Original articleCategorizing the Stage of Glaucoma From Pre-Diagnosis to End-Stage Disease
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.