Prediction of Visual Field Progression in Patients with Primary Open-Angle Glaucoma, Mainly Including Normal Tension Glaucoma

Abstract

An objective method to predict individual visual field progression will contribute to realise personalised medication. The purpose of this study was to establish a predictive formula for glaucomatous visual field progression in patients with Primary open-angle glaucoma, mainly including normal tension glaucoma. This study was a large-scale, longitudinal and retrospective study including 498 eyes of 312 patients visiting from June 2009 to May 2015. In this analysis, 191 eyes of 191 patients meeting all eligible criteria were used. A predictive formula to calculate the rate of glaucomatous visual field progression (mean deviation slope) was obtained through multivariate linear regression analysis by adopting “Angle of Retinal Nerve Fibre Layer Defect” at the baseline, “Vertical Cup-Disc ratio” at the baseline, “Presence or absence of Disc Haemorrhage” during the follow-up period, and “Mean IOP change (%)” during the follow-up period as predictors. Coefficient of determination of the formula was 0.20. The discriminative ability of the formula was evaluated as moderate performance using receiver operating characteristic analysis, and the area under the curve was approximately 0.75 at all cut-off values. Internal validity was confirmed by bootstrapping. The predictive formula established by this type of approach might be useful for personalised medication.

<p>Predicting Lifetime Transition Risk of Severe Visual Field Defects Using Monte Carlo Simulation in Japanese Patients with Primary Open-Angle Glaucoma</p>

“…Furthermore, the variables used in the previous study were limited because the dataset was obtained from daily practice. 12 In the future, prospective studies with a range of variables such as those obtained from advanced imaging technique (OCTA, etc.) will be needed to establish better predictive accuracy.…”

“…This prognosis-predicting model was developed to predict changes in the MD value over the lifetime of individual patients using our formula for estimating the MD slope of POAG patients. The details of formula development were previously reported, 12 and can be summarized in the outline as follows. This formula was obtained using a multiple regression analysis with data on 20 clinical parameters, belonging to six categories, from the above patient population (191 eyes of 191 patients).…”

“…This formula was developed using a multiple regression analysis based on data obtained from patients with primary open-angle glaucoma (POAG), mainly comprising normal-tension glaucoma (NTG). 12 In the management of glaucoma, it is important to maintain the patient's visual fields over his/her lifetime to prevent the quality of vision being negatively impacted. In order to achieve this, medical care must be provided in consideration of the future visual fields during the patient's lifespan, as well as visual field progression.…”

“…This formula was developed using a multiple regression analysis based on data obtained from patients with primary open-angle glaucoma (POAG), mainly comprising normal-tension glaucoma (NTG). 12 …”

Cost-effectiveness and budget impact analysis of a patient visit support system for blindness reduction in Japanese patients with glaucoma

“…MD is available to estimate the severity and extent of visual field defects as a simplified descriptor value 23 . MD slope was used to confirm the progression of glaucoma in previous studies 24,25 . The rates derived from the specified MD slope in three distinct disease progression groups were applied to Figure 1.…”