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

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PurposeTo 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.MethodsA 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.ResultsThe 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.ConclusionsA 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.

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