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Editors Selection IGR 9-2
Clinical forms of glaucoma: Additional risk factors
Comment by Stefano Miglior on:
14038 Asymmetries and visual field summaries as predictors of glaucoma in the ocular hypertension treatment study, Levine RA; Demirel S; Fan J et al., Investigative Ophthalmology and Visual Science, 2006; 47: 3896-3903
The recent paper by Levine et al. (800) for the OHTS Group is aimed at assessing the clinical relevance of Visual Field and IOP asymmetries in predicting the development of POAG in the OHTS. An asymmetry of retinal sensitivity assessed by means of single test location differences between the two eyes (an analysis that has been specifically developed for the purpose of this study, and not yet available in the standard software of the Humphrey Field Analyzer) turned out to be an additional predictive factor on top of the previously reported baseline predictive factors of the OHTS, including PSD. On the other side, an asymmetry equal or greater than 2 mmHg between the two eyes at baseline resulted to be an additional predictive factor on top of the mean IOP. The evidence is quite strong, given the robust statistical
Asymmetry of retinal sensitivity and of IOP are additional risk factors for conversion (OHTS)analysis, the adequacy of the sample and the size of Hazard ratios and their confidence limits. And the difference between the worse and better eyes, in terms of risk to develop POAG, is quite impressive. The conclusions provided by the Authors are well supported by the data and outline the need of considering inter-eyes asymmetries in IOP and retinal sensitivities to better assess the individual risk of progression to POAG of the two eyes. The results provided by this study can be immediately translated in the clinical practice as far as the IOP asymmetry is concerned. On the other side, however, since the analysis of visual field asymmetry is not yet available in the standard Humphrey field analyzer, it seems quite awkward to foresee an easy and immediate clinical use of such an important variable to identify the OH eyes at greater risk for progressing to POAG.
Note by the editor: establishing asymmetry of IOP measurements between the two eyes should be based on repeated IOP measurements.
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