Ophthalmology
Volume 117, Issue 9 , Pages 1674-1683, September 2010

Predicting the Onset of Glaucoma:

The Confocal Scanning Laser Ophthalmoscopy Ancillary Study to the Ocular Hypertension Treatment Study

  • Robert N. Weinreb, MD

      Affiliations

    • Department of Ophthalmology, University of California-San Diego, Hamilton Glaucoma Center, La Jolla, California
    • Corresponding Author InformationCorrespondence: Robert N. Weinreb, MD, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0946
    • ,
  • Linda M. Zangwill, PhD

      Affiliations

    • Department of Ophthalmology, University of California-San Diego, Hamilton Glaucoma Center, La Jolla, California
    • ,
  • Sonia Jain, PhD

      Affiliations

    • Family and Preventive Medicine, University of California-San Diego, La Jolla, California
    • ,
  • Lida M. Becerra, MS

      Affiliations

    • Family and Preventive Medicine, University of California-San Diego, La Jolla, California
    • ,
  • Keri Dirkes, MPH

      Affiliations

    • Department of Ophthalmology, University of California-San Diego, Hamilton Glaucoma Center, La Jolla, California
    • ,
  • Jody R. Piltz-Seymour, MD

      Affiliations

    • University of Pennsylvania Health Systems, Bristol, Pennsylvania
    • ,
  • George A. Cioffi, MD

      Affiliations

    • Ophthal-Discoveries in Sight, Devers Eye Institute, Portland, Oregon
    • ,
  • Gary L. Trick, PhD

      Affiliations

    • Ophthalmology, Henry Ford Health System, Detroit, Michigan
    • ,
  • Anne L. Coleman, MD, PhD

      Affiliations

    • Jules Stein Institute-UCLA, Los Angeles, California
    • ,
  • James D. Brandt, MD

      Affiliations

    • University of California-Davis Eye Center, Sacramento, California
    • ,
  • Jefferey M. Liebmann, MD

      Affiliations

    • Department of Ophthalmology, The New York Eye and Ear Infirmary, New York, New York
    • ,
  • Mae O. Gordon, PhD

      Affiliations

    • Department of Ophthalmology, Washington University School of Medicine, St. Louis, Missouri
    • ,
  • Michael A. Kass, MD

      Affiliations

    • Department of Ophthalmology, Washington University School of Medicine, St. Louis, Missouri
    • ,
  • OHTS CSLO Ancillary Study Group

Received 13 November 2009; received in revised form 15 March 2010; accepted 17 March 2010. published online 14 July 2010.

Available online: July 14, 2010.

Objective

To evaluate the predictive ability of baseline confocal scanning laser ophthalmoscopy (CSLO) Glaucoma Probability Score (GPS) for the development of primary open-angle glaucoma (POAG) and to compare it with the Moorfields regression analysis (MRA) classification, other topographic optic disc parameters, and stereophotograph-based cup-to-disc ratio.

Design

Longitudinal, randomized clinical trial.

Participants

We included 857 eyes of 438 participants in the CSLO Ancillary Study to the Ocular Hypertension Treatment Study (OHTS) with good quality baseline CSLO images.

Methods

The ability of baseline GPS, MRA, and optic disc parameters to predict the development of POAG was evaluated in univariate and multivariable proportional hazard ratio analyses. Likelihood ratios and positive and negative predictive values were compared.

Main Outcome Measures

The POAG end point as determined by repeatable changes in the visual field or optic disc.

Results

Sixty-four eyes of 50 CSLO Ancillary Study participants developed POAG. Median time to reach a POAG end point was 72.3 months. The 93 eyes of 388 participants not reaching endpoint were followed for a median of 124.9 months. Baseline GPS identified many more eyes as outside normal limits than the MRA. In multivariable analyses, all regional and global baseline GPS indices were significantly associated with the development of POAG; hazard ratios (95% confidence interval) ranged from 2.92 to 3.74 for an outside normal limits result. The MRA indices were also significantly associated with the development of POAG in multivariable analyses. In addition, the predictive ability of baseline GPS, MRA and stereometric parameters were similar to the predictive ability of models using photograph-based horizontal cup-to-disc ratio.

Conclusions

These results suggest that baseline GPS, MRA, and stereoparameters alone or when combined with baseline clinical and demographic factors can be used to predict the development of POAG end points in OHTS participants and are as effective as stereophotographs for estimating the risk of developing POAG in ocular hypertensive subjects.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found after the references.

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 Manuscript no. 2009-1585.

 Financial Disclosure(s): The authors have made the following disclosures.

 R.N. Weinreb - Support - Heidelberg Engineering, GmbH.

 L.M. Zangwill - Support - Heidelberg Engineering, Heidelberg, Germany; Carl Zeiss Meditec Inc, Dublin, CA.

 J. Piltz - Support - Seymour, Pfizer, Inc., Alcon Laboratories, Inc., Allergan, Inc., Merck.

 G.A. Cioffi - Consultant - Allergan, Inc., Pfizer Inc, C.

 G.L. Trick - Consultant - Allergan, Inc.

 A.L. Coleman - Consultant - Alcon Laboratories, Inc., Allergan, Inc., Pfizer, Inc.

 J.D. Brandt - Consultant - Alcon Laboratories, Inc., Allergan, Inc., Pfizer, Inc.; Lecturer - Alcon Laboratories, Inc., Allergan, Inc., Pfizer, Inc.

 J.M. Liebmann - Consultant - Alcon Laboratories, Inc., Allergan, Inc., Optovue, Inc., Heidelberg Engineering, GmbH, Pfizer, Inc., Topcon Medical Systems, Inc., Diopsys, Inc.; Support - Carl Zeiss Meditec, Inc.; Diopsys, Inc., Heidelberg Engineering, GmbH, Optovue, Inc., Pfizer, Inc., Topcon Medical Systems, Inc.

 M.A. Kass – Consultant – Pfizer, Inc.

 Supported by NIH/NEI grants, EY11158 (RNW), (EY09341, EY09307 [MOG, MAK]), Horncrest Foundation awards, NIH Vision Core Grant P30 EY02687, Merck Research Laboratories, Pfizer Inc, White House Station, New Jersey.

PII: S0161-6420(10)00323-4

doi:10.1016/j.ophtha.2010.03.044

Ophthalmology
Volume 117, Issue 9 , Pages 1674-1683, September 2010

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