FACTORS PREDICTIVE OF RAPID VISUAL FIELD LOSS IN EARLY GLAUCOMA

描述（由申请人提供）：原发性开角型青光眼（POAG）是一种慢性进行性视神经病变和潜在致盲性疾病。因此，它给患者、其家庭以及整个社会带来了社会和经济负担。青光眼的损害是不可逆转的，因为一旦视神经细胞死亡，还没有什么可以恢复。目前的青光眼治疗策略通常旨在相当积极地治疗所有患者，这是基于所有患者都会随着时间的推移而恶化并且最终疾病会影响每个患者的假设。然而，视野（VF）进展的速度可以从患者到患者有很大的不同，这是至关重要的，以确定这些患者的VF迅速恶化。 VF进展患者的早期识别将允许迅速强化治疗以防止进一步损害。相反，对于视野保持稳定的患者，可以减少对有限医疗资源的使用，并可以避免与过度治疗相关的发病率。该提案的目标是开发一种监测模型，以估计早期青光眼患者VF进展的风险。该模型将基于标准的临床测量，临床医生和患者都很容易获得。我们的假设是，结合VF数据和临床因素的模型在VF进展的早期识别方面比目前仅关注VF数据的监测具有更好的性能。分析样品的质量和完整性大大加强了这种应用。我们将在高眼压治疗研究中使用279例（362只眼）患有POAG的受试者队列。它包含高质量的每两年一次的视野（VF）测试结果，中位随访时间为13年。这是最大的初始队列。所有患者在POAG诊断之前和之后根据标准化方案进行前瞻性随访。病例定义是标准化的，掩蔽的和特定的原因。每只眼睛都有一个时间零点，代表POAG诊断的日期。时间零点允许我们检查POAG确定前后的因素，以及从确定日期到进展的时间。将在青光眼初始治疗协作研究（CIGTS）中的234例患者的子样本中交叉验证监测模型，这些患者具有电子记录的逐点VF阈值。我们将把监测模型放在同一个，高光顾的网站上作为OHTS预测模型的POAG的发展。这一建议代表了个性化青光眼护理的重要一步。我们的长期目标是通过准确估计患者青光眼进展的个体化风险来辅助个性化管理程序，以便临床医生和患者可以就监测频率和积极治疗的需要做出个性化的、基于证据的决定。

DESCRIPTION (provided by applicant): Primary open angle glaucoma (POAG) is a chronic progressive optic neuropathy and potentially blinding disease. It thus places a social and economic burden on patients, their families, as well as the general society. Glaucoma damage is irreversible because nothing yet can restore the optic nerve cells once they are dead. Current strategies for glaucoma treatment are often aimed to treat all patients rather aggressively, based on the assumption that all patients will get worse over time and eventually the disease will impact each patient. However, rates of visual field (VF) progression can vary substantially from patient to patient and it is crucial to identify these patients whose VFs deteriorate rapidly. Early identification of patients with VF progression would allow for prompt intensification of treatment to prevent further damage. Conversely, for patients whose visual fields remain stable the use of limited healthcare resources could be reduced and the morbidity associated with over-treatment could be avoided. The goal of this proposal is to develop a surveillance model to estimate the risk of VF progression in patients with early glaucoma. The model will be based on standard clinical measures and easily accessible to clinicians and patients. Our hypothesis is that a model incorporating both VF data and clinical factors would have a better performance in early identification of VF progression than the current surveillance focusing on VF data alone. This application is greatly strengthened by the quality and completeness of the analysis sample. We will use the cohort of 279 participants (362 eyes) who developed POAG in the Ocular Hypertension Treatment Study. It contains high-quality bi-annual visual field (VF) test results with a median follow-up of thirteen years. This is the largest inception cohort. All patients were followed prospectively according to a standardized protocol prior to and after POAG diagnosis. Case definition was standardized, masked and cause-specific. Each eye has a time zero representing the date of POAG diagnosis. Time zero allows us to examine factors before and after POAG ascertainment, as well as time to progression from the ascertainment date. The surveillance model will be cross-validated in a sub-sample of 234 patients in the Collaborative Initial Glaucoma Treatment Study (CIGTS) who had point-wise VF thresholds recorded electronically. We will put the surveillance model on the same, highly patronized web site as the OHTS prediction model for the development of POAG. This proposal represents an important step towards personalizing glaucoma care. Our long-term objective is to assist a personalized management procedure through an accurate estimating of patients' individualized risk of glaucoma progression, so that clinicians and patients can make individualized, evidence- based decisions as to the frequency of monitoring and need for aggressive treatment.