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    New technology predicts conversion to POAG

     

    While all patients were untreated at baseline, some received IOP therapy during the study.

    After 10 years, 29 of the 116 (25%) patients who completed the study developed POAG.  The mean conversion time was 48 months, with a range of 12–84 months.

    In a multivariate analysis, the researchers found a statistically significant difference between converters and non-converters for the following parameters: older age (hazard ratio [HR] 1.0); SWAP Glaucoma Hemifield test outside normal limts (HR 4.3); greater SLP inter-eye symmetry (HR 1.1); lower CSLO rim volume (HR 1.1); and greater CSLO cup-to-disc ratio.

    Gender, IOP, CCT, ibopamine test results, SAP and FDT variables were comparable between groups, so the researchers did not deem them predictive for glaucoma conversion.

    These results differed with earlier studies finding that higher IOP, thinner CCT and greater SAP pattern standard deviation (PSD) at baseline were predictive.

    The researchers speculated that the discrepancy could be ascribed to such factors as the number and race of the people in the study populations, anti-glaucoma therapy, data collection methods used, visual field and optic disc evaluation methods, and definitions of ocular hypertension and conversion to glaucoma.

    Recent: Glaucoma may not be the disease you think it is

    They suggested a different reason for the failure of FDT to predict glaucoma in this study. The test gave rise to a high percentage of abnormal results in their cohort. While the percentage of patients with abnormal FDT results was similar to that reported by other authors, this number was greater than the number that would be expected to convert to glaucoma, which raised the possibility that the high sensitivity of FDT in detecting early glaucomatous damage could be partly explained by false positive results.

    Salvetat and her colleagues could not find any other studies that examined the predictive ability of the ibopamine test for conversion to POAG. They found the results of this test to be very poor, with a sensitivity of 69% and a specificity of 41.4%, suggesting that a large proportion of the patients had a reduced outflow of the aqueous humour, even if many did not go on to develop POAG.

    In this study, 86.2% of converters received treatment during the study period compared with 77% of non-converters, perhaps because the clinicians identified them as most likely to develop the disease.

    Related: Electroretinography detects early glaucoma signs

    The results were in agreement with several previous studies, which showed that structural damage can often be detected several years before the development of visual field defects.

    The researchers acknowledged several limitations to their study.  They didn’t assess all the factors that previous studies have identified as predictive of POAG, including family history, myopia, diabetes, race, cardiovascular disease, systemic blood hypotension and hypertension, ocular perfusion pressure, and local and systemic therapy.

    Study limitations

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