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Validating and Updating the OHTS-EGPS Model Predicting 5-year Glaucoma Risk among Ocular Hypertension Patients Using Electronic Records 利用电子记录验证和更新预测眼压病患者 5 年青光眼风险的 OHTS-EGPS 模型。
IF 2.8 Q1 OPHTHALMOLOGY Pub Date : 2025-03-01 DOI: 10.1016/j.ogla.2024.10.009
David M. Wright PhD , Augusto Azuara-Blanco PhD , Chris Cardwell PhD , Giovanni Montesano PhD , David P. Crabb PhD , Gus Gazzard MD , Anthony J. King MD , Rodolfo Hernández PhD , James E. Morgan DPhil , Bethany Higgins PhD , Yemisi Takwoingi PhD

Objective

To validate and update the Ocular Hypertension Treatment Study-European Glaucoma Prevention Study (OHTS-EGPS) model predicting risk of conversion from ocular hypertension (OHT) to glaucoma using electronic medical records (EMR).

Design

Evaluation and update of a risk prediction algorithm using EMRs and linked visual field (VF) tests.

Participants

Newly diagnosed OHT patients attending hospital glaucoma services in England. Inclusion criteria are as follows: intraocular pressure (IOP) 22 to 32 mmHg (either eye); normal baseline VF test, defined as Glaucoma Hemifield Test (GHT) “within normal range” in a reliable VF test; at least 2 VF tests in total; no significant ocular comorbidities.

Methods

Risk factors are as follows: age, ethnicity, sex, IOP, vertical cup-to-disc ratio, central corneal thickness, VF pattern standard deviation, family history of glaucoma, systemic hypertension, diabetes mellitus, and glaucoma treatment. Glaucoma conversion was defined as 2 consecutive and reliable VF tests with GHT “outside normal limits” and/or need for glaucoma surgery. For validation, the OHTS-EGPS model was applied to predict a patient’s risk of developing glaucoma in 5 years. In the updating stage, the OHTS model was refitted by re-estimating the baseline hazard and regression coefficients. The updated model was cross-validated and several variants were explored.

Main Outcome Measures

Measures of discriminative ability (c-index) and calibration (calibration slope) were calculated and pooled across hospitals using random effects meta-analysis.

Results

From a total of 138 461 patients from 10 hospital glaucoma services in England, 9030 patients with OHT fitted the inclusion criteria. A total of 1530 (16.9%) patients converted to glaucoma during this follow-up period. The OHTS-EGPS model provided a pooled c-index of 0.61 (95% confidence interval: 0.60–0.63), ranging from 0.55 to 0.67 between hospitals. The pooled calibration slope was 0.45 (0.38–0.51), ranging from 0.25 to 0.64 among hospitals. The overall refitted model performed better than the OHTS-EGPS model, with a pooled c-index of 0.67 (0.65–0.69), ranging from 0.65 to 0.75 between hospitals.

Conclusions

We performed an external validation of the OHTS-EGPS model in a large English population. Refitting the model achieved modest improvements in performance. Given the poor performance of the OHTS-EGPS model in our population, one should use caution in its application to populations that differ from those in the OHTS and EGPS.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
目的利用电子病历(EMR)验证和更新OHTS-EGPS模型,预测由OHT转变为青光眼的风险:设计:利用电子病历和相关视野(VF)测试对风险预测算法进行评估和更新:纳入标准:眼压 22-32 mmHg:纳入标准:眼压 22-32 mmHg(任一眼);正常基线视野测试,即在可靠的视野测试中青光眼半视野测试(GHT)"在正常范围内";总共至少进行两次视野测试;无重大眼部并发症:危险因素:年龄、种族、性别、眼压、垂直杯盘比、中心角膜厚度、VF模式标准偏差、青光眼家族史、全身性高血压、糖尿病、青光眼治疗。青光眼转换的定义是连续两次可靠的 VF 测试,GHT "超出正常范围 "和/或需要进行青光眼手术。在验证阶段,采用 OHTS-EGPS 模型预测患者 5 年内患青光眼的风险。在更新阶段,通过重新估计基线危险系数和回归系数来重新拟合 OHTS 模型。对更新后的模型进行了交叉验证,并探讨了几种变体:采用随机效应荟萃分析法计算并汇总各医院的判别能力(c-指数)和校准(校准斜率):来自英格兰十家医院青光眼服务部门的 138,461 名患者中,有 9030 名 OHT 患者符合纳入标准。在随访期间,共有 1530 名(16.9%)患者转为青光眼。OHTS-EGPS模型的集合c指数为0.61(95%置信区间:0.60,0.63),各医院之间的c指数从0.55到0.67不等。汇总校准斜率为 0.45 (0.38, 0.51),各医院之间的斜率范围为 0.25 至 0.64。重新拟合的模型总体表现优于 OHTS-EGPS 模型,汇总 c 指数为 0.67 (0.65, 0.69),各医院之间为 0.65 至 0.75:结论:我们在大量英国人口中对 OHTS-EGPS 模型进行了外部验证。重新拟合模型可适度提高性能。鉴于 OHTS-EGPS 模型在我们的人群中表现不佳,因此在应用于不同于 OHTS 和 EGPS 的人群时应谨慎。
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引用次数: 0
Incidence of Uveitis Following Initiation of Prostaglandin Analogs versus Other Glaucoma Medications 开始使用前列腺素类似物与其他青光眼药物后葡萄膜炎的发生率:来自 SOURCE 资料库的研究。
IF 2.8 Q1 OPHTHALMOLOGY Pub Date : 2025-03-01 DOI: 10.1016/j.ogla.2024.10.010
Muhammad Z. Chauhan MD, MS , Abdelrahman M. Elhusseiny MD, MSc , Shikha Marwah MS , Ahmed B. Sallam MD, PhD , Joshua D. Stein MD, MS , Krishna S. Kishor MD

