{
  "abstract": "ForewordWe 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-HeathGlaucoma UK Professor of Ophthalmology, UCL IntroductionThe 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.orgEditorsMarta PazosCarlo E. TraversoAnanth ViswanathanEvidence-Based Working GroupMethodological oversightAugusto Azuara-Blanco Manuele MichelessiLeaders of evidence reviewAugusto Azuara-Blanco Manuele Michelessi (EGS)Marta Pazos (EGS)Riaz Qureshi (US Cochrane Eyes and Vision Group)Evidence reviewAugusto Azuara-Blanco João Barbosa Breda Carlo Alberto CutoloGerhard GarhöferManuele MichelessiMarta PazosVerena ProkoshAndrew TathamEvidence consensus panelLuís Abegão PintoAugusto Azuara-BlancoGauti JóhannessonMarta PazosNorbert PfeifferIngeborg StalmansAndrew TathamCarlo E. TraversoAnanth ViswanathanEvidence patient’s feedback panelStelios GeorgoulasMarta PazosAndrew TathamThe Guidelines Task ForceLuís Abegão PintoEleftherios AnastasopoulosFlorent AptelAugusto Azuara-Blanco (advisor)João Barbosa BredaLuca BagnascoChiara BonzanoRupert BourneCarlo Alberto CutoloTheodoros FilippopoulosPanayiota FountiGerhard GarhöferGus GazzardDimitrios GiannoulisMichele IesterAndreas KatsanosAnthony KhawajaMiriam KolkoAntoine LabbéSophie LemmensManuele MichelessiAna MiguelFrancesco OddoneMarta Pazos (chair)Verena ProkoschAlessandro RabioloAlexander K SchusterCédric SchweitzerRiccardo ScottoAndrew TathamMarc Toeteberg-HarmsFotis TopouzisCarlo E. Traverso (chair)Ananth Viswanathan (chair)The Guidelines Writers, Authors and ContributorsLuís Abegão PintoIke AhmedZeynep AktasAugusto Azuara-BlancoAlessandro BagnisJoão Barbosa BredaChiara BonzanoRupert BournePaola CassotanaMaria Francesca CordeiroCarlo Alberto CutoloBarbara CvenkelPanayiota FountiJulian García-FeijooGerhard GarhöferTed Garway-HeathDaniele GaudenziGus GazzardStelios GeorgoulasFrancisco GoñiFranz GrehnAnders HejilEsther HoffmanMichele IesterGauti JóhannessonAnthony KhawajaAnthony KingMiriam KolkoEvgenia KonstantakopoulouYves LachkarSanna LeinonenSophie LemmensKarl MerciecaManuele MichelessiFrancesco OddoneMarta PazosDorothea PetersNorbert PfeifferVerena ProkoschLuca RossettiJohn SalmonLeopold SchmettererCédric SchweitzerRiccardo ScottoIngeborg StalmansGordana Sunaric-MégevandIan TapplyAndrew TathamJohn ThygessenFotis TopouzisCarlo E. TraversoNeeru VallabhAnanth ViswanathanThe Guidelines Internal ReviewersLuís Abegão PintoElefterios AnastasopoulosFlorent AptelJoão Barbosa BredaHenny BeckersChiara BonzanoRupert Bourne (ccordinator)Alain BronCarlo A. CutoloBarbara CvenkelTheodoros FilippopoulosPanayiota FountiGerhard GarhöferDimitrios GiannoulisFranz GrehnIngrida JanulevicieneStylianos KandarakisAndreas KatsanosAnthony KhawajaAnthony KingJames KirwanMiriam KolkoAntoine LabbéSanna LeinonenSophie LemmensKeith MartinJose Maria Martinez de la CasaFrances Meier-GibbonsStefano MigliorAna MiguelGiovanni MontesanoMarta PazosSergei PetrovVerena ProkoschAlessandro RabioloCédric SchweitzerAlexander K SchusterIngeborg StalmansMarc Toeteberg-HarmsFotis TopouzisCarlo E. TraversoAnja TuulonenAnanth ViswanathanZoya VeselovskayaIlgaz YalvaçMia Zoric GeberThe Experts by Experience Group (patients’ panel)Kate BackhausCarol BronzeAsle HaaukasMona KriegDeborah LoiDora RoloSarah TaylerTeam of Clinica Oculistica - University of Genova, Policlinico Ospedale San martino IRCCS - for medical editing and graphicsLuca BagnascoAlessandro BagnisChiara BonzanoPaola Cassottana (EGS Fellow)Carlo CattiCarlo Alberto CutoloDaniele Gaudenzi (EGS Fellow)Michele IesterMaria MusolinoRiccardo ScottoCarlo E. TraversoExternal Reviews from Glaucoma Societies AGSAPGSWGALAGSPAGSThe EGS Executive CommitteeIngeborg Stalmans (President)Luís Abegão Pinto (Vice President)Norbert Pfeiffer (Treasurer)Fotis Topouzis (Past President)Gauti Jóhannesson (Secretary)Marta Pazos (Adjunct Secretary)Panayiota FountiSanna LeinonenLuca RosettiThe Board of The EGS FoundationCarlo E. TraversoFotis TopuzisJohn ThygesenFranz GrehnAnders HeijlAll contributors have provided the appropriate COI visible in detail at www.eugs.org/pages/guidesurgical/ Glossary5-FU 5-fluorouracilAAC