Assessment of Cumulative Incidence and Severity of Primary Open-Angle Glaucoma Among Participants in the Ocular Hypertension Treatment Study After 20 Years of Follow-up

Kass, Michael A.; Heuer, Dale K.; Higginbotham, Eve J.; Parrish, Richard K.; Khanna, Cheryl L.; Brandt, James D.; Soltau, Joern B.; Johnson, Chris; Keltner, John L.; Huecker, Julia; Wilson, Brad; Liu, Lei; Miller, J. Phillip; Quigley, Harry A.; Gordon, Mae O.

doi:10.1001/jamaophthalmol.2021.0341

Cited by 45 publications

(32 citation statements)

References 14 publications

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“…Recently a prediction model was applied to the Ocular Hypertension Treatment Study (OHTS 3). 40 The model accounted for baseline age, IOP, central corneal thickness, vertical cup-disc ratio and VF pattern standard deviation; baseline categorisation into low-, medium-, and high-risk tertiles led to 20-year cumulative incidences of POAG representative of the baseline risk groups. Future such tools must be able to automatically incorporate metrics of optic nerve head, nerve fibre layer and macular imaging, rates of VF change, as well as information from electronic patient records.…”

Section: Discussionmentioning

confidence: 99%

Validation of the RCOphth and UKEGS glaucoma risk stratification tool ‘GLAUC-STRAT-fast’

et al. 2022

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Background/aimsThe aim of this study was to validate the Glaucoma Risk Stratification Tool (GLAUC-STRAT-fast) currently recommended by the Royal College of Ophthalmologists for the risk stratification of patients with glaucoma in the UK National Health Service Hospital Eye Service.MethodsGLAUC-STRAT fast was applied to the LiGHT trial participants by risk-stratifying the worse eye of each patient at baseline and after 3 years of treatment. Metrics of disease severity or treatment intensity used for the validation were: increased number of monitoring visits or treatment escalations; needing a trabeculectomy; a reduction of >2 dB in visual field mean deviation (VF MD) during the monitoring period; identification of rapid VF loss on total (TD) and/or pattern deviation (PD). The proportion of eyes within each baseline stratum for each of the above markers was compared against the other strata, using a χ2 test for proportions.ResultsThere was an association between the baseline stratification and the number of treatment escalations needed to maintain the eye-specific target intraocular pressure (p=0.001), the number of visits needed throughout the 3-year follow-up period (p=0.001), the need for trabeculectomy (p<0.001) and absolute loss of MD over the course of the monitoring period (p<0.001). The rate of VF progression was not associated with baseline risk stratification for TD or PD progression (p≥0.007, with Bonferroni correction).ConclusionThe GLAUC-STRAT fast tool is a useful tool for risk stratifying eyes with ocular hypertension or open angle glaucoma. Further research is needed to confirm and validate its applicability to more advanced glaucomas and generalisability to clinical use.Trial registration numberThe LiGHT trial is registered at controlled-trials.com (ISRCTN32038223).

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Section: Discussionmentioning

confidence: 99%

Validation of the RCOphth and UKEGS glaucoma risk stratification tool ‘GLAUC-STRAT-fast’

et al. 2022

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“… 14 , 15 However, after the development and validation of the risk estimation calculators using the results of the Ocular Hypertension Treatment Study and the European Glaucoma Prevention Study, glaucoma has been the front runner in its clinical application. 16 , 17 Although new biomarkers may modify the original interpretation, 18 currently its use has still a role as a supplementary tool to help decide which patients would benefit the most from treatment. 19 …”

Section: Discussionmentioning

confidence: 99%

External Validation and Clinical Applicability of Two Optical Coherence Tomography–Based Risk Calculators for Detecting Glaucoma

Ventura-Abreu

Biarnés

Batlle-Ferrando

et al. 2022

Trans. Vis. Sci. Tech.

