

Overall, the review did not identify any high-quality clinical practice guidelines, highlighting the urgent need for robust guidance to enhance evidence-based management of childhood glaucoma.

Of the 68 reports identified, only three studies met the inclusion criteria. None of these guidelines were developed specifically for childhood glaucoma. Two were from the United States and focused on paediatric eye examinations, while one from Australia included childhood glaucoma within broader glaucoma management.

A common recommendation across the guidelines was that children should receive eye screening or comprehensive assessments to detect paediatric eye disease. Additional screening was advised for those at high risk of childhood glaucoma. One guideline recommended interventions including tube surgery and topical beta-blockers or carbonic anhydrase inhibitors.

Most recommendations were based on low to moderate levels of evidence or expert opinion, underlining the lack of robust, condition-specific data.

Methodology

The literature search was conducted on 9 March 2020 in Medline, Embase, CINAHL, Global Index Medicus, and several guideline databases and websites maintained by optometry and ophthalmology associations. The aim was to identify English-language guidelines on childhood glaucoma published in the previous ten years.

Two reviewers independently screened the titles, abstracts, and full texts of the retrieved records against predefined eligibility criteria. Discrepancies were resolved through discussion or consultation with a third reviewer. One reviewer extracted data using a standardised form, with all data checked for accuracy by a second reviewer. Study quality was assessed independently by two reviewers using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. The findings were synthesised narratively.

Applicability / External validity

Only three guidelines were included in the review—two from the United States and one from Australia. None were developed specifically for childhood glaucoma, limiting the applicability of the review’s findings.

Geographic focus

The included guidelines originated from the United States and Australia.

Summary of quality assessment

There is medium confidence in the review’s conclusions. The study applied language restrictions and limited the timeframe to the past decade, which may have excluded relevant guidelines.