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Assessing Early Stage Open-Angle Glaucoma in Patients by Isolated-Check Visual Evoked Potential
Published on: May 25, 2020
Development and Validation of Simple Clinical and OCT-Based Prognostic Scores for Visual Outcomes in Branch Retinal
Hiroki Sano1, Ryoji Yanai2, Hirotaka Kondo2
1Department of Ophthalmology, Tokushima Red Cross Hospital, Komatsushima, Japan.
Objective:
This study aimed to develop and externally validate simple, clinically interpretable scoring systems for predicting 12-month visual outcomes in eyes with branch retinal vein occlusion (BRVO), and to evaluate whether the incorporation of OCT biomarkers improves prognostic performance.
Design:
Retrospective, multicenter cohort study.
Subjects:
This study included 356 treatment-naïve eyes from 356 patients with BRVO-associated macular edema. The development cohort comprised 311 eyes from 2 institutions, whereas an independent cohort of 45 eyes from a third institution underwent external validation.
Methods:
A baseline clinical score, the visual acuity and patient age (VAP), was constructed using baseline logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) and age. The VAP-O is an extended score, incorporating OCT-derived biomarkers reflecting retinal structural integrity, including disorganization of the retinal inner layers, hyperreflective foci count, and ellipsoid zone/external limiting membrane disruption. The discriminative ability of each score for predicting poor visual outcome, defined as a 12-month logMAR BCVA of ≥0.3, was evaluated using receiver operating characteristic (ROC) curve analysis in both cohorts.
Main Outcome Measures:
Area under the curve (AUC), sensitivity, and specificity.
Results:
The VAP score in the development cohort demonstrated good discriminative performance for poor visual outcome (AUC, 0.791; 95% confidence interval [CI], 0.724-0.858), with an optimal cutoff value of ≥2. The VAP-O score demonstrated superior performance (AUC, 0.839; 95% CI, 0.771-0.908), with an optimal cutoff value of ≥4. In the external validation cohort, both scores retained discriminative ability, with an AUC of 0.856 (95% CI, 0.734-0.978) for the VAP score and 0.945 (95% CI, 0.879-1.00) for the VAP-O score.
Conclusions:
The VAP score provides a simple and clinically accessible tool for early risk stratification of visual prognosis in BRVO. The incorporation of OCT-derived biomarkers into the VAP-O score further improves discriminative performance. These interpretable scoring systems may support individualized prognostic assessment and clinical decision-making in routine ophthalmic practice.
Financial Disclosure(S):
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.