American journal of ophthalmology · 2026
Risk-Stratified Monitoring of Open Angle Glaucoma Suspects Based on Diagnostic Conversion Risk.
СтатьяНазвание и аннотация: Перевод в очереди
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Yoo Kristy, Wu Linda, James Alanna, Lung Khristina, Camp Andrew, Bolo Kyle, Xu Benjamin Y
Аннотация
OBJECTIVE: To assess annual rates and determinants of diagnostic conversion from open angle glaucoma suspects (OAGS) to primary open angle glaucoma (POAG) in the United States and develop a pragmatic, risk-stratified framework for tailoring follow-up frequency based on per-visit conversion risk.
DESIGN: Retrospective cohort study.
METHODS: Patients with newly diagnosed OAGS between 2007 and 2021 were identified in Optum's de-identified Clinformatics Data Mart Database based on International Classification of Diseases codes. Inclusion required (1) continuous enrollment during a 3-year lookback period and 5-year study period from index (first) date of OAGS diagnosis, (2) diagnosis by an ophthalmologist or optometrist with ≥1 optical coherence tomography (OCT) or visual field test, and (3) no prior glaucoma-specific treatment or POAG diagnosis. Cox proportional hazards modeling was performed to assess factors associated with diagnostic conversion to POAG. In a secondary analysis, subgroups were created based on age and treatment status and predicted probability of conversion was estimated for each group.
MAIN OUTCOME(S) AND MEASURE(S): Diagnostic conversion of POAG.
RESULTS: Among 83 305 OAGS patients (57.6% female; 5.4% Asian; 11.1% Black; 12.7% Hispanic; 70.8% non-Hispanic White), 17 134 (20.6%) converted to POAG, corresponding to an overall annual conversion rate of 6.1% (9.4% in year 1, 5.3% in years 2-5). On multivariable Cox regression, older age (HR ≥ 1.38), male sex (HR = 1.12), Black race (HR = 1.14), location outside the Northeast (HR ≥ 1.24), record of gonioscopy (HR = 1.90), and OAGS treatment (HR ≥ 1.31) were associated with greater hazard of conversion (P ≤ .02). Among the lowest-risk patients (<50 years; untreated), annual conversion was 2.0% with follow-up every 0.9 ± 0.6 years, whereas the highest-risk patients (>70 years; treated) had a 16.7% annual conversion rate with follow-up every 0.4 ± 0.4 years after year 1. When standardized to a 5.0% per-visit conversion threshold, corresponding monitoring intervals were 6.1 years and 0.6 years, respectively.
CONCLUSIONS: The rate of conversion from OAGS to POAG is <6.0% per year beyond the first year after diagnosis. 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, thereby improving clinical efficiency and resource allocation.
DESIGN: Retrospective cohort study.
METHODS: Patients with newly diagnosed OAGS between 2007 and 2021 were identified in Optum's de-identified Clinformatics Data Mart Database based on International Classification of Diseases codes. Inclusion required (1) continuous enrollment during a 3-year lookback period and 5-year study period from index (first) date of OAGS diagnosis, (2) diagnosis by an ophthalmologist or optometrist with ≥1 optical coherence tomography (OCT) or visual field test, and (3) no prior glaucoma-specific treatment or POAG diagnosis. Cox proportional hazards modeling was performed to assess factors associated with diagnostic conversion to POAG. In a secondary analysis, subgroups were created based on age and treatment status and predicted probability of conversion was estimated for each group.
MAIN OUTCOME(S) AND MEASURE(S): Diagnostic conversion of POAG.
RESULTS: Among 83 305 OAGS patients (57.6% female; 5.4% Asian; 11.1% Black; 12.7% Hispanic; 70.8% non-Hispanic White), 17 134 (20.6%) converted to POAG, corresponding to an overall annual conversion rate of 6.1% (9.4% in year 1, 5.3% in years 2-5). On multivariable Cox regression, older age (HR ≥ 1.38), male sex (HR = 1.12), Black race (HR = 1.14), location outside the Northeast (HR ≥ 1.24), record of gonioscopy (HR = 1.90), and OAGS treatment (HR ≥ 1.31) were associated with greater hazard of conversion (P ≤ .02). Among the lowest-risk patients (<50 years; untreated), annual conversion was 2.0% with follow-up every 0.9 ± 0.6 years, whereas the highest-risk patients (>70 years; treated) had a 16.7% annual conversion rate with follow-up every 0.4 ± 0.4 years after year 1. When standardized to a 5.0% per-visit conversion threshold, corresponding monitoring intervals were 6.1 years and 0.6 years, respectively.
CONCLUSIONS: The rate of conversion from OAGS to POAG is <6.0% per year beyond the first year after diagnosis. 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, thereby improving clinical efficiency and resource allocation.