RAND-like Appropriateness Methodology Consensus for Primary Open-Angle Glaucoma in Latin America

• Published in: American journal of ophthalmology 2012-09, Vol.154 (3), p.460-465.e7
• Main Authors: Lerner, S. Fabian, Singh, Kuldev, Susanna, Remo, Wilson, M. Roy, Lee, Brian L, Maul, Eugenio
• Format: Article
• Language: English
• Subjects: Antihypertensive Agents - administration & dosage; Biological and medical sciences; Clinical trials; Evidence-Based Medicine; Expert Testimony; Experts; Filtering Surgery - methods; Glaucoma; Glaucoma and intraocular pressure; Glaucoma Drainage Implants; Glaucoma, Open-Angle - diagnosis; Glaucoma, Open-Angle - therapy; Humans; Intraocular Pressure; Latin America; Medical sciences; Meetings; Miscellaneous; Ophthalmology; Ophthalmology - standards; Outcome Assessment (Health Care); Practice Patterns, Physicians; Primary Health Care - standards; Surveys and Questionnaires; United States; Utilization Review
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2012.03.015

Purpose To report the results of a Latin American consensus panel regarding the diagnosis and management of primary open-angle glaucoma and to compare these results with those from a similar panel in the United States. Design A RAND-like (Research and Development) appropriateness methodology was used to assess glaucoma practice in Latin America. Methods The 148 polling statements created for the RAND- like analysis in the United States and 10 additional statements specific to glaucoma care in Latin America were presented to a panel of Latin American glaucoma experts. Panelists were polled in private using the RAND- like methodology before and after the panel meeting. Results Consensus agreement or disagreement among Latin American experts was reached for 51.3% of statements before the meeting and increased to 66.5% in the private, anonymous meeting after polling (79.0% agreement, 21.0% disagreement). Although there was a high degree of concordance (111 of 148 statements; 75%) between the results of this Latin American panel and the United States panel, there were some notable exceptions relating to diagnostic and therapeutic decision making. Conclusions This RAND-like consensus methodology provides a perspective of how Latin American glaucoma practitioners view many aspects of glaucoma and compares these results with those obtained using a similar methodology from practitioners in the United States. These findings may be helpful to ophthalmologists providing glaucoma care in Latin America and in other regions of the world.