*Department of Ophthalmology, New York University School of Medicine †Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York ‡Department of Ophthalmology, New York Medical College, Valhalla, NY.
J Glaucoma. 2014 Jan;23(1):1-4. doi: 10.1097/IJG.0b013e31825af795.
To investigate the longitudinal variability of glaucoma risk calculation in ocular hypertensive (OHT) subjects.
We reviewed the charts of untreated OHT patients followed in a glaucoma referral practice for a minimum of 60 months. Clinical variables collected at baseline and during follow-up included age, central corneal thickness (CCT), intraocular pressure (IOP), vertical cup-to-disc ratio (VCDR), and visual field pattern standard deviation (VFPSD). These were used to calculate the 5-year risk of conversion to primary open-angle glaucoma (POAG) at each follow-up visit using the Ocular Hypertension Treatment Study and European Glaucoma Prevention Study calculator (http://ohts.wustl.edu/risk/calculator.html). We also calculated the risk of POAG conversion based on the fluctuation of measured variables over time assuming the worst case scenarios (final age, highest PSD, lowest CCT, highest IOP, and highest VCDR) and best case scenarios (baseline age, lowest PSD, highest CCT, lowest IOP, and lowest VCDR) for each patient. Risk probabilities (%) were plotted against follow-up time to generate slopes of risk change over time.
We included 27 untreated OHT patients (54 eyes) followed for a mean of 98.3±18.5 months. Seven individuals (25.9%) converted to POAG during follow-up. The mean 5-year risk of conversion for all patients in the study group ranged from 2.9% to 52.3% during follow-up. The mean slope of risk change over time was 0.37±0.81% increase/y. The mean slope for patients who reached a POAG endpoint was significantly greater than for those who did not (1.3±0.78 vs. 0.042±0.52%/y, P<0.01). In each patient, the mean risk of POAG conversion increased almost 10-fold when comparing the best case scenario with the worst case scenario (5.0% vs. 45.7%, P<0.01).
The estimated 5-year risk of conversion to POAG among untreated OHT patients varies significantly during follow-up, with a trend toward increasing over time. Within the same individual, the estimated risk can vary almost 10-fold based on the variability of IOP, CCT, VCDR, and VFPSD. Therefore, a single risk calculation measurement may not be sufficient for accurate risk assessment, informed decision-making by patients, and physician treatment recommendations.
研究原发性开角型青光眼（POAG）高危人群的青光眼风险计算的纵向变化。
我们回顾了在青光眼转诊机构接受至少 60 个月随访的未经治疗的高眼压（OHT）患者的图表。在基线和随访期间收集的临床变量包括年龄、中央角膜厚度（CCT）、眼内压（IOP）、垂直杯盘比（VCDR）和视野模式标准差（VFPSD）。这些变量用于使用眼科高血压治疗研究和欧洲青光眼预防研究计算器（http://ohts.wustl.edu/risk/calculator.html）计算每位患者在每次随访时发生原发性开角型青光眼（POAG）的 5 年转化率。我们还根据假设最差情况（最终年龄、最高 PSD、最低 CCT、最高 IOP 和最高 VCDR）和每位患者的最佳情况（基线年龄、最低 PSD、最高 CCT、最低 IOP 和最低 VCDR）来计算 POAG 转换的风险。计算随时间推移测量变量变化的风险，并生成随时间变化的风险变化斜率。
我们纳入了 27 名未经治疗的 OHT 患者（54 只眼），平均随访 98.3±18.5 个月。7 名患者（25.9%）在随访期间转为 POAG。在研究组的所有患者中，5 年内所有患者的转换风险平均值在随访期间从 2.9%到 52.3%不等。随时间变化的风险变化平均斜率为 0.37±0.81%/y。达到 POAG 终点的患者的平均斜率明显大于未达到 POAG 终点的患者（1.3±0.78 与 0.042±0.52%/y，P<0.01）。在每个患者中，将最佳情况与最差情况进行比较时，POAG 转换的平均风险增加了近 10 倍（5.0%与 45.7%，P<0.01）。
未经治疗的 OHT 患者的估计 5 年内发生 POAG 的转化率在随访期间差异显著，呈随时间增加的趋势。在同一患者中，基于 IOP、CCT、VCDR 和 VFPSD 的变异性，估计风险几乎可以变化 10 倍。因此，单次风险计算测量可能不足以进行准确的风险评估、患者知情决策和医生治疗建议。
