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Developing standards for the development of glaucoma virtual clinics using a modified Delphi approach
  1. Aachal Kotecha1,
  2. Simon Longstaff2,
  3. Augusto Azuara-Blanco3,
  4. James F Kirwan4,
  5. James Edwards Morgan5,
  6. Anne Fiona Spencer6,
  7. Paul J Foster1
  1. 1 NIHR Biomedical Research Centre (BRC) at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
  2. 2 Ophthalmology department, Royal Hallamshire Hospital, Sheffield, UK
  3. 3 Institute of Clinical Science, Queen’s University Belfast, Belfast, UK
  4. 4 Queen Alexandra Hospital, Portsmouth, UK
  5. 5 Department of Ophthalmology, University of Wales College of Medicine, Cardiff, UK
  6. 6 Department of Ophthalmology, Manchester Royal Eye Hospital and Manchester Academic and Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
  1. Correspondence to Dr Aachal Kotecha, Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK; aachalkotecha{at}


Purpose To obtain consensus opinion for the development of a standards framework for the development and implementation of virtual clinics for glaucoma monitoring in the UK using a modified Delphi methodology.

Methods A modified Delphi technique was used that involved sampling members of the UK Glaucoma and Eire Society (UKEGS). The first round scored the strength of agreement to a series of standards statements using a 9-point Likert scale. The revised standards were subjected to a second round of scoring and free-text comment. The final standards were discussed and agreed by an expert panel consisting of seven glaucoma subspecialists from across the UK. A version of the standards was submitted to external stakeholders for a 3-month consultation.

Results There was a 44% response rate of UKEGS members to rounds 1 and 2, consisting largely of consultant ophthalmologists with a specialist interest in glaucoma. The final version of the standards document was validated by stakeholder consultation and contains four sections pertaining to the patient groups, testing methods, staffing requirements and governance structure of NHS secondary care glaucoma virtual clinic models.

Conclusions Use of a modified Delphi approach has provided consensus agreement for the standards required for the development of virtual clinics to monitor glaucoma in the UK. It is anticipated that this document will be useful as a guide for those implementing this model of service delivery.

  • virtual clinic
  • glaucoma
  • standards
  • Delphi

Statistics from


  • Contributors AK: study design, data analysis, data interpretation, manuscript preparation and critique. SL and PJF: study design, data interpretation and manuscript critique. AA-B, JFK, JEM and AFS: data interpretation and manuscript critique.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Survey responses from both rounds are available for sharing purposes.

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