Predicting the onset of glaucoma: the confocal scanning laser ophthalmoscopy ancillary study to theOcular Hypertension Treatment Study.
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.


METHODS
Longitudinal, randomized clinical trial.


METHODS
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.


METHODS
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.
Weinreb
Robert N
RN
Department of Ophthalmology, University of California-San Diego, Hamilton Glaucoma Center, La Jolla, California 92093-0946, USA. Weinreb@eyecenter.ucsd.edu
Zangwill
Linda M
LM
Jain
Sonia
S
Becerra
Lida M
LM
Dirkes
Keri
K
Piltz-Seymour
Jody R
JR
Cioffi
George A
GA
Trick
Gary L
GL
Coleman
Anne L
AL
Brandt
James D
JD
Liebmann
Jefferey M
JM
Gordon
Mae O
MO
Kass
Michael A
MA
D005189:False Positive Reactions; D005260:Female; D005902:Glaucoma, Open-Angle / Q000175:diagnosis*; D006801:Humans; D007429:Intraocular Pressure; D007834:Lasers; D016013:Likelihood Functions; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension / Q000188:drug therapy; D009887:Ophthalmoscopy; D009898:Optic Disk / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000175:diagnosis*; D010781:Photography; D011237:Predictive Value of Tests; D011336:Probability; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity