title: Categorizing the stage of glaucoma from pre-diagnosis to end-stage disease.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: University of Washington, Seattle, Washington, USA.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Mills
authors.forename: Donald L
authors.initials: DL
authors.lastname: Budenz
authors.forename: Paul P
authors.initials: PP
authors.lastname: Lee
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Noecker
authors.forename: John G
authors.initials: JG
authors.lastname: Walt
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Siegartel
authors.forename: Stacy J
authors.initials: SJ
authors.lastname: Evans
authors.forename: John J
authors.initials: JJ
authors.lastname: Doyle
mesh_terms: D003941:Diagnostic Techniques, Ophthalmological; D005902:Glaucoma, Open-Angle / Q000145:classification* / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D012189:Retrospective Studies; D012720:Severity of Illness Index