Purpose

To evaluate the risk of incidence rates of uveitis among patients starting topical glaucoma therapy.

Design

Retrospective database study utilizing the Sight Outcomes Research Collaborative (SOURCE) Ophthalmology Data Repository.

Participants

Adult glaucoma patients who were recently started on topical glaucoma therapy.

Methods

Using data from 10 health systems contributing data to the SOURCE data repository, we identified all adult glaucoma patients who had been newly started on a topical glaucoma medication (prostaglandin analogs [PGAs], beta-blockers [BBs], alpha agonists [AAs], and carbonic anhydrase inhibitors [CAIs]). Patients with pre-existing documentation of uveitis were excluded.

Main Outcome Measures

Incidence of uveitis within 3 months of initiating therapy with different topical glaucoma medications.

Results

We included 67 517 patients who were newly prescribed a topical glaucoma medication. The mean age of the patients was 67.3 ± 13.2 years and ∼59% were females. A total of 567 patients (0.87%) developed uveitis within 3 months of initiating the therapy. The incidence of uveitis was 0.32%, 1.95%, 1.63%, and 1.68% for users of PGAs, BBs, AAs, and CAIs, respectively. After adjusting for sociodemographic factors, individuals using topical BBs, AAs, and CAIs had significantly higher odds of developing uveitis versus those using PGAs (P < 0.001 for all comparisons).

Conclusions

The use of PGAs was not associated with higher odds of developing uveitis compared with other classes of topical glaucoma medications.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
目的:评估开始接受局部青光眼治疗的患者发生葡萄膜炎的风险:利用视力结果研究合作组织(SOURCE)眼科数据存储库进行回顾性数据库研究:最近开始接受局部青光眼治疗的成人青光眼患者:利用向 SOURCE 数据库提供数据的 10 个医疗系统的数据,我们确定了所有新近开始使用局部青光眼药物(前列腺素类似物 (PGA)、β-受体阻滞剂 (BB)、α-激动剂 (AA) 和碳酸酐酶抑制剂 (CAI))的成人青光眼患者。排除已有葡萄膜炎记录的患者:主要结果指标:开始使用不同青光眼局部药物治疗后 3 个月内葡萄膜炎的发生率:我们纳入了 67517 名新处方青光眼局部用药的患者。患者的平均年龄为 67.3±13.2 岁,59% 为女性。共有 567 名患者(0.87%)在开始治疗后 3 个月内患上葡萄膜炎。PGAs、BBs、AAs和CAIs使用者的葡萄膜炎发病率分别为0.32%、1.95%、1.63%和1.68%。在对社会人口因素进行调整后,与使用 PGAs 的人相比,使用外用 BBs、AAs 和 CAIs 的人患葡萄膜炎的几率明显更高(PConclusions:与其他类别的外用青光眼药物相比,使用 PGAs 与较高的葡萄膜炎发病几率无关。
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引用次数: 0
The Association between Glaucoma Severity and Hip Fractures in California Medicare Beneficiaries 加利福尼亚州医疗保险受益人青光眼严重程度与髋部骨折之间的关系。
IF 2.8 Q1 OPHTHALMOLOGY Pub Date : 2025-03-01 DOI: 10.1016/j.ogla.2024.10.002
Sayan K. Chatterjee MPH , Ramin Talebi BS , Ken Kitayama MD, PhD , Andrew G. Young MD , Fei Yu PhD , Victoria L. Tseng MD, PhD , Anne L. Coleman MD, PhD

Purpose

To examine the association between glaucoma severity and hip fractures in older adults.

