Curtin Karen, Stein Joshua D, Stagg Brian C, Fino Nora, Conley Matthew, Johnson Taylor, Patil Ayesha, Paulson Chase, Pompoco Christian, Wirostko Barbara M
Ophthalmology & Visual Sciences, University of Utah School of Medicine, Moran Eye Center, Salt Lake City, Utah; Division of Epidemiology, Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
Ophthalmology and Visual Sciences, University of Michigan Medicine, Kellogg Eye Center, Ann Arbor, Michigan.
Ophthalmol Glaucoma. 2025 Mar-Apr;8(2):133-142. doi: 10.1016/j.ogla.2024.10.006. Epub 2024 Oct 21.
To identify clinical factors associated with conversion to exfoliation glaucoma (XFG) in exfoliation syndrome (XFS) patients who are most at risk of progression to XFG within 3 years for increased surveillance and early preventive interventions.
A retrospective patient cohort study design was employed.
A source population of XFS patients ≥ 50 years was identified from electronic medical records in the Utah Population Database. From this, 487 study patients with one or more dilated eye examinations before chart-confirmed XFS onset in 2011 or later and ≥ 3 years of subsequent eye examinations were selected for study.
We implemented binomial linear mixed models with L1-penalized estimation to select variables associated with conversion. Models included a random intercept to account for within-patient correlation for eye-level data. Candidate demographic, lifestyle, systemic, and ocular comorbidities data were obtained, and diagnoses were categorized as binary (history or no history). These potential factors between conversion and nonconversion patients were used in model selection of variables jointly predictive of conversion. Odds ratios and confidence intervals were calculated using the link logit.
To determine the main outcome of conversion to XFG following an index diagnosis of XFS compared with nonconversion within 3 years, clinical records of each subject's left and right eyes were assessed to confirm XFS and date of onset and date of XFG onset, if conversion occurred. Clinical measurements (e.g., intraocular pressure [IOP], cup-to-disc ratio, provider notes, and IOP-lowering procedures and medications) were used to corroborate conversion status.
Eighteen variables jointly predicted XFG conversion within 3 years correctly in 71% of patient eyes. The odds of conversion were the highest for exudative age-related macular degeneration (AMD), 2.3-fold (P = 0.004). Other predictive variables included nonexudative AMD (P = 0.05), primary open angle glaucoma (P < 0.001), obstructive sleep apnea (P = 0.03), and ocular hypertension (P = 0.003) diagnosed before XFS onset.
We determined a set of clinically relevant factors that predicted which newly diagnosed XFS patients progressed to XFG within 3 years. A planned validation will independently confirm if these prognostic indicators hold promise in other settings.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
确定剥脱综合征（XFS）患者中与进展为剥脱性青光眼（XFG）相关的临床因素，这些患者在3年内进展为XFG的风险最高，以便加强监测并进行早期预防性干预。
采用回顾性患者队列研究设计。
从犹他州人口数据库的电子病历中确定年龄≥50岁的XFS患者源人群。从中选择487例研究患者，这些患者在2011年或之后经图表确认XFS发病前有一次或多次散瞳眼部检查，且随后有≥3年的眼部检查。
我们采用带有L1惩罚估计的二项式线性混合模型来选择与病情转化相关的变量。模型包括一个随机截距，以考虑眼水平数据的患者内相关性。获取了候选人口统计学、生活方式、全身和眼部合并症数据，并将诊断分类为二元（有病史或无病史）。这些病情转化患者和未转化患者之间的潜在因素被用于联合预测病情转化的变量的模型选择。使用连接logit计算优势比和置信区间。
为了确定XFS指数诊断后3年内进展为XFG与未进展的主要观察结果，评估了每个受试者左右眼的临床记录，以确认XFS及其发病日期以及XFG发病日期（如果发生病情转化）。临床测量指标（如眼压[IOP]、杯盘比、医生记录以及降眼压程序和药物）用于证实病情转化状态。
18个变量联合预测3年内XFG病情转化，在71%的患者眼中预测正确。渗出性年龄相关性黄斑变性（AMD）的病情转化几率最高，为2.3倍（P = 0.004）。其他预测变量包括非渗出性AMD（P = 0.05）、原发性开角型青光眼（P < 0.001）、阻塞性睡眠呼吸暂停（P = 0.03）以及在XFS发病前诊断的高眼压症（P = 0.003）。
我们确定了一组临床相关因素，这些因素可预测哪些新诊断的XFS患者在3年内进展为XFG。一项计划中的验证将独立确认这些预后指标在其他情况下是否有前景。
在本文末尾的脚注和披露中可能会找到专有或商业披露信息。
