Nitta Koji, Tachibana Gaku, Wajima Ryotaro, Inoue Sachie, Ohigashi Tatsuya, Otsuka Naomi, Kurashima Hiroaki, Santo Kazunori, Hashimoto Masayo, Shibahara Hidetoshi, Hirukawa Mai, Sugiyama Kazuhisa
Department of Ophthalmology, Fukui-Ken Saiseikai Hospital, Fukui, Japan.
Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
Clin Ophthalmol. 2020 Jul 10;14:1967-1978. doi: 10.2147/OPTH.S247618. eCollection 2020.
To maintain visual fields and quality of life over a lifetime, medical practice must be conducted taking into consideration not only visual field progression but also future visual field changes that occur over the patients' expected lifespan. The purpose of this study is to investigate the feasibility of establishing a model that predicts prognosis, estimating the proportion of glaucoma patients with severe visual field defects.
The data of 191 patients with primary open-angle glaucoma, with a predominance of normal-tension glaucoma, were used for this study. The model was developed based on patients' backgrounds and risk factors, using Monte Carlo simulation. A "severe visual field defect" was defined as ≤-20 dB. The mean deviation (MD) value for 10,000 virtual patients in each simulation pattern (144 patterns) was calculated using a predictive formula to estimate the MD slope, and the effects of risk factors and intraocular pressure (IOP) reduction on the proportion of patients with severe visual field defects were evaluated.
Younger age, later-stage disease, more severe glaucomatous structural abnormalities and the presence of disc hemorrhage were associated with an increase in the progression rate of patients with severe visual field defects. Conversely, lower IOP was associated with a decrease in this rate.
Combining regression analysis with Monte Carlo simulation could be a useful method for developing predictive models of prognosis in glaucoma patients.
为了在患者的整个生命周期内维持视野和生活质量，医疗实践不仅要考虑视野进展，还要考虑患者预期寿命期间发生的未来视野变化。本研究的目的是探讨建立一个预测预后的模型的可行性，估计患有严重视野缺损的青光眼患者的比例。
本研究使用了191例原发性开角型青光眼患者的数据，其中以正常眼压性青光眼为主。该模型基于患者的背景和危险因素，采用蒙特卡罗模拟法建立。“严重视野缺损”定义为≤-20dB。使用预测公式计算每种模拟模式（144种模式）下10000名虚拟患者的平均偏差（MD）值，以估计MD斜率，并评估危险因素和眼压（IOP）降低对严重视野缺损患者比例的影响。
年龄较小、疾病晚期、青光眼结构异常更严重以及存在视盘出血与严重视野缺损患者的进展率增加相关。相反，眼压降低与该比率降低相关。
将回归分析与蒙特卡罗模拟相结合可能是建立青光眼患者预后预测模型的一种有用方法。
