Assessment of the level of harm resulting from glaucoma progression due to review delay.

BACKGROUND/OBJECTIVES: Reporting harm in monitoring delay for glaucoma patients is important but current guidance is limited. This study attempts to refine harm assessment using clinician expertise to identify the factors that should be considered in defining monitoring delay related harm. METHODS: National survey of glaucoma specialists through UK & Eire Glaucoma Society. RESULTS: For perimetric harm, the importance of the severity of the reference visual field as well as the importance of locational loss (central and inferior visual field) in defining harm, were highlighted. Other factors such as only eye and loss of driving status should also be considered in defining harm. A delay of >50% was considered as the reference point for defining delay causing harm for the majority of respondents. For pre-perimetric delay there was less agreement on level of harm. CONCLUSION: Recognising harm from glaucoma monitoring delay is important. However, it is a difficult process which is largely non-standardised. Harm itself should be defined by clinical deterioration (global and locational visual field loss) and psychological consequences. A strict definition of delay needs to be defined for the purpose of harm reporting. Other factors such as only eyed or loss of independence should also be considered when considering if harm has occurred.