Glaucoma severity / staging
To discuss how to best handle SNOMED coding for glaucoma severity / staging
Comments
Hi Ian Rodrigues
We can certainly look into this. Could you give me some examples of what the diagnosis terms would look like or even how you do this currently? There may be a number of different ways to do this so having some examples would help my understanding.
The problems with having glaucoma severity as a post-coordination of a diagnosis are:
Severity changes over time but glaucoma diagnosis largely does not - mild POAG becomes moderate POAG etc
Changing diagnoses over time may be clunky
There are multiple staging systems for glaucoma.
Might we be able to have glaucoma stage as an observable, e.g. like IOP? It can have a method (i.e. the grading system), and then a datetime of the assessment. The severity can change according to the datetime it was assessed and the classification system used, like IOP can change over time and by the measurement device.
Thanks!
Thanks Elaine Wooler so what we were wondering is if we could create SNOMED codes for the different categories of the most widely used glaucoma staging/severity systems (under SNOMED "Staging and Scales" or "Observable entity" - whatever you think would be most appropriate) and then specify which glaucoma diagnosis codes these staging systems are applicable for (it will most likely be ALL glaucoma related diagnosis codes, as can't immediately think of any glaucoma diagnosis codes that would not be applicable).
The two staging scales that we would probably want to code are -
ICD-9 classification (or a newer version if it exists):
Hodapp-Anderson-Parrish staging:
Hi
Elaine Wooler - since the last Eye Care CRG, I've been discussing further with 
Anthony Khawaja options to best handle SNOMED coding of glaucoma severity / staging.
At the last meeting we presented a couple of well known glaucoma staging systems (the Hodapp-Anderson-Parrish staging system and the ICD-9 classification system) and discussed the merits as well as potential issues of both.
We were previously considering post-co-ordination for glaucoma severity, however are now wondering if disease severity is probably best thought of as an entity in its own right and noted that on the SNOMED browser, "Staging and Scales" have already been separated out from clinical findings and diagnoses:
We would therefore value your advice as to if this might be the way to go? It would potentially allow the use multiple glaucoma staging systems that each relate to a list of glaucoma SNOMED diagnosis terms that are valid for the staging system in question. Thanks