Acute angle closureACG Angle closure glaucomaAGIS Advanced glaucoma intervention studyAH Aqueous humourAI Artificial intelligenceALT Argon laser trabeculoplastyANA-LIS Singapore asymptomatic narrow angles laser iridotomy studyAS-OCT Anterior Segment OCTBAC Benzalkalonium chlorideCCT Central corneal thicknessCDR Cup to disc ratioCGRN Childhood glaucoma research networkCIGTS Collaborative initial glaucoma treatment studyCNTGS Collaborative normal tension glaucoma studyDCT Dynamic contour tonometryEAGLE Effectiveness of early lens extraction for the treatment of primary angle closure glaucomaEbE Expert by experienceEGPS European glaucoma prevention studyEGS European glaucoma societyEMA The European Medicines AgencyEMGT Early manifest glaucoma trialFC Fixed combinationFc Flow chartFDT Frequency doubling technologyFL Fixation lossesFN False negativesFP False positiveGAT Goldmann applanation tonometryGC Ganglion cellGDD Glaucoma long tube draining deviceGHT Glaucoma hemifield testGITS Glaucoma intensive treatment studyGRADE Grading of recommendations, assessment, development and evaluationsHRT Heidelberg retina tomographyICE Irido-corneal endothelial syndromeIOL Intraocular lensIOP Intraocular pressureIPL IridoplastyITC Iridotrabecular contactIV IntravenousLiGHT Laser in glaucoma and ocular hypertension trialLoGTS Low-tension glaucoma treatment studyLPI Laser peripheral iridotomyLV Loss varianceMD Mean defect or mean deviationMIBS Minimally Invasive Bleb-forming ShuntsMIGS Minimally invasive glaucoma surgeryMMC Mitomycin CNCT Non-contact tonometryNd:YAG Neodymium-doped yttrium aluminum garnetNTG Normal tension glaucomaOAG Open angle glaucomaOCT Optical coherence tomographyOHT Ocular hypertensionOHTS The ocular hypertension treatment studyONH Optic nerve headORA Ocular response analyserOSD Ocular surface disease PAC Primary angle closurePACG Primary angle closure glaucomaPACS Primary angle closure suspectPAS Peripheral anterior synechiaePCG Primary congenital glaucomaPDS Pigment dispersion syndromePGA Prostaglandin analoguePOAG Primary open angle glaucomaPG Pigmentary glaucomaPRS Polygenic risk scorePSD Pattern standard deviationPTVT Primary tube versus trabeculectomy studyPXF Pseudoexfoliation syndromePXFG Pseudoexfoliation glaucomaRCT Randomised controlled trialRNFL Retinal nerve fiber layerRoP Rate of progressionSAP Standard automated perimetrySITA Swedish interactive threshold algorithmSLT Selective laser trabeculoplastySWAP Short-wavelength automated perimetryTAGS Treatment of advanced glaucoma studyTLPI Thermal laser peripheral iridoplastyTM Trabecular meshworkTVT Tube versus trabeculectomy studyUBM Ultrasound biomicroscopyUGH Uveitis-glaucoma-hyphaema syndromeUKGTS United Kingdom glaucoma treatment studyVEGF Vascular endothelial growth factorVF Visual fieldVFI Visual field indexZAP Zhongshan angle closure prevention trial",
  "authors": [
    {
      "affiliations": [],
      "name": "Marta Pazos"
    },
    {
      "affiliations": [],
      "name": "Carlo E. Traverso"
    },
    {
      "affiliations": [],
      "name": "Ananth Viswanathan"
    },
    {
      "affiliations": [],
      "name": "European Glaucoma Society"
    },
    {
      "affiliations": [],
      "name": "The Guidelines Task Force"
    },
    {
      "affiliations": [],
      "name": "The Guidelines Writers, Authors and Contributors"
    },
    {
      "affiliations": [],
      "name": "The Guidelines Internal Reviewers"
    },
    {
      "affiliations": [],
      "name": "The Experts by Experience group (patients’ panel)"
    },
    {
      "affiliations": [],
      "name": "Team of Clinica oculistica of the university of Genoa for medical editing and graphics"
    },
    {
      "affiliations": [],
      "name": "External Reviews"
    },
    {
      "affiliations": [],
      "name": "The EGS Executive Committee"
    },
    {
      "affiliations": [],
      "name": "The Board of The EGS Foundation"
    }
  ],
  "title": "European Glaucoma Society – Terminology and guidelines for glaucoma, 6th Edition",
  "uid": "25d2349c-6e6f-5b68-841d-9e0b2053d354"
}