Design

Retrospective cross-sectional study.

Subjects

California (CA) Medicare beneficiaries in 2019 with Parts A & B coverage.

Methods

Multivariable logistic regression was used to analyze the association between glaucoma severity (mild, moderate, and severe vs. no glaucoma) and hip fracture, after adjusting for age, sex, race and ethnicity, and Charlson Comorbidity Index score. A subgroup analysis was performed only in individuals with glaucoma to examine the odds of hip fracture for those with moderate and severe glaucoma compared to those with mild glaucoma.

Main Outcome Measures

The variations in the odds of hip fractures for patients with and without glaucoma and for patients with moderate and severe glaucoma compared to those with mild glaucoma.

Results

Of the 2 717 346 beneficiaries in the study population, 220 662 (8.1%) had glaucoma. In multivariable regression analysis, those with mild (odds ratio [OR]: 0.83; 95% confidence interval [CI]: 0.78–0.88) and moderate glaucoma (OR: 0.88; 95% CI: 0.84–0.92) had reduced odds of hip fracture compared with those with no glaucoma. There was no statistically significant association between severe vs. no glaucoma and hip fracture (OR: 0.96; 95% CI: 0.91–1.02). Among individuals with glaucoma, the odds of hip fracture were higher for those with severe glaucoma (OR: 1.17; 95% CI: 1.08–1.27), compared with those with mild glaucoma.

Conclusions

In the CA Medicare population, the presence of glaucoma was associated with decreased likelihood of hip fracture. However, in those with glaucoma, increased glaucoma severity was associated with an increased likelihood of hip fracture. Potential mediating mechanisms requiring further study include fear of falls and physical inactivity in patients with glaucoma.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
目的:研究老年人青光眼严重程度与髋部骨折之间的关系:研究对象:2019 年加州 A 部分和 B 部分医疗保险受益人:采用多变量逻辑回归分析青光眼严重程度(轻度、中度和重度与无青光眼)与髋部骨折之间的关系,并对年龄、性别、种族和民族以及查尔森合并症指数评分进行调整。仅对青光眼患者进行了亚组分析,以研究中度和重度青光眼患者与轻度青光眼患者发生髋部骨折的几率:有青光眼和无青光眼患者髋部骨折几率的变化,以及中度和重度青光眼患者与轻度青光眼患者髋部骨折几率的变化:在 2,717,346 名研究对象中,220,662 人(8.1%)患有青光眼。在多变量回归分析中,与没有青光眼的人相比,患有轻度青光眼(赔率[OR]:0.83,95% 置信区间[CI]:0.78-0.88)和中度青光眼(赔率:0.88,95% 置信区间[CI]:0.84-0.92)的人发生髋部骨折的几率较低。重度青光眼和无青光眼与髋部骨折之间没有明显的统计学关联(OR:0.96,95% CI:0.91-1.02)。在青光眼患者中,与轻度青光眼患者相比,中度青光眼患者(OR:1.07;95% CI:0.99-1.15)和重度青光眼患者(OR:1.17;95% CI:1.08-1.27)发生髋部骨折的几率更高:结论:在加州医疗保险人群中,患有青光眼与髋部骨折的可能性降低有关。然而,在患有青光眼的人群中,青光眼严重程度的增加与髋部骨折可能性的增加有关。需要进一步研究的潜在中介机制包括青光眼患者害怕跌倒和缺乏运动。
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引用次数: 0
The Multifaceted Nongenetic Risk Factors for Primary Open-angle Glaucoma 原发性开角型青光眼的多方面非遗传风险因素--系统综述。
IF 2.8 Q1 OPHTHALMOLOGY Pub Date : 2025-03-01 DOI: 10.1016/j.ogla.2024.10.004
Jens Rovelt MSc, PhD , Josefine Freiberg MD, PhD , Augusto Azuara-Blanco MD, PhD , Gianni Virgili MD , Miriam Kolko MD, PhD

Topic

A synthesis of the current knowledge on risk factors for primary open-angle glaucoma (POAG).

