Poursoroush Asma, Abedi Vida, Huang Xiaoqin, Li Jiang, Sadr Alireza Vafaei, de Jongh Curry Amy L, Pasquale Louis R, Boland Michael V, Johnson Chris A, Yousefi Siamak
Department of Biomedical Engineering, University of Memphis and University of Tennessee Health Science Center, Memphis, USA.
Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA, 17033, USA.
Ophthalmol Ther. 2025 Jun 28. doi: 10.1007/s40123-025-01174-3.
Our aim in this work is to identify a subtype of ocular hypertensive eyes that benefited the most from topical hypertensive medication.
We included 1636 patients (817 patients in the active group and 819 in the observation group) who participated in the Ocular Hypertension Treatment Study (OHTS). We developed principal component analysis (PCA), t-distributed stochastic neighbor embedding (t-SNE), and unsupervised density-based clustering, then applied to the baseline visual fields (VFs) to identify different clusters of eyes. For each cluster, the rate of mean deviation (MD) worsening was calculated based on 7 years of follow-up. To determine which cluster (subtype) of eyes responded better to the ocular hypertensive medications, MD worsening was compared between the active and observation groups within each cluster of eyes separately.
We identified 13 clusters based on visual field (VF) tests at baseline visits. Among these, one cluster demonstrated a significantly better response to ocular hypotensive medication compared to the others. Key distinguishing characteristics of this cluster included a lower frequency of family history of glaucoma (p = 0.006) but a higher prevalence of heart disease (p < 0.001) and high blood pressure (p < 0.001). Interestingly, although eyes in this cluster had a worse baseline MD than those in all other clusters (- 2.2 ± 0.1 dB vs. + 0.47 ± 1.2 dB, p < 0.001) and patients were older (64.3 ± 9.5 vs. 54.7 ± 8.94 years, p < 0.001), this was the only cluster where the MD progression rate in the treatment (active) group was significantly lower than in the observation group (+ 0.04 dB/year vs. - 0.09 dB/year, p = 0.03). Furthermore, treated eyes in this cluster had a significantly better MD progression rate than treated eyes in all other clusters (+ 0.04 dB/year vs. - 0.07 dB/year, p < 0.001).
We identified a subtype of ocular hypertensive eyes in the OHTS that showed a better response to topical hypotensive medications, as indicated by the least risk of progression.
我们这项研究的目的是确定局部降压药物治疗受益最大的高眼压症患者亚型。
我们纳入了参与高眼压症治疗研究（OHTS）的1636例患者（治疗组817例，观察组819例）。我们开展了主成分分析（PCA）、t分布随机邻域嵌入（t-SNE）和基于密度的无监督聚类，然后应用于基线视野（VF）以识别不同的眼簇。对于每个簇，根据7年的随访计算平均偏差（MD）恶化率。为了确定哪种眼簇（亚型）对降压药物反应更好，分别比较了每个眼簇内治疗组和观察组的MD恶化情况。
根据基线访视时的视野（VF）测试，我们识别出13个簇。其中，一个簇对降眼压药物的反应明显优于其他簇。该簇的关键区别特征包括青光眼家族史频率较低（p = 0.006），但心脏病患病率较高（p < 0.001）和高血压患病率较高（p < 0.001）。有趣的是，尽管该簇中的眼基线MD比所有其他簇中的眼更差（-2.2±0.1 dB对+0.47±1.2 dB，p < 0.001）且患者年龄更大（64.3±9.5岁对54.7±8.94岁，p < 0.001），但这是唯一治疗（治疗）组MD进展率显著低于观察组的簇（+0.04 dB/年对-0.09 dB/年，p = 0.03）。此外，该簇中接受治疗的眼的MD进展率明显优于所有其他簇中接受治疗的眼（+0.04 dB/年对-0.07 dB/年，p < 0.001）。
我们在OHTS中识别出一种高眼压症患者亚型，其对局部降压药物表现出更好的反应，进展风险最低。
