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(Investigative Ophthalmology and Visual Science. 2006;47:3896-3903.)
© 2006 by The Association for Research in Vision and Ophthalmology, Inc.
DOI:  10.1167/iovs.05-0469
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Asymmetries and Visual Field Summaries as Predictors of Glaucoma in the Ocular Hypertension Treatment Study

Richard A. Levine,1 Shaban Demirel,2 Juanjuan Fan,1 John L. Keltner,3,4 Chris A. Johnson,2 Michael A. Kass,5 and the Ocular Hypertension Treatment Study Group6

1From the Department of Mathematics and Statistics, San Diego State University, San Diego, California; 2Discoveries In Sight, Devers Eye Institute, Legacy Health System, Portland, Oregon; 3the Departments of Ophthalmology and Visual Sciences and 4Neurology and Neurological Surgery, University of California, Davis, Sacramento, California; and the 5Department of Ophthalmology and Visual Sciences, Washington University, St Louis, Missouri.

PURPOSE. To evaluate whether baseline visual field data and asymmetries between eyes predict the onset of primary open-angle glaucoma (POAG) in Ocular Hypertension Treatment Study (OHTS) participants.

METHODS. A new index, mean prognosis (MP), was designed for optimal combination of visual field thresholds, to discriminate between eyes that developed POAG from eyes that did not. Baseline intraocular pressure (IOP) in fellow eyes was used to construct measures of IOP asymmetry. Age-adjusted baseline thresholds were used to develop indicators of visual field asymmetry and summary measures of visual field defects. Marginal multivariate failure time models were constructed that relate the new index MP, IOP asymmetry, and visual field asymmetry to POAG onset for OHTS participants.

RESULTS. The marginal multivariate failure time analysis showed that the MP index is significantly related to POAG onset (P < 0.0001) and appears to be a more highly significant predictor of POAG onset than either mean deviation (MD; P = 0.17) or pattern standard deviation (PSD; P = 0.046). A 1-mm Hg increase in IOP asymmetry between fellow eyes is associated with a 17% increase in risk for development of POAG. When threshold asymmetry between eyes existed, the eye with lower thresholds was at a 37% greater risk of development of POAG, and this feature was more predictive of POAG onset than the visual field index MD, though not as strong a predictor as PSD.

CONCLUSIONS. The MP index, IOP asymmetry, and binocular test point asymmetry can assist in clinical evaluation of eyes at risk of development of POAG.




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