Clinical Relevance

This review advances understanding, guides future research, and informs strategies for preventing and treating POAG.

Method

We conducted a systematic search of PubMed, Embase, Web of Science, and the Cochrane Library to identify relevant systematic reviews (SRs) published in English after 2012. The inclusion criteria focused on SRs investigating risk factors for POAG. We registered the study prospectively in the PROSPERO database (CRD42022351372) and used Covidence and the Risk of Bias in Systematic Reviews tool to manage article selection and assess the risk of bias in the included SRs. Data was extracted independently by 2 authors.

Results

After removing duplicate SRs, we assessed 2542 SRs. Of these, 2396 were determined to be irrelevant, leaving 138 for a full-text review. Following this, 78 were excluded with reasons, resulting in 60 SRs. Of these, 30 had a low risk of bias. In our bias assessment, SRs categorized as high risk of bias were characterized by 1) lack of sufficient detail in the bias assessment of the SR and 2) insufficient information or missing calculations of heterogeneity among the included studies. In our study, we identified 22 risk factors associated with POAG. The SRs covered a wide range of risk factors for POAG. Among these, the strongest associations with POAG, based on effect size, were observed in 2 SRs related to obstructive sleep apnea (OSA), with a pooled odds ratio (OR) of 3.66 (95% confidence interval [CI]: 1.70–7.90) and an adjusted OR of 2.46 (95% CI: 1.32–4.59). Similarly, 2 SRs investigating Helicobacter pylori (H. pylori) infections showed significant associations, with pooled ORs of 2.08 (95% CI: 1.48–2.93) and 2.08 (95% CI: 1.42–3.04), respectively.

