The value of guidelines and consensus and the reality of clinical practice

Consensus is important in medical care: 1. to delineate diagnostic criteria and staging severity of disease; and 2. to provide guidance on how best to monitor and treat a disease. The quality and nature of consensus will improve over time, moving from expert opinion to evidence-based assessments. Several techniques exist to quantitate the degree of consensus that exists. Consensus is lacking in glaucoma for both the definition and classification of the severity of the disease, although initial efforts have begun. Key steps in providing care for patients are often not done on a regular basis in the USA, particularly gonioscopy, optic nerve assessments, regular follow-up visits, and setting a target pressure range for treatment success. Patients with actual glaucoma in the USA may not be treated as aggressively as they should, given the findings of published studies. Several techniques can successfully alter physician behavior. Technology may offer the potential to greatly assist physicians in improving care delivery, especially when combined with standardized definitions and disease severity staging systems.