FOLLOW-UP INTRAOCULAR PRESSURE AND THE RISK OF DEVELOPING PRIMARY OPEN-ANGLE GLAU

描述(由申请人提供)：多达1000万40岁以上的美国人因高眼压而有患青光眼的风险，但据估计，这1000万人中只有240万人每年患POAG的风险为2%，因此达到了开始降压治疗的成本效益门槛。挑战是从75%的治疗无效的人中确定25%的“有风险”的人接受了治疗。我们的预测模型基于眼压治疗研究(OHTS)和欧洲青光眼预防研究(EGPS)未经治疗的手臂(n=1,319名参与者)的汇总数据，计算了患有高眼压症的个体发生原发性开角型青光眼(POAG)的5年风险。这一预测模型可以在我们的交互式“风险计算器”网站上找到，该网站在不到一年的时间里吸引了来自72个国家的8000多名独立访问者。我们希望提高这种风险计算器的预测准确性和临床实用性。到目前为止，还没有预测模型，包括我们的预测模型，为临床医生和患者提供循证指导，根据患者的基线风险因素(目标1)调整不同的目标眼压(以毫米汞为单位)来降低青光眼风险。本研究的具体目的是：目的1.确定降低眼压对POAG发病风险的影响。我们还将确定调整CCT的眼压是否提高了POAG发展预测模型的精度。目的2.确定与高眼压患者随访(治疗和未治疗)眼压相关的基线因素。目的3.确定现有的OHTS/EGPS基线预测模型对POAG发展的预测准确性是否通过包含有关随访眼压水平、趋势或变异性的信息来提高。通过在我们的网站上放置出版物的链接或PDF副本，并在基于网络的交互式风险计算器上包括目标治疗IOPS的计算，将加快将研究成果转化为临床实践的速度。分析数据集将包括OHTS和EGPS的治疗组和未治疗组，总共N=2614名参与者，平均随访时间为5.5年，260例POAG病例。已经对数据集进行了不确定和统一，以便可以进行拟议的分析。OHTS和EGPS的指导委员会已经批准了协作分析。

DESCRIPTION (provided by applicant): As many as 10 million Americans over the age of 40 years are at risk for developing glaucoma because of ocular hypertension, but only 2.4 million of these 10 million are estimated to have a >2% annual risk of developing POAG and thus meet the cost-effectiveness threshold to initiating hypotensive treatment. The challenge is to identify the 25% of the "at risk" individuals for whom treatment is indicated from the 75% for whom treatment is not cost-effective. Our prediction model which calculates the 5-year risk of developing primary open angle glaucoma (POAG) in individuals with ocular hypertension is based on the pooled data of the untreated arms (n=1,319 participants) of the Ocular Hypertension Treatment Study (OHTS) and the European Glaucoma Prevention Study (EGPS). This prediction model is available on our interactive "risk calculator" web site which has attracted more than 8,000 unique visitors from 72 countries in less than a year. We would like to increase the predictive accuracy and clinical utility of this risk calculator. No prediction model to date, including ours, gives clinicians and patients evidence-based guidance on the reduction of glaucoma risk at various target IOPs (in mmHg) adjusted for the patient's baseline risk factors (Aim 1). The Specific Aims of the proposed study are: Aim 1. To determine the impact of IOP reduction on the risk of developing POAG. We will also determine whether adjusting IOP for CCT increases the precision of the prediction model for development of POAG. Aim 2. To identify baseline factors associated with follow-up IOP (treated and untreated) in ocular hypertensive individuals. Aim 3. To determine if the predictive accuracy of the existing OHTS/EGPS baseline prediction model for the development of POAG is increased by including information on follow-up IOP level, trend or variability. Translation of research findings into clinical practice will be accelerated by placing a link or PDF copy of publications on our website and by including the calculation of target treatment IOPs on the web-based interactive risk calculator. The analysis dataset will include both treated and untreated groups in OHTS and EGPS, a total of N=2,614 participants with a median follow-up of 5.5 years and 260 cases of POAG. The datasets have already been de-identified and harmonized so that the proposed analyses can be undertaken. The Steering Committees of the OHTS and EGPS have approved the collaborative analyses.