ID
37466
Description
ICHOM Macular Degeneration data collection Version 3.0.1 Revised: April 10th, 2017 International Consortium for Health Outcomes Measurement (ICHOM), Source: http://www.ichom.org/ For Macular Degeneration, the following conditions and treatment approaches (or interventions) are covered by our Standard Set. Conditions: Neovascular Macular Degeneration Neovascular Age Related Macular Degeneration | Polypoidal Choroidal Vasculopathy | Myopic Neovascular Macular Degeneration | Other Forms of Neovascular Macular Degeneration (includes Post-Traumatic, Inflammatory, Idiopathic, Macular Telangiectasia Type 2) Non-Neovascular Age Related Macular Degeneration Treatment approaches: Intravitreal anti-VEGF treatment | Other intravitreal treatment | Photodynamic therapy | Thermal laser photocoagulation | Retinal radiation therapy | Transpupillary thermotherapy | Retinal surgical treatment This document contains the Baseline - Clinical Form. It has to be filled in at Patient's entrance into outcome tracking system for Macular Degeneration. Collecting Patient-Reported Outcome Measure: Brief Impact of Vision Impairment Questionnaire (Brief IVI): The Brief IVI includes costs for commercial use, and requires an agreement license. Therefore this questionnaire is not included in this Version of the standard set. Reference: Rodrigues IA, Sprinkhuizen SM, Barthelmes D, et al. Defining a Minimum Set of Standardized Patient-centered Outcome Measures for Macular Degeneration. American Journal of Opthalmology. 2016;168:1–12. doi: 10.1016/j.ajo.2016.04.012 The Standard set of ICHOM was supported by the WillsEye Hospital (America’s First World’s Best), Retina Suisse, St. Erik Eye Hospital, Macular Society, The Retina Society, Save sight Institute and The Macula Foundation (Preserving and Restoring Vision).
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Mots-clés
Versions (2)
- 30/07/2019 30/07/2019 -
- 30/04/2020 30/04/2020 - Sarah Riepenhausen
Détendeur de droits
ICHOM
Téléchargé le
30 juillet 2019
DOI
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Licence
Creative Commons BY-NC 3.0
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ICHOM Macular Degeneration
Baseline - Clinical Form
- StudyEvent: ODM
Description
Demographic factors
Alias
- UMLS CUI-1
- C1704791
Description
Age in years, calculated from birth date at commencement of therapy INCLUSION CRITERIA: ALl patients TIMING: Baseline REPORTING SOURCE: Clinical or administrative data
Type de données
date
Unités de mesure
- DD/MM/YYYY
Alias
- UMLS CUI [1]
- C0421451
Description
INCLUSION CRITERIA: ALl patients TIMING: Baseline REPORTING SOURCE: Clinical or administrative data
Type de données
integer
Alias
- UMLS CUI [1]
- C0079399
Description
Baseline Functional Status
Alias
- UMLS CUI-1
- C0598463
- UMLS CUI-2
- C1442488
Description
SUPPORTING DEFINITION: Distance visual acuity (best of uncorrected, corrected using glasses or contact lenses, or pinhole) in the affected eye INCLUSION CRITERIA: ALl patients TIMING: Baseline REPORTING SOURCE: Clinical RESPONSE OPTIONS: Numerical value preferably reported in LogMAR. Snellen may be used but needs to be converted to LogMAR. Please refer to page 13 of the reference guide for a Snellen to LogMAR conversion table.
Type de données
integer
Alias
- UMLS CUI [1]
- C0429537
Description
SUPPORTING DEFINITION: Distance visual acuity (best of uncorrected, corrected using glasses or contact lenses, or pinhole) in the fellow eye INCLUSION CRITERIA: ALl patients TIMING: Baseline REPORTING SOURCE: Clinical RESPONSE OPTIONS: Numerical value preferably reported in LogMAR. Snellen may be used but needs to be converted to LogMAR. Please refer to page 13 for a Snellen to LogMAR conversion table.
