Progression from ocular hypertension to visual field loss in the English hospital eye service

Kelly, Stephen R.; Khawaja, Anthony P.; Bryan, Susan R; Azuara‐Blanco, Augusto; Sparrow, J M; Crabb, David P.

doi:10.1136/bjophthalmol-2019-315052

Cited by 18 publications

(16 citation statements)

References 19 publications

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“…VF data were extracted from an EMR (Medisoft; Medisoft Ltd., Leeds, UK) from five regionally different National Health Service Hospital Trust glaucoma clinics in England in November 2015 as described elsewhere. 18 – 20 In short, all patient data were anonymized at the point of data extraction and subsequently transferred to a single secure database held at City, University of London. Subsequent analyses of the data were approved by a research ethics committee of City, University of London.…”

Section: Methodsmentioning

confidence: 99%

Hierarchical Censored Bayesian Analysis of Visual Field Progression

Montesano

Garway-Heath

Ometto

et al. 2021

Trans. Vis. Sci. Tech.

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Purpose To develop a Bayesian model (BM) for visual field (VF) progression accounting for the hierarchical, censored and heteroskedastic nature of the data. Methods Three versions of a hierarchical BM were developed: a simple linear (Hi-linear); censored at 0 dB (Hi-censored); heteroskedastic censored (Hi-HSK). For the latter, we modeled the test variability according to VF sensitivity using a large test-retest cohort (1396 VFs, 146 eyes with glaucoma). We analyzed a large cohort of 44,371 VF tests from 3352 eyes from five glaucoma clinics. We quantified the bias in the estimated rate-of-progression, the detection of progression (Hit-rate [HR]), the median time-to-progression and the prediction error of future observations (mean absolute error [MAE]). HR and time-to-progression were compared at matched false-positive-rate (FPR), quantified using permutations of a separate test-retest cohort (360 tests, 30 eyes with glaucoma). BMs were compared to simple linear regression and Permutation-Analyses-of Pointwise-Linear-Regression. Differences in time-to-progression were tested using survival analysis. Results Censored models showed the smallest bias in the rate-of-progression. The three BMs performed very similarly in terms of HR and time-to-progression and always better than the other methods. The average reduction in time-to-progression was 37% with the BMs ( P < 0.001) at 5% FPR. MAE for prediction was very similar among methods. Conclusions Bayesian hierarchical models improved the detection of VF progression. Accounting for censoring improves the precision of the estimates, but minimal effect is provided by accounting for heteroskedasticity. Translational Relevance These results are relevant for quantification of VF progression in practice and for clinical trials.

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Section: Methodsmentioning

confidence: 99%

Hierarchical Censored Bayesian Analysis of Visual Field Progression

Montesano

Garway-Heath

Ometto

et al. 2021

Trans. Vis. Sci. Tech.

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“…Refinements of this tool could be able to identify patients suitable for less intense monitoring; data from the English HES service indicate that less than 20% of OHT patients convert to POAG over a 5year period, suggesting some groups may require less intensive follow-up. 41 Future sub-group refinements of such tools could also prove useful and further allow the adjustment of HES resources depending on disease characteristics (e.g. OHT, angle closure, secondary glaucoma).…”

Section: Discussionmentioning

confidence: 99%

“…There was an association between the baseline stratification and the proportion of patients requiring an increased number of treatment escalations to maintain the eye-specific target IOP. In total, 9.9% (41) of eyes stratified as Green, 17.8% (34) of eyes stratified as Amber and 22.4% (24) of eyes stratified as Red needed treatment escalations that fell outside the IQR range (0 to 2) of the LiGHT cohort treatment escalations during the course of the 3-year trial (χ 2 (2, N=713)=14.6, p=0.001) (Figure 3).…”

Section: Disease Managementmentioning

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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“…EMGT study also revealed that a reduction by 1 mmHg in IOP from baseline leads to 10% decrease in the risk of glaucoma progression, whereby 1 mmHg increment leads to 11% increase in the risk of glaucoma progression [8]. IOP lowering therapy reduces the conversion rate from OHT to POAG with a predicted 5-year conversion rate of 14% and 26.9% in the treated and untreated group, respectively [15]. Despite the strong association between OHT and glaucoma, there is a subset of POAG patients that has glaucomatous neuropathy in the absence of ocular hypertension known as 'normaltension glaucoma'.…”

Section: Ocular Hypertensionmentioning

confidence: 94%

“…Although not all patients with increased IOP develop POAG, it has been recognized as the most important risk factor for the disease and control of IOP remains the main focus of treatment in POAG. Patients without glaucomatous signs and symptoms but having IOP above 21 mmHg are diagnosed to have ocular hypertension (OHT) and ocular hypertensive patients have a 17.5% cumulative risk of conversion to glaucoma in 5-year [15]. The findings of the studies such as OHTS and EMGT suggested that elevated IOP is a significant predictive factor for the development and progression of POAG [6]- [8].…”

Section: Ocular Hypertensionmentioning

confidence: 99%

Medical Management of Open-Angle Glaucoma: Focus on Mechanisms of Action and Adverse Drug Reactions

Razali¹,

Hassan²,

Bakar³

et al. 2021

JCHS

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Glaucoma is an optic neuropathy characterised by optic nerve degeneration associated with visual field defects. It remains the world’s number one cause of irreversible blindness and patients usually present at late stage of the disease since it is generally asymptomatic until severe. The disease is subdivided into primary and secondary with primary open-angle glaucoma (POAG) being the most common type. At present, lowering the intraocular pressure (IOP) remains the only proven efficient approach in delaying the onset or preventing the progression of the disease. Medical treatment with topical antiglaucoma agents is the treatment of choice in open angle glaucoma. The use of antiglaucoma drugs aims to reduce IOP by enhancing aqueous humour (AH) outflow, reducing AH production, or both. The choice to use any available treatment option should be carefully considered in an attempt to maximise benefits and reducing the risk of developing adverse drug reactions. This review highlights the six classes of ocular hypotensive agents currently in use for POAG treatment including prostaglandin analogues; B-adrenergic receptor blockers; a-2 adrenergic receptor stimulants; carbonic anhydrase inhibitors; muscarinic receptor stimulants; rho kinase inhibitors with regards to their mechanism/s of action and potential adverse drug reactions, and antiglaucoma fixed drug combinations.

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Progression from ocular hypertension to visual field loss in the English hospital eye service

Cited by 18 publications

References 19 publications

Hierarchical Censored Bayesian Analysis of Visual Field Progression

Hierarchical Censored Bayesian Analysis of Visual Field Progression

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

Medical Management of Open-Angle Glaucoma: Focus on Mechanisms of Action and Adverse Drug Reactions

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