OBJECTIVES: In order to conduct a multi-national retrospective chart review with the purposes of assessing resource utilization and costs associated with disease progression in Europe, a glaucoma staging system (GSS) was needed. To date no universally accepted GSS exists, particularly one that takes into account economic considerations. We developed and tested a modified system to allow for unambiguous stage assignment of patients experiencing varied severity of disease. METHODS: A review of currently developed GSSs was conducted and the Bascom Palmer GSS was selected as most adaptable for economic analyses. A modified-Delphi panel of physicians specializing in glaucoma treatment suggested modifications to the system, with the end goal of assessing the economic impact of treating glaucoma. Three centers were identified in each of the four participating countries: France, Germany, Italy and U.K. Approximately 12 charts per center were selected based on the inclusion/exclusion criteria described in the study protocol. The revised GSS was applied on all identified charts to classify patients by disease severity. Clinical and demographic data were obtained from the charts and national-level financial data were obtained from health economists in each country. RESULTS: The final GSS comprises six stages based principally on visual field parameters. End-stage disease definition was based on poor visual acuity and inability to perform visual fields. The staging system was able to classify over 100 identified charts of glaucoma patients from normal to end-stage disease, and facilitated resource utilization abstraction by individual stage. CONCLUSIONS: An improved GSS to track progression was designed which allows staging of patients from historical chart data. This GSS may be used to monitor long-term progression and is a useful tool for the purposes of assessing the economic impact of glaucoma progression. The tool should be tested prospectively to determine its ultimate utility in clinical practice.