Personalized Prediction of Glaucoma Progression Under Different Target Intraocular Pressure Levels Using Filtered Forecasting Methods.
Personalized Prediction of Glaucoma Progression Under Different Target Intraocular Pressure Levels Using Filtered Forecasting Methods.
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DOI：
10.1016/j.ophtha.2017.10.033
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发表时间：
2018-04
期刊：
影响因子：
13.7
通讯作者：
Stein JD
中科院分区：
文献类型：
--
作者：
Kazemian P;Lavieri MS;Van Oyen MP;Andrews C;Stein JD
生成开角型青光眼（OAG）患者在不同眼内压（IOP）水平下如何经历疾病进展的个性化预测，以帮助临床医生设置个性化目标IOP。使用2项随机对照试验的纵向数据进行次要分析。571名来自协作初始青光眼治疗研究（CIGTS）或晚期青光眼干预研究（AGIS）的中度或晚期OAG受试者。使用来自试验参与者的周长和眼压测量数据，我们开发并验证了用于快速、缓慢和非进展性OAG患者的卡尔曼滤波器模型。卡尔曼滤波器可以在不同目标IOP水平下生成OAG进展的个性化和动态更新的预测。对于每名参与者，我们确定了如果患者在未来5年内将其IOP维持在7个水平（6、9、12、15、18、21或24 mmHg）之一时，平均偏差（MD）将如何变化。如果IOP从试验中达到的水平升高或降低3、6和9 mmHg，我们还对同一时间范围内MD的变化进行建模和预测。不同目标IOP水平下MD变化的个性化估计。共有571名参与者（平均（标准差（SD））年龄64.2（10.9）岁），平均（SD）随访6.5（2.8）年。我们的模型预测，平均而言，快速进展者在目标IOP为6、15和24 mmHg的情况下，5年内分别损失2.1、6.7和11.2 dB MD。相比之下，平均而言，在相同的目标IOP和时间范围内，进展缓慢者将损失0.8、2.1和4.1 dB MD。当使用我们的工具量化所有571例患者的OAG进展动力学时，我们发现在不同目标IOP下，黑人与白人、男性与女性以及CIGTS与AGIS参与者之间的进展在5年内没有统计学显著差异（所有P>0.05）。这是我们知道的第一个临床决策工具，可以在不同的目标IOP水平下生成OAG进展轨迹的个性化预测。这种方法可以帮助临床医生为OAG患者确定适当的个性化目标IOP。
To generate personalized forecasts of how patients with open-angle glaucoma (OAG) experience disease progression at different intraocular pressure (IOP) levels, to aid clinicians with setting personalized target IOPs. Secondary analyses using longitudinal data from 2 randomized controlled trials. 571 participants with moderate or advanced OAG from the Collaborative Initial Glaucoma Treatment Study (CIGTS) or the Advanced Glaucoma Intervention Study (AGIS). Using perimetric and tonometric data from trial participants, we developed and validated Kalman filter models for fast-, slow-, and non-progressing patients with OAG. The Kalman filter can generate personalized and dynamically-updated forecasts of OAG progression under different target IOP levels. For each participant, we determined how mean deviation (MD) would change if the patient maintains his/her IOP at one of seven levels (6, 9, 12, 15, 18, 21, or 24 mmHg) over the next 5 years. We also model and predict changes to MD over the same time horizon if IOP is increased or decreased by 3, 6, and 9 mmHg from the level attained in the trials. Personalized estimates of the change in MD under different target IOP levels. There were 571 participants (mean (standard deviation (SD)) age 64.2 (10.9) years) who were followed for a mean (SD) of 6.5 (2.8) years. Our models predicted that, on average, fast-progressors would lose 2.1, 6.7, and 11.2 dB MD under target IOPs of 6, 15, and 24 mmHg, respectively over 5 years. In contrast, on average, slow-progressors would lose 0.8, 2.1, and 4.1 dB MD under the same target IOPs and time frame. When using our tool to quantify the OAG progression dynamics for all 571 patients, we found no statistically significant differences over 5 years between progression for blacks vs. whites, males vs. females, and CIGTS vs. AGIS participants under different target IOPs (P>0.05 for all). This is the first clinical decision-making tool we are aware of that generates personalized forecasts of the trajectory of OAG progression at different target IOP levels. This approach can help clinicians determine an appropriate and personalized target IOP for patients with OAG.
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影响因子：
3.8
作者：
Bogaarts, J. G.;Gommer, E. D.;Reulen, J. P. H.
通讯作者：
Reulen, J. P. H.
影响因子：
13.7
作者：
De Moraes, Carlos Gustavo;Jasien, Jessica V.;Ritch, Robert
通讯作者：
Ritch, Robert
影响因子：
13.7
作者：
Stein JD;Ruiz D Jr;Belsky D;Lee PP;Sloan FA
通讯作者：
Sloan FA
DOI：
10.1111/j.2517-6161.1977.tb01600.x
发表时间：
1977-01-01
期刊：
JOURNAL OF THE ROYAL STATISTICAL SOCIETY SERIES B-METHODOLOGICAL
影响因子：
--
作者：
DEMPSTER, AP;LAIRD, NM;RUBIN, DB
通讯作者：
RUBIN, DB
影响因子：
2.6
作者：
LEFFERTS, EJ;MARKLEY, FL;SHUSTER, MD
通讯作者：
SHUSTER, MD