Risk-Stratified Monitoring Framework for Glaucoma Suspects Could Safely Reduce Low-Risk Follow-Up Visits
核心洞察
A large retrospective cohort study of 83,305 open angle glaucoma suspects (搜索) found an overall annual conversion rate to primary open angle glaucoma (搜索) of 6.1%, with 20.6% converting over five years.
Older age, male sex, Black race, and prior OAGS treatment were significantly associated with higher hazard of diagnostic conversion.
Among lowest-risk patients (under 50, untreated), annual conversion was just 2.0%, suggesting follow-up intervals could be safely extended to approximately 6 years.
A new study published in the American Journal of Ophthalmology offers a data-driven framework for tailoring follow-up frequency in patients with suspected open angle glaucoma, potentially reshaping how clinicians allocate monitoring resources across risk groups.
Drawing on a cohort of more than 83,000 patients, investigators from the study led by K. Yoo and colleagues quantified annual rates of diagnostic conversion from open angle glaucoma suspects (搜索) (OAGS) to primary open angle glaucoma (搜索) (POAG) and developed a pragmatic, risk-stratified model for surveillance.
Conversion Rates and Key Risk Factors
The retrospective analysis identified 83,305 patients with newly diagnosed OAGS between 2007 and 2021 using Optum (搜索)'s de-identified Clinformatics Data Mart Database. Over a five-year study period, 17,134 patients (20.6%) converted to POAG, yielding an overall annual conversion rate of 6.1%. The rate was notably higher in the first year after diagnosis at 9.4%, declining to 5.3% in years two through five.
Multivariable Cox proportional hazards modeling revealed several factors significantly associated with greater hazard of conversion. Older age carried a hazard ratio of 1.38 or higher, while male sex (HR=1.12), Black race (HR=1.14), and geographic location outside the Northeast (HR≥1.24) were also independent predictors. A record of gonioscopy (HR=1.90) and OAGS treatment (HR≥1.31) were among the strongest associations (p≤0.02 for all).
A Framework for Risk-Stratified Surveillance
In a secondary analysis, the researchers stratified patients by age and treatment status to estimate predicted probability of conversion. The contrast between extremes was stark: among the lowest-risk patients—those under 50 years of age and untreated—annual conversion was just 2.0%, with actual follow-up occurring every 0.9±0.6 years. At the other end, patients over 70 who were treated had a 16.7% annual conversion rate and were followed every 0.4±0.4 years after the first year.
When standardized to a 5.0% per-visit conversion threshold, the corresponding monitoring intervals were 6.1 years for the lowest-risk group and 0.6 years for the highest-risk group.
Clinical Implications
The authors conclude that estimating per-visit conversion risk enables risk-stratified surveillance strategies that may safely reduce visit frequency for very low-risk patients while preserving timely detection in higher-risk groups. Such an approach, they argue, could improve clinical efficiency and resource allocation without compromising patient safety.
The study population was 57.6% female, with 70.8% identifying as non-Hispanic White, 12.7% as Hispanic, 11.1% as Black, and 5.4% as Asian. All patients were required to have continuous enrollment during a three-year lookback period and the five-year study period, diagnosis by an ophthalmologist or optometrist with at least one optical coherence tomography or visual field test, and no prior glaucoma-specific treatment or POAG diagnosis.