IOP-related codes to add
This thread will allow further discussion of the proposal to add SNOMED codes related to IOP.
Comments
Hi s1baxter
Could you provide definitions for:
Maximum IOP
Maximum untreated IOP
Just so I can understand the distinction between them and not sure what you mean by maximum. For example the definition on 723235005 |Maximum blood pressure (observable entity)| is An aggregated blood pressure that refers to the maximum over multiple cardiac cycles, e.g. over 24 hours
Is there something similar for maximum IOP?
many thanks
Thanks Elaine Wooler - for maximum IOP, often we will ask patients what their maximum IOP was historically. This helps us assess their ocular history and helps inform our target IOP for their treatment plan. It can be a self-reported value, particularly for new patients presenting for care, where they may have had IOP values recorded at the prior practice but we do not have that information currently in our records. As such, it is usually not secondarily derived based on an array of recorded IOP values in a given EHR. "Maximum untreated IOP" represents their maximum eye pressure while not having any treatment (like medications, lasers, or surgeries). "Maximum IOP" does not have any specification regarding treatment history, although in practice treated IOP should be lower than untreated IOP. Adding Ian Rodrigues and Anthony Khawaja if they have any additional comments, and certainly anyone from the group can comment and add further clarification. Thanks!
Just editing to add that the maximum IOP (or maximum untreated IOP) may not always be strictly patient/self-reported per se. Sometimes it can be physician-reported based on a review of the prior records, either from the same system or records obtained from the system of prior care. The time frame is not over a 24-hour cycle but rather represents the maximum over all preceding time/ entirety of patient history leading up to that point.
A good point. I suppose a DERIVED max IOP would be something that is calculated from other fields. A REPORTED max IOP would be from patient history? We could have a hierarchy here - max IOP, and under that, "patient-reported", "physician reported", "derived from historical measures", "unspecified", or similar?
I've added the concepts for maximum IOP, maximum untreated IOP and target IOP. We don't usually add concepts of the type - Presenting IOP as this not a quality like maximum or target but is evident from the date so information model derived. Would this cause any issues if this were not added?
Actually, I think it is OK to leave out "presenting", as that can be inferred as the original IOP in a series at one centre? Some may argue we want to enter a historic presenting IOP, but we can just enter historic IOPs with their dates. That's my opinion, anyway!
I agree. As long as we have target IOP and maximum untreated IOP I'm happy!
Agree as well. This is great news that maximum IOP and target IOP have been added. thanks so much Elaine Wooler !!
Thanks Sally. Some ORA (Ocular Response Analyzer) comments:
Need to specify if IOPg (Goldmann-correlated IOP) or IOPcc (corneal-compensated IOP), as both are output
The outputs are not integers - the pressures are given to one decimal place
Should we also include the Corvis? I believe that outputs numbers to one decimal place as well, and there is a bIOP for "best" corrected for corneal properties, and a standard NCT one.
Thanks Anthony Khawaja I am not super familiar with ORA so this is very helpful! Seems reasonable to include Corvis as well.
Hi everyone, I am creating discussion pages for categories of topics arising from our meeting on 3/23/2023. My apologies for the delay in posting; just returned from spring break. I will put the IOP-related ones here, and then a separate one for gonioscopic grading.
Here are some of the intraocular pressure (IOP)-related codes that the group thought would be useful to add to SNOMED (based on survey of glaucoma specialists and discussion at the last meeting):
Maximum IOP
Maximum untreated IOP
Presenting IOP
Target IOP
Laterality: These would apply to each eye (left eye, right eye). Unlike diagnosis codes there isn't a bilateral situation for this one.
Range of Observed Values: In terms of the range of observed values, we expect these to be positive integers.
Associated Units: The associated units would be mm Hg for each value.
Method of tonometry: Another associated code to develop is the ability to denote the method of tonometry used, which is currently not represented completely in SNOMED (there is a code for non-contact tonometry but otherwise the specifications for other forms are lacking). Here is a suggested list for methods of tonometry from one of our group members in the survey that was administered:
Goldman applanation
Rebound (iCare)
Non-contact
Pneumatonometer
Mackay-Marg (Tonopen)
Dynamic contour
Indentation
Tactile
ORA