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Journal article
For Which Glaucoma Suspects Is It Appropriate to Initiate Treatment?
Ophthalmology (Rochester, Minn.), v 116(4), pp 710-716
01 Apr 2009
PMID: 19344823
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Objective: Because uncertainty exists about which glaucoma suspects should be treated, this study sought to identify the glaucoma suspects who an expert panel could agree would be appropriate or inappropriate to treat.
Design: The RAND/UCLA appropriateness method, a well-established procedure to synthesize the scientific literature with expert opinion to resolve uncertainty on a health topic.
Participants: Eleven-member panel composed of recognized international leaders in the field of glaucoma.
Methods: Based on a systematic review of the literature on potentially important factors to consider when deciding to initiate treatment, more than 1000 scenarios of glaucoma suspects initially were created. The panel formally rated the appropriateness of initiating treatment for glaucoma suspects through a 2-round modified Delphi method, a technique that preserves the confidentiality of individual panelists' ratings but allows panelists to compare their own ratings with those of the entire panel.
Main Outcome Measures: Final ratings for scenarios were categorized as appropriate, uncertain, or inappropriate to treat according to typical prespecified statistical criteria previously used in projects using the RAND/UCLA appropriateness method. Tools were developed to help clinicians to approximate the panel ratings of glaucoma suspects.
Results: The panel chose age, life expectancy, intraocular pressure (IOP), central corneal thickness, cup-to-disc ratio, disc size, and family history as the variables to consider when deciding whether to treat glaucoma suspects. Permutations of these variables created 1800 unique scenarios. The panel rated 587 (33%) scenarios as appropriate, 585 (33%) as uncertain, and 628 (35%) as inappropriate for treatment initiation. Analysis of variance determined that IOP had greater impact than any other variable on panel ratings. A point system was created with 96% sensitivity and 93% specificity for predicting panel ratings of appropriateness for a glaucoma suspect.
Conclusions: An expert panel can reach agreement on the appropriateness and inappropriateness of treatment for glaucoma suspects.
Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. Ophthalmology 2009; 116:710-716 (C) 2009 by the American Academy of Ophthalmology.
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Details
- Title
- For Which Glaucoma Suspects Is It Appropriate to Initiate Treatment?
- Creators
- Eric M. Cheng - University of California, Los AngelesJoAnn A. Giaconi - University of California, Los AngelesAnne L. Coleman - University of California, Los AngelesBrian L. Lee - Kaiser PermanenteRobert N. Weinreb - University of California San DiegoSydne J. Newberry - RAND CorporationMarika J. Suttorp - RAND CorporationMatthias Schonlau - RAND CorporationMurray FingeretNeeru Gupta - University of TorontoRoger A. Hitchings - Moorfields Eye HospitalHenry D. Jampel - Johns Hopkins UniversityThomas L. Lewis - Salus UniversityStefano MigliorRichard P. Mills - Swedish Medical CenterNorbert Pfeiffer - Johannes Gutenberg University MainzFotis Topouzis - Aristotle University of ThessalonikiThomas W. Samuelson - Minnesota Eye ConsultantsAppropriateness of Treating Glaucoma Suspects RAND Study Group
- Publication Details
- Ophthalmology (Rochester, Minn.), v 116(4), pp 710-716
- Publisher
- Elsevier
- Number of pages
- 7
- Grant note
- K23NS058571 / NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Neurological Disorders & Stroke (NINDS) K23NS058571 / National Institute of Neurological Disorders and Stroke (NINDS, Washington, DC); United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Neurological Disorders & Stroke (NINDS) Pfizer, Inc., New York, New York; Pfizer
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Pennsylvania College of Optometry (PCO)
- Web of Science ID
- WOS:000264814600016
- Scopus ID
- 2-s2.0-63149163756
- Other Identifier
- 991022022610204721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Ophthalmology