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Purpose To clinically validate the diagnostic ability of two optical coherence tomography (OCT)-based glaucoma diagnostic calculators (GDCs). Methods We conducted a retrospective, consecutive sampling of 76 patients with primary open-angle glaucoma, 107 glaucoma suspects, and 67 controls. Demographics, reliable visual field testing, and macular and optic disc OCT were collected. The reference diagnosis was compared against the probability of having glaucoma obtained from two GDCs derived from multivariate logistic regressions using quantitative and qualitative (GDC1) or only quantitative (GDC2) OCT data. The discrimination (area under the curve [AUC]) and calibration (calibration plots) were compared for both calculators and the best OCT parameters. Results GDC2 was able to identify 46.9% more suspects and 14.7% more glaucomatous eyes than GDC1. Both GDCs obtained the highest discriminative ability in glaucomatous eyes (GDC1 AUC = 0.949; GDC2 = 0.943 vs inferior peripapillary retinal nerve fiber layer [pRNFL] = 0.931; P = 0.43). The discriminating ability was not as good for glaucoma suspects, but the GDCs were not inferior to pRNFL (GDC 1 AUC = 0.739; GDC2 = 0.730; inferior pRNFL = 0.760; P = 0.54) and GDC2 was still able to correctly identify up to 30.8% more cases than the conventional OCT classification. Calibration showed risk underestimation for both groups and calculators, but it was better in GDC2 and in patients with glaucoma. Conclusions OCT-based calculators showed an excellent diagnostic performance in glaucomatous eyes. GDC2 was able to identify approximately 30% more cases than the conventional pRNFL inferior OCT classification in both groups, suggesting a potential role of these composite scores in clinical practice. Translational Relevance These OCT-based calculators may improve glaucoma diagnosis in clinical care.

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“…Population‐based studies have shown a direct correlation between IOP levels and POAG prevalence; however, IOP levels higher than 21 mmHg is a parameter associated with a wide range of glaucoma frequency in different populations (e.g., 71.0% in Barbados vs. 13.0% in the Northeast Italy) 24–26,71,73–75 . Moreover, some patients present glaucoma with no high IOP levels (normal tension glaucoma), and others with ocular hypertension do not display any glaucomatous visual field defect after a long period of time 76 . Ocular perfusion pressure has also been considered another risk factor for POAG; however, it may be a confounder since IOP impacts negatively ocular perfusion pressure calculation 77–79 …”

Section: Risk Factors For Glaucoma Developmentmentioning

confidence: 99%

“…[24][25][26]71,[73][74][75] Moreover, some patients present glaucoma with no high IOP levels (normal tension glaucoma), and others with ocular hypertension do not display any glaucomatous visual field defect after a long period of time. 76 Ocular perfusion pressure has also been considered another risk factor for POAG; however, it may be a confounder since IOP impacts negatively ocular perfusion pressure calculation. [77][78][79]…”

Section: Elevated Iopmentioning

confidence: 99%

Primary glaucomas in adults: Epidemiology and public health‐A review

Reis

Paula

Furtado

2022

Clinical Exper Ophthalmology

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Glaucoma is a mixed group of optic neuropathies that lead to irreversible visual field loss and blindness if left untreated. It is estimated that 3.5% of the global population aged 40 to 80 years have any glaucoma, being the primary open‐angle and the primary angle‐closure glaucoma the most prevalent forms. Although the age‐standardised prevalence of blindness caused by glaucoma has decreased substantially over the last decades, population growth and ageing impose many challenges in preventing glaucoma‐related morbidities on a global level. In addition, difficulties in diagnoses and treatment, along with its chronic and irreversible nature, urge the development and implementation of innovative approaches in confronting the disease. This manuscript reviews recent literature related to the epidemiology of primary glaucomas in adults, the risk factors attributed to the development of the disease, and discuss challenges and potential solutions from a public health perspective.

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Assessment of Cumulative Incidence and Severity of Primary Open-Angle Glaucoma Among Participants in the Ocular Hypertension Treatment Study After 20 Years of Follow-up

Cited by 45 publications

References 14 publications

Validation of the RCOphth and UKEGS glaucoma risk stratification tool ‘GLAUC-STRAT-fast’

Validation of the RCOphth and UKEGS glaucoma risk stratification tool ‘GLAUC-STRAT-fast’

External Validation and Clinical Applicability of Two Optical Coherence Tomography–Based Risk Calculators for Detecting Glaucoma

Primary glaucomas in adults: Epidemiology and public health‐A review

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