Type de données
integer
Alias
- UMLS CUI [1,1]
- C0429537
- UMLS CUI [1,2]
- C0205394
- UMLS CUI [1,3]
- C0015392
Description
SUPPORTING DEFINITION: Results preferably reported in LogMAR. Snellen may be used but needs to be converted to LogMAR. INCLUSION CRITERIA: ALl patients TIMING: Baseline REPORTING SOURCE: Clinical
Type de données
integer
Alias
- UMLS CUI [1]
- C1302978
Description
INCLUSION CRITERIA: ALl patients TIMING: Baseline REPORTING SOURCE: Clinical RESPONSE OPTIONS: Record details of the distance at which visual acuity is measured
Type de données
integer
Alias
- UMLS CUI [1,1]
- C0429537
- UMLS CUI [1,2]
- C0012751
Description
Baseline clinical status
Alias
- UMLS CUI-1
- C0449440
- UMLS CUI-2
- C1442488
Description
INCLUSION CRITERIA: ALl patients TIMING: Baseline, Each clinical visit to check for change REPORTING SOURCE: Clinical TYPE: Single answer
Type de données
integer
Alias
- UMLS CUI [1,1]
- C0024437
- UMLS CUI [1,2]
- C0332307
Description
SUPPORTING DEFINITION: Geographic atrophy is defined as an area of hypopigmentation or hyperfluorescence of at least 250 μm in its minimum linear dimension with 2 of the 3 following characteristics: (i) circular shape, (ii) sharp borders, or (iii) visibility of choroidal vessels within the area of geographic atrophy INCLUSION CRITERIA: ALl patients TIMING: Baseline, Each clinical visit to check for change REPORTING SOURCE: Clinical TYPE: Single answer
Type de données
integer
Alias
- UMLS CUI [1]
- C1536085
Description
SUPPORTING DEFINITION: Abnormal thickening of the subretinal tissue complex (material between Bruch's membrane and outer retina) anywhere in the macular area INCLUSION CRITERIA: ALl patients TIMING: Baseline, Each clinical visit to check for change REPORTING SOURCE: Clinical TYPE: Single answer
Type de données
integer
Alias
- UMLS CUI [1]
- C0423434
Description
SUPPORTING DEFINITION: Discrete elevations of the retinal pigment epithelium (RPE) anywhere in the macular area with solid (fibrovascular or haemorrhagic PED) or fluid (serous PED) matter below the corresponding retinal pigment epithelium INCLUSION CRITERIA: ALl patients TIMING: Baseline, Each clinical visit to check for change REPORTING SOURCE: Clinical TYPE: Single answer
Type de données
integer
Alias
- UMLS CUI [1]
- C0339546
Description
SUPPORTING DEFINITION: Solid (fibrovascular or haemorrhagic) or fluid (Serous) PED below the corresponding retinal pigment epithelium INCLUSION CRITERIA: All patients If answered '1' or '2' on Pigment epithelial detachment (PED) TIMING: Baseline, Each clinical visit to check for change REPORTING SOURCE: Clinical TYPE: Single answer
Type de données
integer
Alias
- UMLS CUI [1,1]
- C0339546
- UMLS CUI [1,2]
- C0332307
Description
Associated clinical history
Alias
- UMLS CUI-1
- C0262926
- UMLS CUI-2
- C0332281
Description
SUPPORTING DEFINITION: Select all that apply INCLUSION CRITERIA: All patients TIMING: Baseline, Annually from baseline REPORTING SOURCE: Clinical TYPE: Multiple answers. Separate multiple entries with "";""
Type de données
boolean
Alias
- UMLS CUI [1,1]
- C0009488
- UMLS CUI [1,2]
- C1299003
- UMLS CUI [1,3]
- C0154833
- UMLS CUI [2]
- C0011884
- UMLS CUI [3]
- C0035328
- UMLS CUI [4]
- C0035302
Description
SUPPORTING DEFINITION: Select all that apply INCLUSION CRITERIA: All patients TIMING: Baseline, Annually from baseline REPORTING SOURCE: Clinical TYPE: Multiple answers. Separate multiple entries with "";""
Type de données
boolean
Alias
- UMLS CUI [1,1]
