A panel assessment of glaucoma management: modification of existing RAND-like methodology for consensus in ophthalmology. Part I: Methodology and design.

PURPOSE

To examine ways to improve existing methodology to reach appropriate consensus in the treatment of primary open-angle glaucoma.

DESIGN

Evidence-based literature and accumulated expert opinion.

METHODS

A core nonvoting steering committee composed of four individuals created 148 statements. Another nonvoting individual with expertise in clinical epidemiology reviewed all evidence in support of or against each statement and summarized this information. After review of these summaries, 10 panelists voted on each of the statements both before and after a panel meeting where each question was discussed by the panel. The polling was conducted online using a customized software program for the process.

RESULTS

Consensus was reached on most statements both before and after the panel meeting. The proportion of questions where consensus agreement or disagreement was reached increased from 82 of 148 before the panel meeting to 110 of 148 after the meeting. Detailed information regarding the results of the polling are provided in the accompanying article.(1)

CONCLUSIONS

Refinements to existing descriptions of modified RAND-like appropriateness methodology was successful in allowing a group of ophthalmology panelists to reach consensus for or against most statements developed by nonpanelists. Future studies should be conducted to compare how robust and valid this methodology is as compared with other methods of determining optimal clinical care decision making.