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Assessing the Importance of IOP Variables in Glaucoma Using a Modified Delphi Process

Lee, Paul P. MD, JD*; Sultan, Marla B. MD, MBA† ‡; Grunden, John W. PharmD; Cioffi, George A. MD§for the IOP Consensus Panel

doi: 10.1097/IJG.0b013e3181b4ca8d
Original Studies
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Purpose To assess the degree of consensus among glaucoma experts on the measurement, characterization, and potential implications of intraocular pressure (IOP) and its fluctuation for glaucoma treatment.

Methods A multinational panel of 9 glaucoma experts used a modified Delphi process to rate the level of agreement with 72 statements characterizing methods of measuring IOP, the importance of IOP reduction, and clinical implications of changes in IOP over time. After receiving a literature review, panelists rated each statement on a 9-point Likert scale. A panel meeting was held to discuss the ratings followed by a second round of independent ratings. Consensus and nonconsensus regarding the panel's agreement with each statement were determined using a binomially distributed statistical definition.

Results The panel found consensus in 46% of 81 statements, nonconsensus in 6%, and indeterminate status in 48%. Categories having the highest proportion of statements with consensus were importance of IOP reduction (4/4 statements), importance of long-term IOP fluctuation and reduction (6/9), and impact of medication on short-term and long-term IOP fluctuation (6/10 for each). Indeterminate statements were distributed unevenly with 74% of statements related to IOP measurement rated indeterminate compared with 38% related to the clinical implications of short-term and long-term IOP fluctuation.

Conclusions A modified Delphi process was useful in identifying areas of consensus regarding IOP measurement and importance of IOP fluctuation among glaucoma experts. Concurrently, the need for additional investigations assessing the role of IOP changes in glaucoma management is highlighted by the indeterminate and nonconsensus ratings.

*Glaucoma Service, Duke University Eye Center, Durham, NC

New York Eye and Ear Infirmary

Pfizer Inc, New York, NY

§Ophthalmology-Discoveries in Sight, Devers Eye Institute, Portland, OR

Supported by Pfizer Inc, New York, NY.

Reprints: Paul P. Lee, MD, JD, Glaucoma Service, Duke University Eye Center, 2351 Erwin Road, Box 3802, Durham, NC 27710 (e-mail: lee00106@mc.duke.edu).

Received for publication July 22, 2008

accepted June 20, 2009

Disclosures: Dr Lee is a consultant for Alcon, Allergan, Genentech, and Pfizer, a guest lecturer for Merck, has equity in Merck and Pfizer, has received research support from Pfizer, Allergan, Alcon, and Genentech, and has patents held by Duke University Eye Center. Dr. Sultan and Dr. Grunden are employees of Pfizer Inc.

© 2010 Lippincott Williams & Wilkins, Inc.