Conclusion

This article summarizes the current knowledge on risk factors for POAG from published SRs. Our findings highlight the complexity of the disease and the nature of the factors that may affect various populations. Among the reported associations with low risk of bias, we found the highest effect estimates for OSA and H. pylori infections in relation to POAG. Our review helps advance understanding, guide future research, and inform strategies for the prevention and treatment of POAG.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
主题:原发性开角型青光眼(POAG综述有关原发性开角型青光眼(POAG)风险因素的现有知识:我们对 PubMed、Embase、Web of Science 和 Cochrane 图书馆进行了系统检索,以确定 2012 年后发表的相关英文系统综述 (SR)。纳入标准侧重于调查 POAG 风险因素的系统综述。我们在 PROSPERO 数据库(CRD42022351372)中对研究进行了前瞻性登记,并使用 Covidence 和系统性综述偏倚风险(ROBIS)工具来管理文章选择和评估纳入的 SR 中的偏倚风险。数据由两位作者独立提取:去除重复的 SR 后,我们评估了 2,542 篇 SR。其中 2396 篇被确定为不相关,剩下 138 篇进行全文审阅。之后,有 78 篇被有理由地排除,最终得出 57 篇报告。其中,30 篇的偏倚风险较低。在我们的偏倚评估中,被归类为高偏倚风险的 SR 具有以下特点:1)SR 的偏倚评估缺乏足够的细节;2)信息不足或缺少对纳入研究之间异质性的计算。在我们的研究中,我们发现了 22 个与 POAG 相关的风险因素。SR涵盖了POAG的多种风险因素。其中,根据效应大小,与青光眼相关性最强的是与阻塞性睡眠呼吸暂停(OSA)有关的两项SR研究,其汇总比值比(OR)为3.66(95% CI:1.70-7.90),调整比值比(OR)为2.46(95% CI:1.32-4.59)。同样,调查幽门螺旋杆菌(H. pylori)感染的两个SR也显示出显著的相关性,汇总OR分别为2.08(95% CI:1.48-2.93)和2.08(95% CI:1.42-3.04):本文总结了目前从已发表的SRs中获得的有关POAG风险因素的知识。我们的研究结果突显了该疾病的复杂性以及可能影响不同人群的因素的性质。在偏倚风险较低的相关报道中,我们发现OSA和幽门螺杆菌感染对POAG的影响估计值最高。我们的综述有助于加深理解、指导未来的研究并为 POAG 的预防和治疗策略提供依据。
{"title":"The Multifaceted Nongenetic Risk Factors for Primary Open-angle Glaucoma","authors":"Jens Rovelt MSc, PhD ,&nbsp;Josefine Freiberg MD, PhD ,&nbsp;Augusto Azuara-Blanco MD, PhD ,&nbsp;Gianni Virgili MD ,&nbsp;Miriam Kolko MD, PhD","doi":"10.1016/j.ogla.2024.10.004","DOIUrl":"10.1016/j.ogla.2024.10.004","url":null,"abstract":"<div><h3>Topic</h3><div>A synthesis of the current knowledge on risk factors for primary open-angle glaucoma (POAG).</div></div><div><h3>Clinical Relevance</h3><div>This review advances understanding, guides future research, and informs strategies for preventing and treating POAG.</div></div><div><h3>Method</h3><div>We conducted a systematic search of PubMed, Embase, Web of Science, and the Cochrane Library to identify relevant systematic reviews (SRs) published in English after 2012. The inclusion criteria focused on SRs investigating risk factors for POAG. We registered the study prospectively in the PROSPERO database (CRD42022351372) and used Covidence and the Risk of Bias in Systematic Reviews tool to manage article selection and assess the risk of bias in the included SRs. Data was extracted independently by 2 authors.</div></div><div><h3>Results</h3><div>After removing duplicate SRs, we assessed 2542 SRs. Of these, 2396 were determined to be irrelevant, leaving 138 for a full-text review. Following this, 78 were excluded with reasons, resulting in 60 SRs. Of these, 30 had a low risk of bias. In our bias assessment, SRs categorized as high risk of bias were characterized by 1) lack of sufficient detail in the bias assessment of the SR and 2) insufficient information or missing calculations of heterogeneity among the included studies. In our study, we identified 22 risk factors associated with POAG. The SRs covered a wide range of risk factors for POAG. Among these, the strongest associations with POAG, based on effect size, were observed in 2 SRs related to obstructive sleep apnea (OSA), with a pooled odds ratio (OR) of 3.66 (95% confidence interval [CI]: 1.70–7.90) and an adjusted OR of 2.46 (95% CI: 1.32–4.59). Similarly, 2 SRs investigating <em>Helicobacter pylori</em> (<em>H. pylori</em>) infections showed significant associations, with pooled ORs of 2.08 (95% CI: 1.48–2.93) and 2.08 (95% CI: 1.42–3.04), respectively.</div></div><div><h3>Conclusion</h3><div>This article summarizes the current knowledge on risk factors for POAG from published SRs. Our findings highlight the complexity of the disease and the nature of the factors that may affect various populations. Among the reported associations with low risk of bias, we found the highest effect estimates for OSA and <em>H. pylori</em> infections in relation to POAG. Our review helps advance understanding, guide future research, and inform strategies for the prevention and treatment of POAG.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 2","pages":"Pages 188-198"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Lost in the Angle: The Mystery of the Missing XEN 迷失在角度:失踪的XEN之谜。
IF 2.8 Q1 OPHTHALMOLOGY Pub Date : 2025-03-01 DOI: 10.1016/j.ogla.2024.12.005
Miguel Santos MD, Telma Gala, Luís Abegão Pinto MD, PhD
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引用次数: 0
American Glaucoma Society-American Academy of Ophthalmology Position Statement on Nicotinamide Use for Glaucoma Neuroprotection 美国青光眼学会-美国眼科学会关于尼古丁酰胺用于青光眼神经保护的立场声明。
IF 2.8 Q1 OPHTHALMOLOGY Pub Date : 2025-03-01 DOI: 10.1016/j.ogla.2025.01.002
Aakriti Garg Shukla MD, MSc, George A. Cioffi MD, Simon W.M. John PhD, Qing Wang MD, PhD, Jeffrey M. Liebmann MD, American Glaucoma Society and American Academy of Ophthalmology
{"title":"American Glaucoma Society-American Academy of Ophthalmology Position Statement on Nicotinamide Use for Glaucoma Neuroprotection","authors":"Aakriti Garg Shukla MD, MSc,&nbsp;George A. Cioffi MD,&nbsp;Simon W.M. John PhD,&nbsp;Qing Wang MD, PhD,&nbsp;Jeffrey M. Liebmann MD,&nbsp;American Glaucoma Society and American Academy of Ophthalmology","doi":"10.1016/j.ogla.2025.01.002","DOIUrl":"10.1016/j.ogla.2025.01.002","url":null,"abstract":"","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 2","pages":"Pages 112-116"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Identifiable Historic and Observable Factors May Predict Progression to Exfoliation Glaucoma in Newly Diagnosed Exfoliation Patients 可识别的历史因素和可观察到的因素可预测新诊断的剥脱性青光眼患者向剥脱性青光眼的发展。
IF 2.8 Q1 OPHTHALMOLOGY Pub Date : 2025-03-01 DOI: 10.1016/j.ogla.2024.10.006
Karen Curtin PhD , Joshua D. Stein MD, MS , Brian C. Stagg MD, MS , Nora Fino MS , Matthew Conley MD , Taylor Johnson BS , Ayesha Patil MD , Chase Paulson MD , Christian Pompoco BS , Barbara M. Wirostko MD, FARVO

