We have had a query from a member who is translating content and has come across:
246883008 |Bulbar conjunctival drainage bleb | and subtypes:
• 246886000 |Drainage bleb, flat (disorder)|
• 246884002 |Drainage bleb, functional (disorder)|
• 246885001 |Drainage bleb, leaking (disorder)|
410724009 |Disorder of filtering bleb| and subtypes:
• 413665004 |Bleb associated endophthalmitis (disorder)|
• 13081000119109 |Complication of filtering bleb (disorder)|
• 410721001 |Failed filtering bleb (disorder)|
• 408765004 |Leaking filtering bleb (disorder)|
• 410722008 |Inadvertent filtering bleb (disorder)|
• 98851000119102 |Inflammation of filtering bleb (disorder)|
• 336691000119100 |Postprocedural blebitis (disorder)|
• 733310006 |Conjunctival blebitis following glaucoma surgery (disorder)|
246883008 |Bulbar conjunctival drainage bleb is defined in SNOMED as a blister of the conjunctiva; 410724009 |Disorder of filtering bleb| is defined with a separate morphology of filtering bleb but without a finding site.
Their comment is - "We think these refer to the same condition. I could find only a handful articles that refer to drainage bleb, even fewer that were recent. Everything I found on drainage bleb or filtering bleb concerned the eye, usually in the context of a glaucoma. I think the entire branch of 246883008 |Bulbar conjunctival drainage bleb | should be retired as duplicate with 410724009 |Disorder of filtering bleb|; and I think the latter should be remodelled with finding site eye structure or even conjunctiva."
Are they correct or are these different? I have also found it difficult to find recent references for drainage blebs. With regards to the body structure involved for filtering blebs the procedure concepts such as 34854007 |Repair of filtering bleb (procedure)| use the body structure Anterior eyeball segment structure (body structure)
Appreciate your advice.
Thanks Elaine
13 Comments
Elaine Wooler
Hi, I don't think these questions are being notified so linking specific people for now.
Anthony Khawaja Ian Rodrigues Sally Baxter Eric Brown
I also have another question I will be posting soon.
Many thanks for any input you can give.
Sally Baxter
Thanks Elaine Wooler I agree there is overlap here, but may be best to add to the agenda for our next CRG meeting to discuss synchronously...
Anthony Khawaja
Agree - one to discuss. Also, I'm not sure what a "disorder" is, and whether a functional drainage bleb is a disorder....
Ian Rodrigues
Thanks Elaine Wooler
I would say that 246885001 |Drainage bleb, leaking (disorder)| and 408765004 |Leaking filtering bleb (disorder)| and 246886000 |Drainage bleb, flat (disorder)| and 410721001 |Failed filtering bleb (disorder)| are synonymous terms and would support a decision to merge them
As Anthony Khawaja has said, I wouldn't have put 246884002 |Drainage bleb, functional (disorder)| as a disorder. A "Clinical Finding" would be more appropriate IMO.
I agree the correct body structure involved would be "conjunctiva".
Elaine Wooler
We have 408764000 |Filtering bleb (morphologic abnormality)| as a post surgical anatomy so can use that as the body structure.
If the bleb is functional then it should indeed be a finding rather than a disorder. Disorders are always and necessarily abnormal.
Sally Baxter
From 5/18/23 CRG meeting:
Consensus that the following are synonyms: 246885001 |Drainage bleb, leaking (disorder)| and 408765004 |Leaking filtering bleb (disorder)|
Keep these terms separate: 246886000 |Drainage bleb, flat (disorder)| 410721001 |Failed filtering bleb (disorder)|
Can change "Drainage bleb, flat" to "Filtering bleb, flat"
Elaine Wooler
Whilst making these changes I have come across the following two concepts:
2 is a subtype of 1. Are these actually all complications of the filtering bleb and therefore 410724009 |Disorder of filtering bleb (disorder)| is not needed any disorder would be a complication?
Sally Baxter
Thanks Elaine Wooler , interesting question. I think this category of "disorder of filtering bleb" would be good to keep, since the child concepts may be concepts that people want to specifically denote (and not just lump them all into "complications"). Perhaps the "complication of filtering bleb" term, in this context, is meant to denote an "other" category, e.g. other complications or disorders that are not captured in the other children concepts. Maybe for consistency of nomenclature, instead of "complication of filtering bleb", it should be "other disorder of filtering bleb"? However, I defer to the glaucoma specialists who are more intimately familiar with bleb management and would have more knowledge of how the glaucoma community would like to code these.
Ian Rodrigues
Thanks Elaine Wooler . I agree with Sally Baxter I would say that probably the better parent term is as it currently is - "Disorder of filtering bleb" but the difference between disorder or complication of filtering bleb is semantic.
If we are allowed to, I would go with Sally Baxter suggestion and rename "Complication of filtering bleb" to "Other disorder of filtering bleb" or what ever the appropriate terminology would be.
Elaine Wooler
Thanks Sally Baxter and Ian Rodrigues unfortunately terms such as "other' are not allowed in SNOMED as by nature they are unspecified and a catch all phrase similar to those you find in a classification. I can leave it as is though for now and we can look at this again at a later date.
Anthony Khawaja
For me, I think there is a difference between a "Complication" and "Disorder" - in particular, I think a failed bleb is not a complication, just an ending of its success (i.e. back to square one). A complication is something potentially harmful that would not have occurred if there wasn't a bleb. A small point, and there may be different views on this!
Michael Boland
I agree with Anthony's take on this. The other terms should be under 410724009, not under the child "complication" term.
Michael Boland
And to the earlier comment, there are complications of surgical blebs, so I would not rename or remove that term.