- C0009488
- UMLS CUI [1,2]
- C1299003
- UMLS CUI [1,3]
- C0730362
- UMLS CUI [1,4]
- C1518912
- UMLS CUI [2]
- C0730285
- UMLS CUI [3]
- C0339543
- UMLS CUI [4]
- C0024441
- UMLS CUI [5]
- C0026850
Description
SUPPORTING DEFINITION: Select all that apply INCLUSION CRITERIA: All patients TIMING: Baseline, Annually from baseline REPORTING SOURCE: Clinical TYPE: Multiple answers. Separate multiple entries with "";""
Type de données
boolean
Alias
- UMLS CUI [1,1]
- C0009488
- UMLS CUI [1,2]
- C1299003
- UMLS CUI [2]
- C0017601
- UMLS CUI [3,1]
- C3887709
- UMLS CUI [3,2]
- C0205394
Description
SUPPORTING DEFINITION: Select all that apply INCLUSION CRITERIA: All patients TIMING: Baseline, Annually from baseline REPORTING SOURCE: Clinical TYPE: Multiple answers. Separate multiple entries with "";""
Type de données
boolean
Alias
- UMLS CUI [1,1]
- C0009488
- UMLS CUI [1,2]
- C1299003
- UMLS CUI [2]
- C0002418
Description
SUPPORTING DEFINITION: Select all that apply INCLUSION CRITERIA: All patients TIMING: Baseline, Annually from baseline REPORTING SOURCE: Clinical TYPE: Multiple answers. Separate multiple entries with "";""
Type de données
boolean
Alias
- UMLS CUI [1,1]
- C0009488
- UMLS CUI [1,2]
- C1299003
- UMLS CUI [2]
- C0086543
- UMLS CUI [3]
- C0010038
Description
SUPPORTING DEFINITION: Select all that apply INCLUSION CRITERIA: All patients TIMING: Baseline, Annually from baseline REPORTING SOURCE: Clinical TYPE: Multiple answers. Separate multiple entries with "";""
Type de données
boolean
Alias
- UMLS CUI [1,1]
- C0009488
- UMLS CUI [1,2]
- C1299003
- UMLS CUI [1,3]
- C0205394
Description
SUPPORTING DEFINITION: Select all that apply INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Clinical TYPE: "Multiple answers. Separate multiple entries with "";"""
Type de données
boolean
Alias
- UMLS CUI [1,1]
- C0549184
- UMLS CUI [1,2]
- C0205156
- UMLS CUI [1,3]
- C0024437
- UMLS CUI [1,4]
- C0087111
Description
SUPPORTING DEFINITION: Select all that apply INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Clinical TYPE: "Multiple answers. Separate multiple entries with "";"""
Type de données
boolean
Alias
- UMLS CUI [1,1]
- C0205156
- UMLS CUI [1,2]
- C0024437
- UMLS CUI [1,3]
- C0087111
- UMLS CUI [2,1]
- C1554888
- UMLS CUI [2,2]
- C3895948
Description
SUPPORTING DEFINITION: Select all that apply INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Clinical TYPE: "Multiple answers. Separate multiple entries with "";"""
Type de données
boolean
Alias
- UMLS CUI [1,1]
- C0205156
- UMLS CUI [1,2]
- C0024437
- UMLS CUI [1,3]
- C0087111
- UMLS CUI [2]
- C1444685
Description
SUPPORTING DEFINITION: Select all that apply INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Clinical TYPE: "Multiple answers. Separate multiple entries with "";"""
Type de données
boolean
Alias
- UMLS CUI [1,1]
- C0205156
- UMLS CUI [1,2]
- C0024437
- UMLS CUI [1,3]
- C0087111
- UMLS CUI [2]
- C0940918
Description
SUPPORTING DEFINITION: Select all that apply INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Clinical TYPE: "Multiple answers. Separate multiple entries with "";"""
Type de données
boolean
Alias
- UMLS CUI [1,1]
- C0205156
- UMLS CUI [1,2]
- C0024437
- UMLS CUI [1,3]
- C0087111
- UMLS CUI [2]
- C0441510
Description
SUPPORTING DEFINITION: Select all that apply INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Clinical TYPE: "Multiple answers. Separate multiple entries with "";"""
Type de données
boolean
Alias
- UMLS CUI [1,1]
- C0205156