Objective

To identify clinical factors associated with conversion to exfoliation glaucoma (XFG) in exfoliation syndrome (XFS) patients who are most at risk of progression to XFG within 3 years for increased surveillance and early preventive interventions.

Design

A retrospective patient cohort study design was employed.

Subjects

A source population of XFS patients ≥ 50 years was identified from electronic medical records in the Utah Population Database. From this, 487 study patients with one or more dilated eye examinations before chart-confirmed XFS onset in 2011 or later and ≥ 3 years of subsequent eye examinations were selected for study.

Methods

We implemented binomial linear mixed models with L1-penalized estimation to select variables associated with conversion. Models included a random intercept to account for within-patient correlation for eye-level data. Candidate demographic, lifestyle, systemic, and ocular comorbidities data were obtained, and diagnoses were categorized as binary (history or no history). These potential factors between conversion and nonconversion patients were used in model selection of variables jointly predictive of conversion. Odds ratios and confidence intervals were calculated using the link logit.

Main Outcome Measures

To determine the main outcome of conversion to XFG following an index diagnosis of XFS compared with nonconversion within 3 years, clinical records of each subject’s left and right eyes were assessed to confirm XFS and date of onset and date of XFG onset, if conversion occurred. Clinical measurements (e.g., intraocular pressure [IOP], cup-to-disc ratio, provider notes, and IOP-lowering procedures and medications) were used to corroborate conversion status.

Results

Eighteen variables jointly predicted XFG conversion within 3 years correctly in 71% of patient eyes. The odds of conversion were the highest for exudative age-related macular degeneration (AMD), 2.3-fold (P = 0.004). Other predictive variables included nonexudative AMD (P = 0.05), primary open angle glaucoma (P < 0.001), obstructive sleep apnea (P = 0.03), and ocular hypertension (P = 0.003) diagnosed before XFS onset.

