Weinreb Robert N, Friedman David S, Fechtner Robert D, Cioffi George A, Coleman Anne L, Girkin Christopher A, Liebmann Jeffrey M, Singh Kuldev, Wilson M Roy, Wilson Richard, Kannel William B
Hamilton Glaucoma Center, University of California-San Diego, La Jolla, CA 92093-0946, USA.
Am J Ophthalmol. 2004 Sep;138(3):458-67. doi: 10.1016/j.ajo.2004.04.054.
To develop a model for estimating the global risk of disease progression in patients with ocular hypertension and to calculate the "number-needed-to-treat" (NNT) to prevent progression to blindness as an aid to practitioners in clinical decision making.
Development of a mathematical model for estimating risk of glaucoma progression.
Population-based studies of patients with ocular hypertension and glaucoma were reviewed by a panel of glaucoma specialists. Measures of disease progression risks derived from three long-term studies and assumptions based on the available data were used to estimate the risk of progression from ocular hypertension to glaucoma and glaucoma to unilateral blindness for untreated and treated patients over a 15-year period. Using these estimates, the NNT (1/absolute risk reduction on treatment) to prevent unilateral blindness in one patient with ocular hypertension was calculated.
In untreated patients, the estimated risk of progression from ocular hypertension to unilateral blindness was 1.5% to 10.5% and in treated patients, the estimated risk of progression was 0.3% to 2.4% over 15 years. From these estimates, between 12 and 83 patients with ocular hypertension will require treatment to prevent one patient from progressing to unilateral blindness over a 15-year period.
Global risk assessment that incorporates all available data plays a vital role in managing patients with ocular hypertension. A more precise understanding of long-term vision loss should be factored into decisions pertaining to the initiation of glaucoma therapy. Undoubtedly, these estimates will evolve and change with the availability of new population-based epidemiologic information and improvements in multivariable model testing.
建立一个模型来估计高眼压症患者疾病进展的总体风险，并计算预防失明进展所需的“治疗需人数”（NNT），以辅助临床医生进行决策。
开发一个用于估计青光眼进展风险的数学模型。
一组青光眼专家对基于人群的高眼压症和青光眼患者研究进行了综述。来自三项长期研究的疾病进展风险测量指标以及基于现有数据的假设，被用于估计未经治疗和接受治疗的患者在15年内从高眼压症进展为青光眼以及从青光眼进展为单眼失明的风险。利用这些估计值，计算出预防一名高眼压症患者单眼失明所需的NNT（1/治疗时的绝对风险降低率）。
在未经治疗的患者中，估计15年内从高眼压症进展为单眼失明的风险为1.5%至10.5%，而在接受治疗的患者中，估计进展风险为0.3%至2.4%。根据这些估计值，在15年期间，需要治疗12至83名高眼压症患者才能预防一名患者进展为单眼失明。
纳入所有可用数据的总体风险评估在管理高眼压症患者方面起着至关重要的作用。在有关青光眼治疗起始的决策中，应考虑对长期视力丧失更精确的理解。毫无疑问，随着新的基于人群的流行病学信息的可得性以及多变量模型测试的改进，这些估计值将会演变和变化。
