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RP Mills, DL Budenz, PP Lee, RJ Noecker, JG Walt, SJ Evans; Categorizing The Progression of Glaucoma from Pre-diagnosis to End-stage Disease by A Novel Six Point Staging System . Invest. Ophthalmol. Vis. Sci. 2002;43(13):2160.
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Purpose:In order to conduct a multi-center retrospective chart review, with the purposes of assessing outcomes and resource utilization associated with glaucoma disease progression, a staging system was required to assign patients to independent disease severity categories. Since no universally accepted glaucoma staging system (GSS) exists, and since current glaucoma staging systems are either too coarse or sometimes ambiguous, we tested a modified system to allow for unambiguous stage assignment for all patients based on visual function parameters recorded in glaucoma charts. Methods:A review of currently developed GSSs was conducted and the Bascom Palmer GSS was selected as most appropriate. A panel of four glaucoma specialists modified the system with consideration given to practical use in retrospectively staging patients using clinical visual function parameters available in glaucoma charts. Initial modifications were made to ensure stages encompassed a complete severity range from pre-diagnosis to complete blindness. The panel revised the modified GSS to be consistent with the typical progression pattern of glaucoma patients. This revised GSS was pretested on 30 charts at one participating site of the study and final modifications were made to assure no ambiguity in patient classification. Results:The final GSS comprises six stages: 0=Normal or OHT, 1= Early, 2= Moderate, 3= Advanced, 4= Severe, 5= End-Stage. Staging criteria were based mainly on Humphrey visual field parameters and included mean defect (MD) as the primary parameter with three sub-domains for adjustments depending on CPSD/PSD and hemifield test for stages 0-1, dB plot for stages 2-4, and including pattern deviation plot for stages 1-4. Stage 5 classifications were based on poor visual acuity and inability to perform fields. The finalized GSS was successfully applied to an new group of 68 randomly selected charts at 6 centers across the US with 100% of pulled charts stagable and all required data recorded in the charts. The instrument was able to classify all glaucoma patients from OHT to end-stage disease. Conclusion:An improved GSS to track the progression of glaucoma was produced which allows staging of the full range of glaucoma patients from historical chart data. This GSS may be used to monitor long-term progression of the chronic, progressive disease of glaucoma. This GSS needs to be further tested, including on a global level, to determine its ultimate utility.
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