Validated prediction model for the development of primary open-angle glaucoma in individuals with ocular hypertension
Validated prediction model for the development of primary open-angle glaucoma in individuals with ocular hypertension
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DOI：
10.1016/j.ophtha.2006.08.031
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发表时间：
2007-01-01
期刊：
影响因子：
13.7
通讯作者：
Gordon, Mae O.
中科院分区：
文献类型：
--
作者：
Gordon, Mae O.
目的：在未经治疗的高眼压个体的大样本独立样本中测试高眼压治疗研究（OHTS）预测模型对原发性开角型青光眼（POAG）发展的有效性和普遍性，并开发一个定量计算器来估计高眼压个体发展POAG的5年风险。设计：从OHTS的观察组开发预测模型，然后使用z统计量比较风险比，c统计量用于区分，以及用于预测风险的系统性高估/低估的校准卡方（2）。研究对象：OHTS观察组（n = 819;中位随访时间6.6年）和EGPS安慰剂组（n = 500;中位随访时间4.8年）。测试：收集了有关人口统计学特征、病史、眼部检查视野（VF）和视盘照片的数据。主要结果测量：由盲读者确定的可再现VF异常或视盘进展的发展，并由盲读终点委员会归因于POAG。在OHTS观察组和EGPS安慰剂组中，独立确定了POAG发展的相同预测因素-基线年龄，眼内压，中央角膜厚度、垂直杯盘比和Humphrey VF模式标准差。POAG发展的合并多变量模型具有良好的区分度（c统计量，0.74）和POAG风险的准确估计（校准卡方（2），7.05）。结论：OHTS预测模型在EGPS安慰剂组中得到验证。基于合并OHTS-EGPS预测模型，估计POAG发生的5年风险的计算器具有较高的精度，将有助于临床医生和患者决定随访期间的测试和检查频率以及开始预防性治疗的可行性。
Objective: To test the validity and generalizability of the Ocular Hypertension Treatment Study (OHTS) prediction model for the development of primary open-angle glaucoma (POAG) in a large independent sample of untreated ocular hypertensive individuals and to develop a quantitative calculator to estimate the 5-year risk that an individual with ocular hypertension will develop POAG.Design: A prediction model was developed from the observation group of the OHTS and then tested on the placebo group of the European Glaucoma Prevention Study (EGPS) using a z statistic to compare hazard ratios, a c statistic for discrimination, and a calibration chi(2) for systematic overestimation/underestimation of predicted risk. The 2 study samples were pooled to increase precision and generalizability of a 5-year predictive model for developing POAG.Participants: The OHTS observation group (n = 819; 6.6 years' median follow-up) and EGPS placebo group (n = 500; 4.8 years' median follow-up). Testing: Data were collected on demographic characteristics, medical history, ocular examination visual fields (VFs), and optic disc photographs.Main Outcome Measure: Development of reproducible VF abnormality or optic disc progression as determined by masked readers and attributed to POAG by a masked end point committee.Results: The same predictors for the development of POAG were identified independently in both the OHTS observation group and the EGPS placebo group-baseline age, intraocular pressure, central corneal thickness, vertical cup-to-disc ratio, and Humphrey VF pattern standard deviation. The pooled multivariate model for the development of POAG had good discrimination (c statistic, 0.74) and accurate estimation of POAG risk (calibration chi(2), 7.05).Conclusions: The OHTS prediction model was validated in the EGPS placebo group. A calculator to estimate the 5-year risk of developing POAG, based on the pooled OHTS-EGPS predictive model, has high precision and will be useful for clinicians and patients in deciding the frequency of tests and examinations during follow-up and advisability of initiating preventive treatment.