Original article
Categorizing the Stage of Glaucoma From Pre-Diagnosis to End-Stage Disease

This project was previously presented as a poster at the Association for Research in Vision and Ophthalmology (ARVO) May 5–10, 2001.
https://doi.org/10.1016/j.ajo.2005.07.044Get rights and content

Purpose

To provide a reliable, comprehensive staging system to assess glaucoma stage in the absence of an universally accepted glaucoma staging system (GSS) on the basis of visual field results.

Design

Literature review and GSS adaptation.

Methods

After a review of published GSSs was conducted, the Bascom Palmer (Hodapp-Anderson-Parrish) GSS was selected as an appropriate platform for a retrospective GSS on the basis of visual fields. The system was modified by a panel of glaucoma specialists, and additional modifications were made after pilot testing to cover the full range of disease progression, from preglaucoma diagnosis to complete blindness; the ordered stages reflect the typical progression of glaucoma.

Results

The GSS is comprised of six ordered stages and is on the basis of the Humphrey visual field. The completed GSS was validated by reviewing patient charts from 12 US glaucoma centers.

Conclusions

The GSS allows accurate staging of 100% of glaucoma on the basis of visual fields and other data, enabling evaluation of disease progression and resource utilization at various glaucoma stages. Additionally, treatment costs may be assigned to determine cost-effectiveness of treatment. Research utilizing the GSS has found that cost of care increases with increasing disease severity. The GSS may be used as the basis for creating treatment guidelines, which have the potential to delay glaucoma progression and lower treatment costs.

Section snippets

Preliminary research

A literature review was conducted to evaluate previously developed GSSs. Examined GSSs included the staging systems used in the Advanced Glaucoma Intervention Study (AGIS)9, 10, 11 and the Collaborative Initial Glaucoma Treatment Study(CIGTS),10, 11, 12 Esterman binocular scale,13 and the Bascom Palmer system.11, 14, 15, 16 These existing GSSs were considered as potential “seed systems” for modification. Consideration was also given to the American Academy of Ophthalmology GSS, but this was not

Results

GSS decision rules were created to determine which parameters should be used to assign patients to stage 0 through stage V. MD was decided on as the primary measure for assigning stages 0 through IV, with three additional criteria for stage adjustments depending on the CPSD/PSD and hemifield test for stages 0 through I, dB plot for stages II through IV, and pattern deviation plot for stages I through IV (Table 2). Additional criteria were included on the basis of decision rules, which apply to

Discussion

A modified version of the Bascom Palmer GSS was developed to enable disease severity assignment of all glaucoma patients on the basis of historical visual field data recorded in patient charts, and to create a GSS that can be used to retrospectively stage patients without clinical judgment by a physician. The GSS was successfully applied by retrospectively assigning unambiguous stages using HVFs from a total of 98 glaucoma charts across seven centers in the United States. Automated visual field

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    This study was supported by a research grant from Allergan, Inc., Irvine, California.

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