Validated Prediction Model for the Development of Primary Open-Angle Glaucoma in Individuals with Ocular Hypertension
Presented at: American Academy of Ophthalmology Annual Meeting, November 2006, Las Vegas, Nevada.
Received 17 May 2006; accepted 3 August 2006. published online 08 November 2006.
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 χ2 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 χ2, 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.
Correspondence to Mae O. Gordon, PhD, OHTS Coordinating Center, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, Box 8203, 660 South Euclid, St. Louis, MO 63110, mae@vrcc.wustl.edu.
Manuscript no. 2006-545.
Supported by grants from the National Eye Institute, Bethesda, Maryland, and National Center for Minority Health and Health Disparities, Bethesda, Maryland (nos. EY09341, EY09307); European Commission, Brussels, Belgium (no. BMH4-CT-96-1598); Merck Research Laboratories, White House Station, New Jersey; Pfizer, Inc., New York, New York; and Research to Prevent Blindness, New York, New York (unrestricted).
⁎ See “Appendix” for writing committee membership and the full membership of each study group.
ABSTRACT