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  • Generating Personalized Target IOPs for Patients With OAG

    By Lynda Seminara
    Selected By: Stephen D. McLeod, MD
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    Journal Highlights

    Ophthalmology, April 2018

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    In secondary analyses of longitudinal data from 2 randomized controlled trials, Kazemian et al. forecasted the progression of open-angle glaucoma (OAG) at different levels of intraocular pressure (IOP) to help establish personalized IOP goals for patients. The tool they derived from real-world experience may improve clinical deci­sion making.

    For their study, the authors devel­oped and validated Kalman filter (KF) models for fast-, slow-, and nonpro­gressing disease among participants with moderate or advanced OAG in the Collaborative Initial Glaucoma Treat­ment Study (CIGTS) or the Advanced Glaucoma Intervention Study (AGIS). The KF can generate personalized and dynamically updated forecasts of OAG progression for different IOP targets. For each participant, the authors determined the expected change in mean deviation (MD) if the patient were to maintain IOP at 1 of 7 levels (6, 9, 12, 15, 18, 21, or 24 mm Hg) for 5 years. In addition, the authors modeled and predicted MD changes for the same time frame if IOP were increased or decreased by 3, 6, and 9 mm Hg from the level attained in the trials. Main outcomes were personalized estimates of the change in MD under the various target IOP levels.

    Among the 571 participants (mean age, 64.2 years; mean follow-up, 6.5 years), the model predicted that, on average, fast disease progression would result in an MD loss of 2.1, 6.7, and 11.2 dB under IOP targets of 6, 15, and 24 mm Hg (respectively) over 5 years. Using the same time frame and IOP targets, the MD loss for slow disease progression would be 0.8, 2.1, and 4.1 dB (respectively). When the tool was used to quantify OAG progression dy­namics for all 571 patients, there were no significant differences in progres­sion during the 5-year period between blacks and whites, males and females, or CIGTS and AGIS participants for the IOP levels studied.

    To the authors’ knowledge, this is the first clinical decision-making tool that generates personalized forecasts of the trajectory of OAG progression for different IOP targets. Thus, it may help clinicians determine appropriate IOP targets for patients with OAG. The authors reported that they are expanding their approach into a user-friendly method that enables uploading of patients’ tonometric and perimetric data, which will generate a personalized real-time forecast of the trajectory of change in MD for differ­ent target IOP levels.

    The original article can be found here.