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Risk calculation variability over time in ocular hypertensive subjects.

Christian Song1, Carlos Gustavo De Moraes, Ilana Forchheimer

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Glaucoma risk in ocular hypertensive patients fluctuates significantly over time. A single measurement may not accurately predict conversion to primary open-angle glaucoma (POAG).

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Area of Science:

  • Ophthalmology
  • Glaucoma Research
  • Clinical Risk Assessment

Background:

  • Ocular hypertension (OHT) is a significant risk factor for primary open-angle glaucoma (POAG).
  • Accurate longitudinal risk assessment is crucial for managing OHT patients and preventing vision loss.
  • Current risk calculators may not fully account for the dynamic nature of clinical variables in OHT.

Purpose of the Study:

  • To investigate the longitudinal variability of glaucoma risk calculation in ocular hypertensive (OHT) subjects.
  • To assess how changes in clinical variables over time impact the calculated 5-year risk of POAG conversion.
  • To determine if a single risk assessment is sufficient for OHT management.

Main Methods:

  • Retrospective chart review of untreated OHT patients with a minimum of 60 months follow-up.
  • Collection of clinical variables: age, central corneal thickness (CCT), intraocular pressure (IOP), vertical cup-to-disc ratio (VCDR), and visual field pattern standard deviation (VFPSD).
  • Calculation of 5-year POAG conversion risk using established calculators, considering both baseline and fluctuating 'best-case' and 'worst-case' scenarios.

Main Results:

  • The mean 5-year POAG conversion risk ranged widely (2.9% to 52.3%) during follow-up in the study group.
  • A trend of increasing risk over time was observed, with a mean slope of 0.37%/year.
  • Individual risk estimates varied nearly 10-fold between best-case (5.0%) and worst-case (45.7%) scenarios.

Conclusions:

  • The 5-year risk of POAG conversion in untreated OHT patients is highly variable over time.
  • Significant fluctuations in IOP, CCT, VCDR, and VFPSD contribute to substantial intra-individual risk variability.
  • Relying on a single risk calculation may lead to inaccurate assessments and suboptimal treatment decisions for OHT patients.