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G. A. Cioffi, P. P. Lee, M. B. Sultan, J. W. Grunden, IOP Consensus Panel; Assessing the Measurement and Value of IOP Changes in Glaucoma Using Modified Delphi Process With Glaucoma Experts. Invest. Ophthalmol. Vis. Sci. 2007;48(13):1267.
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To assess the degree of consensus among glaucoma experts (Barton, Burgoyne, Camras, Caprioli, Heijl, Jonas, Kuwayama, Susanna, Zimmerman) on the measurement, characterization, and potential implications of IOP and its fluctuation over time for glaucoma treatment.
A multinational panel of 9 glaucoma experts used a modified Delphi process to rate levels of agreement using a 9 point likert scale for 72 statements organized into 3 broad domains. The domains included methods of measuring IOP, the importance of reduction, and clinical implications of changes in IOP within a day (short term fluctuation), and over a longer time period (long term fluctuation). A literature review was provided to panelists to assist in independent ratings. Consensus and non-consensus was determined by applying a statistical definition with a binomial distribution. A group meeting was held to discuss the 72 statements, with emphasis of non-consensus or indeterminate agreement. Panelists were provided the results of the group ratings. After discussion, panelists independently re-rated the statements.
The panel found consensus in 46% of the 72 statements, 49% were indeterminate, and 6% identified as non-consensus. For example, panelists agreed that reduction of IOP fluctuation should include reduction in the IOP peak and that care of patients with advancing glaucoma should include measurement of long-term IOP fluctuation. Panelists also agreed that short-term IOP fluctuation is not accurately measured by three IOP measurements during typical office hours (8 am - 5 pm).
A modified Delphi process was useful in identifying areas of consensus regarding IOP measurement and the importance of IOP fluctuation among glaucoma experts. The panel agreed that adequate means of measuring IOP for clinical care exist, although the frequency at which IOP should be measured is poorly defined. The need for additional investigation for assessing the role of IOP changes in glaucoma management is highlighted by the indeterminate and non-consensus ratings among experts.
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