- UMLS CUI [1,2]
- C0024437
- UMLS CUI [1,3]
- C0087111
- UMLS CUI [2,1]
- C1522449
- UMLS CUI [2,2]
- C0035331
Description
SUPPORTING DEFINITION: Select all that apply INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Clinical TYPE: "Multiple answers. Separate multiple entries with "";"""
Type de données
boolean
Alias
- UMLS CUI [1,1]
- C0205156
- UMLS CUI [1,2]
- C0024437
- UMLS CUI [1,3]
- C0087111
- UMLS CUI [2,1]
- C0442379
- UMLS CUI [2,2]
- C0879037
Description
SUPPORTING DEFINITION: Select all that apply INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Clinical TYPE: "Multiple answers. Separate multiple entries with "";"""
Type de données
boolean
Alias
- UMLS CUI [1,1]
- C0205156
- UMLS CUI [1,2]
- C0024437
- UMLS CUI [1,3]
- C0087111
- UMLS CUI [2]
- C0197770
Description
SUPPORTING DEFINITION: Select all that apply INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Clinical TYPE: "Multiple answers. Separate multiple entries with "";"""
Type de données
boolean
Alias
- UMLS CUI [1,1]
- C0205156
- UMLS CUI [1,2]
- C0024437
- UMLS CUI [1,3]
- C0087111
- UMLS CUI [2]
- C0205394
Description
SUPPORTING DEFINITION: Select all that apply INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Clinical TYPE: "Multiple answers. Separate multiple entries with "";"""
Type de données
boolean
Alias
- UMLS CUI [1,1]
- C0205156
- UMLS CUI [1,2]
- C0024437
- UMLS CUI [1,3]
- C0087111
- UMLS CUI [2]
- C0439673
Similar models
Baseline - Clinical Form
- StudyEvent: ODM
(Comment:en)
(Comment:en)
(Comment:en)
C1442488 (UMLS CUI-2)
C0205394 (UMLS CUI [1,2])
C0015392 (UMLS CUI [1,3])
(Comment:en)
(Comment:en)
C0012751 (UMLS CUI [1,2])
C1442488 (UMLS CUI-2)
C0332307 (UMLS CUI [1,2])
(Comment:en)
(Comment:en)
C0024437 (UMLS CUI-2)
(Comment:en)
(Comment:en)
(Comment:en)
(Comment:en)
(Comment:en)
C0442185 (UMLS CUI-2)
(Comment:en)
(Comment:en)
(Comment:en)
C0442185 (UMLS CUI-2)
(Comment:en)
(Comment:en)
(Comment:en)
C0442185 (UMLS CUI-2)
(Comment:en)
C0332307 (UMLS CUI [1,2])
C0154846 (UMLS CUI-2)
(Comment:en)
(Comment:en)
C0332281 (UMLS CUI-2)
C1299003 (UMLS CUI [1,2])
C0154833 (UMLS CUI [1,3])
C0011884 (UMLS CUI [2])
C0035328 (UMLS CUI [3])
C0035302 (UMLS CUI [4])
C1299003 (UMLS CUI [1,2])
C0730362 (UMLS CUI [1,3])
C1518912 (UMLS CUI [1,4])
C0730285 (UMLS CUI [2])
C0339543 (UMLS CUI [3])
C0024441 (UMLS CUI [4])
C0026850 (UMLS CUI [5])
C1299003 (UMLS CUI [1,2])
C0017601 (UMLS CUI [2])
C3887709 (UMLS CUI [3,1])
C0205394 (UMLS CUI [3,2])
C1299003 (UMLS CUI [1,2])
C0002418 (UMLS CUI [2])
C1299003 (UMLS CUI [1,2])
C0086543 (UMLS CUI [2])
C0010038 (UMLS CUI [3])
C1299003 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
C0205156 (UMLS CUI [1,2])
C0024437 (UMLS CUI [1,3])
C0087111 (UMLS CUI [1,4])
C0024437 (UMLS CUI [1,2])
C0087111 (UMLS CUI [1,3])
C1554888 (UMLS CUI [2,1])
C3895948 (UMLS CUI [2,2])
C0024437 (UMLS CUI [1,2])
C0087111 (UMLS CUI [1,3])
C1444685 (UMLS CUI [2])
C0024437 (UMLS CUI [1,2])
C0087111 (UMLS CUI [1,3])
C0940918 (UMLS CUI [2])
C0024437 (UMLS CUI [1,2])
C0087111 (UMLS CUI [1,3])
C0441510 (UMLS CUI [2])
C0024437 (UMLS CUI [1,2])
C0087111 (UMLS CUI [1,3])
C1522449 (UMLS CUI [2,1])
C0035331 (UMLS CUI [2,2])
C0024437 (UMLS CUI [1,2])
C0087111 (UMLS CUI [1,3])
C0442379 (UMLS CUI [2,1])
C0879037 (UMLS CUI [2,2])
C0024437 (UMLS CUI [1,2])
C0087111 (UMLS CUI [1,3])
C0197770 (UMLS CUI [2])
C0024437 (UMLS CUI [1,2])
C0087111 (UMLS CUI [1,3])
C0205394 (UMLS CUI [2])
C0024437 (UMLS CUI [1,2])
C0087111 (UMLS CUI [1,3])
C0439673 (UMLS CUI [2])