Conclusions

We determined a set of clinically relevant factors that predicted which newly diagnosed XFS patients progressed to XFG within 3 years. A planned validation will independently confirm if these prognostic indicators hold promise in other settings.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
目的确定剥脱综合征(XFS)患者中最有可能在3年内发展为剥脱性青光眼(XFG)的相关临床因素,以加强监测和早期预防干预:设计:采用回顾性患者队列研究设计:从犹他州人口数据库的电子病历中确定了 50 岁及以上的 XFS 患者。从中挑选出 487 名在 2011 年或之后经病历确认的 XFS 发病前接受过一次或多次散瞳验光检查,且随后接受过三年或三年以上眼科检查的患者作为研究对象:我们采用二项线性混合模型和 L1 惩罚估计法来选择与转换相关的变量。模型包括一个随机截距,以考虑眼部数据的患者内部相关性。我们获得了候选者的人口统计学、生活方式、全身和眼部合并症数据,并将诊断分为二元(有病史或无病史)。在选择可共同预测转归的变量模型时,使用了转归患者和非转归患者之间的这些潜在因素。主要结果测量指标:为了确定XFS指数诊断后转为XFG与3年内未转为XFS的主要结果,我们评估了每位受试者左右眼的临床记录,以确认XFS以及发病日期和XFG发病日期(如果发生了转归)。临床测量结果,如眼压(IOP)、杯瓣比、提供者记录以及降低眼压的程序和药物,都被用来证实转换状态:18个变量共同预测了71%的患者眼睛在3年内转为XFG的正确率。渗出性老年性黄斑变性(AMD)的转换几率最高,为2.3倍(P=0.004)。其他预测变量包括非渗出性黄斑变性(P=0.05)、原发性开角型青光眼(PConclusions:我们确定了一组临床相关因素,这些因素可预测哪些新诊断的 XFS 患者会在 3 年内发展为 XFG。计划中的验证将独立确认这些预后指标是否适用于其他情况。
{"title":"Identifiable Historic and Observable Factors May Predict Progression to Exfoliation Glaucoma in Newly Diagnosed Exfoliation Patients","authors":"Karen Curtin PhD ,&nbsp;Joshua D. Stein MD, MS ,&nbsp;Brian C. Stagg MD, MS ,&nbsp;Nora Fino MS ,&nbsp;Matthew Conley MD ,&nbsp;Taylor Johnson BS ,&nbsp;Ayesha Patil MD ,&nbsp;Chase Paulson MD ,&nbsp;Christian Pompoco BS ,&nbsp;Barbara M. Wirostko MD, FARVO","doi":"10.1016/j.ogla.2024.10.006","DOIUrl":"10.1016/j.ogla.2024.10.006","url":null,"abstract":"<div><h3>Objective</h3><div>To identify clinical factors associated with conversion to exfoliation glaucoma (XFG) in exfoliation syndrome (XFS) patients who are most at risk of progression to XFG within 3 years for increased surveillance and early preventive interventions.</div></div><div><h3>Design</h3><div>A retrospective patient cohort study design was employed.</div></div><div><h3>Subjects</h3><div>A source population of XFS patients ≥ 50 years was identified from electronic medical records in the Utah Population Database. From this, 487 study patients with one or more dilated eye examinations before chart-confirmed XFS onset in 2011 or later and ≥ 3 years of subsequent eye examinations were selected for study.</div></div><div><h3>Methods</h3><div>We implemented binomial linear mixed models with L1-penalized estimation to select variables associated with conversion. Models included a random intercept to account for within-patient correlation for eye-level data. Candidate demographic, lifestyle, systemic, and ocular comorbidities data were obtained, and diagnoses were categorized as binary (history or no history). These potential factors between conversion and nonconversion patients were used in model selection of variables jointly predictive of conversion. Odds ratios and confidence intervals were calculated using the link logit.</div></div><div><h3>Main Outcome Measures</h3><div>To determine the main outcome of conversion to XFG following an index diagnosis of XFS compared with nonconversion within 3 years, clinical records of each subject’s left and right eyes were assessed to confirm XFS and date of onset and date of XFG onset, if conversion occurred. Clinical measurements (e.g., intraocular pressure [IOP], cup-to-disc ratio, provider notes, and IOP-lowering procedures and medications) were used to corroborate conversion status.</div></div><div><h3>Results</h3><div>Eighteen variables jointly predicted XFG conversion within 3 years correctly in 71% of patient eyes. The odds of conversion were the highest for exudative age-related macular degeneration (AMD), 2.3-fold (<em>P</em> = 0.004). Other predictive variables included nonexudative AMD (<em>P</em> = 0.05), primary open angle glaucoma (<em>P</em> &lt; 0.001), obstructive sleep apnea (<em>P</em> = 0.03), and ocular hypertension (<em>P</em> = 0.003) diagnosed before XFS onset.</div></div><div><h3>Conclusions</h3><div>We determined a set of clinically relevant factors that predicted which newly diagnosed XFS patients progressed to XFG within 3 years. A planned validation will independently confirm if these prognostic indicators hold promise in other settings.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 2","pages":"Pages 133-142"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A Comparative Study of the Handheld IC200 and Slit Lamp-mounted ST500 Rebound Tonometers with Goldmann Applanation Tonometry 手持式 IC200 和装在裂隙灯上的 ST500 回弹式眼压计与戈德曼眼压计的比较研究。
IF 2.8 Q1 OPHTHALMOLOGY Pub Date : 2025-03-01 DOI: 10.1016/j.ogla.2024.10.008
Ryo Tomita MD, Glen P. Sharpe MSc, Devin Betsch MD, Rodolfo Bonatti MD, Balwantray C. Chauhan PhD

Objective

To compare the agreement and repeatability of intraocular pressure (IOP) measured with the slit lamp-mounted ST500 rebound tonometer (iCare Finland Oy), the hand-held IC200 rebound tonometer (iCare Finland Oy), and Goldmann applanation tonometry (GAT).

Design

Cross-sectional study.

Participants

Glaucoma patients and staff of the Eye Care Centre, Nova Scotia Health.

Methods

Intraocular pressure was measured twice each with the IC200, ST500, and GAT. Bland-Altman analysis was used to compare each pair of tonometers and whether the difference between tonometers depended on mean IOP. Intraclass correlation coefficients were also computed. Repeatability of the measurements with each tonometer was assessed by calculating the mean and variance of the difference between the first and second measurements. The relationship between IOP and central corneal thickness was also evaluated.

