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A Unified, Progression-Integrated, Structural Model (PRISM) for Classification of Open Angle Glaucoma and Individuals
C Gustavo De Moraes1, Jeffrey M Liebmann1
1Bernard aNnd Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA.
American Journal of Ophthalmology
|August 10, 2026
Summary
A new seven-stage classification system for open-angle glaucoma (OAG) integrates risk factors, optic nerve imaging, and disease progression. This framework aids in early detection and personalized treatment for glaucoma patients.
Area of Science:
- Ophthalmology
- Glaucoma Research
- Diagnostic Systems
Background:
- Current open-angle glaucoma (OAG) classification systems lack integration of risk profiling and modern diagnostic capabilities.
- Existing frameworks often fail to adequately address the 'pre-perimetric' stage and macular vulnerability.
- There is a need for a staging system that aligns disease definition with biological severity and progression rates.
Purpose of the Study:
- To propose a comprehensive, evidence-based classification system for OAG.
- Integrate risk profiling, advanced optic nerve imaging (OCT), functional testing, and disease velocity into a unified framework.
- Develop a staging system that reflects biological severity, progression rates, and therapeutic urgency.
Main Methods:
- Synthesized data from landmark clinical trials and utility analysis studies.
- Identified critical gaps in existing glaucoma classification systems.
- Developed a novel seven-stage staging framework with a disease progression modifier.
Main Results:
- The proposed system stratifies OAG into seven stages (0-6), incorporating risk factors, OCT-defined glaucomatous optic neuropathy (GON), and visual field loss.
- Stages 0-2 focus on risk stratification in eyes without GON, while Stages 3-6 define increasing severity based on structural and functional damage.
- Introduced a "(+) Disease" modifier to indicate clinically significant active progression, prompting intensive management.
Conclusions:
- A comprehensive staging framework for OAG is proposed, integrating structural imaging, functional testing, and progression risk.
- The framework incorporates OCT-defined GON and an active progression modifier for contemporary diagnostics.
- This unified classification aims to align disease staging with longitudinal risk assessment and clinical urgency.