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C. Nucci et al. (Eds.)

Progress in Brain Research, Vol. 173

ISSN 0079-6123

Copyright r 2008 Elsevier B.V. All rights reserved

CHAPTER 2

Predictive models to estimate the risk of glaucoma development and progression

Felipe A. Medeiros and Robert N. Weinreb

Hamilton Glaucoma Center, University of California, San Diego, La Jolla, CA 92093-0946, USA

Abstract: In this chapter, we review the motivations and steps involved in the construction and validation of predictive models for the development and progression of glaucoma. We start with a critical review of the literature on the risk factors that have been identified as associated with development and progression of the disease. Subsequently, we review the steps necessary to build and validate a predictive model containing risk factors. We analyze the current models that have been proposed to assess risk of glaucoma development in patients with ocular hypertension and we discuss the potential for creating models to assess risk of progression in patients already diagnosed with the disease. Finally, we discuss some of the limitations of currently available models and the perspectives on this area.

Keywords: glaucoma; ocular hypertension; risk; predictive model

Making predictions is an essential part of health care. Prediction models have been continuously developed in several areas of medicine and their use has significantly contributed to the management of many disorders. The identification of risk factors for development or progression of disease is a fundamental component in the construction of prediction models. The concept of risk factor has been a part of the public lexicon for several decades, ever since the landmark Framingham Heart Study first reported in the early 1960s that cigarette smoking, elevated blood cholesterol, and high blood pressure were predictors of the likelihood of dying from heart disease. During the course of the study, other risk factors were identified and Framingham investigators started

Corresponding author. Tel.: 858-8224592; Fax: 858-5341625; E-mail: fmedeiros@eyecenter.ucsd.edu

developing predictive models to evaluate the global risk of cardiovascular disease based on the summation of all major risk factors (D’Agostino et al., 2000, 2001; D’Agostino and Nam, 2004). Because longitudinal data were sparse, the initial models predicting risk levels due to cardiovascular risk factors relied heavily on statistical modeling. As newer data from this and other studies were made available, more robust mathematical models were developed and, eventually, simplified point systems were established to facilitate assessment of an individual’s global risk of progression to an atherosclerotic cardiovascular event.

Risk assessment and prevention has contributed significantly to reduce mortality from cardiovascular disease. The successful implementation of risk assessment in cardiovascular medicine has stimulated its application to several other areas. Recently, the concept of risk assessment has also been applied to ophthalmology, more specifically, for assessment

DOI: 10.1016/S0079-6123(08)01102-3

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