Main Outcome Measures

Agreement and repeatability of IOP measurements with the IC200, ST500, and GAT.

Results

One eye of 157 participants (64 men and 93 women) with a median (interquartile range) age and central corneal thickness of 62 (45–72) years and 553 (533–572) μm, respectively, were enrolled. Median IOP with the IC200, ST500, and GAT was 17.1 (14.3–21.0), 16.5 (14.0–20.8), and 17.0 (14.0–20.5) mmHg, respectively, while the range of IOP (measured with GAT) was 8.5 to 53.0 mmHg. Measurements with the 3 tonometers were not statistically different from each other, and in neither of the 3 paired comparisons was the difference in IOP between 2 tonometers dependent on mean IOP. The intraclass correlation coefficient values (0.97–0.98) showed excellent agreement between the tonometers. The variance of the difference between the first and second measurements of the ST500 was significantly lower than that of GAT (P = 0.04) and IC200 (P < 0.01). Intraclass correlation coefficients for intratonometer repeatability were also excellent (0.97–0.99).

Conclusions

The ST500 shows good agreement with GAT over a large range of IOP and significantly higher repeatability compared to the IC200 and GAT, suggesting it may be advantageous in clinical settings where topical anesthesia or skilled staff are unavailable.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
目的比较使用裂隙灯安装式 ST500 回弹式眼压计(iCare Finland Oy,芬兰赫尔辛基)、手持式 IC200 回弹式眼压计(iCare Finland Oy)和戈德曼眼压计(Goldmann applanation tonometry,GAT)测量眼压的一致性和可重复性:设计:横断面研究:青光眼患者和加拿大哈利法克斯新斯科舍省卫生局眼科护理中心的工作人员:方法:使用 IC200、ST500 和 GAT 各测量两次眼压。使用 Bland-Altman 分析法比较每对眼压计以及眼压计之间的差异是否取决于平均眼压。还计算了类内相关系数。通过计算第一次和第二次测量之间差异的平均值和方差,评估了每种眼压计测量的重复性。还评估了眼压与中心角膜厚度之间的关系:用 IC200、ST500 和 GAT 测量眼压的一致性和重复性:结果:157 名参与者(64 名男性和 93 名女性)中有一只眼睛参加了测量,他们的中位(四分位间范围)年龄和角膜中央厚度分别为 62 (45 - 72) 岁和 553 (533 - 572) μm。使用 IC500、ST500 和 GAT 测量的中位眼压分别为 17.1(14.3 - 21.0)、16.5(14.0 - 20.8)和 17.0(14.0 - 20.5)毫米汞柱,而使用 GAT 测量的眼压范围为 8.5 - 53.0 毫米汞柱。三种眼压计的测量结果没有统计学差异,在三次配对比较中,两种眼压计之间的眼压差异都不取决于平均眼压。ICC 值(0.97-0.98)表明眼压计之间的一致性非常好。ST500 第一次和第二次测量之间的差异方差明显低于 GAT(P = 0.04)和 IC200(P < 0.01)。测试仪内部重复性的 ICC 也非常好(0.97-0.99):ST500 在较大的眼压范围内与 GAT 有良好的一致性,重复性明显高于 IC200 和 GAT,这表明在没有局部麻醉或熟练工作人员的临床环境中,ST500 可能具有优势。
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引用次数: 0
Effective Management of Ahmed Valve Obstruction by Iris Using Only Mydriatic Drops 静脉滴注治疗艾哈迈德瓣膜梗阻的有效方法。
IF 2.8 Q1 OPHTHALMOLOGY Pub Date : 2025-03-01 DOI: 10.1016/j.ogla.2024.11.005
David Oliver-Gutiérrez MD, Laura Sánchez MD, Marta Castany PhD
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引用次数: 0
Association between Device Manufacturer Payments to Surgeons and Minimally Invasive Glaucoma Surgery Utilization in the United States 美国设备制造商向外科医生支付的费用与 MIGS 使用率之间的关联。
IF 2.8 Q1 OPHTHALMOLOGY Pub Date : 2025-03-01 DOI: 10.1016/j.ogla.2024.11.002
Patrick C. Demkowicz BS, Christopher C. Teng MD, MBA, Ji Liu MD, MS, Soshian Sarrafpour MD
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引用次数: 0
期刊
Ophthalmology. Glaucoma
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