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Editors Selection IGR 9-4
Risk Factors: Predictive model for glaucoma development
Comment by Felipe Medeiros on:
24896 Incorporating mortality risk into estimates of 5-year glaucoma risk, Griffin BA; Elliott MN; Coleman AL et al., American Journal of Ophthalmology, 2009; 148: 925-931
Risk assessment in glaucoma has received increased attention in recent years since the publication of results from large multicenter clinical trials, which led to the development and validation of predictive models for glaucoma development. These predictive models have been used to estimate risk of disease development in patients with ocular hypertension based on five predictive factors, including age, intraocular pressure, central corneal thickness and measures of the integrity of the optic nerve head (vertical C/D ratio) and visual field (pattern standard deviation index).
Although older subjects are at an increased risk for glaucoma development, they are probably at lower risk for developing significant disability from the diseaseThe available models predict that older patients have a higher chance of developing early structural and/or functional damage from the disease. However, although older subjects are at an increased risk for glaucoma development, they are probably at lower risk for developing significant disability from the disease, due to their decreased life expectancy compared to younger subjects. Therefore, incorporation of life expectancy information into predictive models for glaucoma becomes of fundamental importance in the decision-making process. Griffin et al. (1371) attempted to incorporate mortality risk (as measured by the Charlson comorbidity score) into estimates of five-year glaucoma risk from a predictive model developed from combined OHTS and EGPS results.
Incorporation of life expectancy information into predictive models for glaucoma becomes of fundamental importance in the decision-making process
They concluded that incorporating mortality risk results in decreased five-year risk estimates of glaucoma, but the magnitude of reduction varied depending on the unadjusted risk of glaucoma development and health status of the patient. It should be noted that the study did not use actual data from patients but rather simulated datasets. Further studies should attempt to validate these findings in longitudinally followed cohorts of subjects. Also, as acknowledged by the authors, the current predictive model estimates the chance of developing early signs of glaucomatous damage to the optic nerve head or visual field, however, the most relevant clinical question would actually be to predict the risk of developing functional disability from the disease. It is likely that the chances of developing disability would be decreased even further in patients with high comorbidity scores. Despite these limitations, Griffin et al. are to be congratulated in addressing this important issue, which clearly has significant impact in the decision-making process of ocular hypertension treatment.
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