The development of a decision analytic model of changes in mean deviation in people with glaucoma: The COA model

Purpose: To create and validate a statistical model predicting progression of primary open-angle glaucoma (POAG) assessed by loss of visual field as measured in mean deviation (MD) using 3 landmark studies of glaucoma progression and treatment. Design: A Markov decision analytic model using patient level data described longitudinal MD changes over 7 years. Participants: Patient-level data from the Collaborative Initial Glaucoma Treatment Study (n = 607), the Ocular Hypertension Treatment Study (OHTS; n = 148; only those who developed POAG in the first 5 years of OHTS) and Advanced Glaucoma Intervention Study (n = 591), the COA model. Methods: We developed a Markov model with transition matrices stratified by current MD, age, race, and intraocular pressure categories and used a microsimulation approach to estimate change in MD over 7 years. Internal validation compared model prediction for 7 years to actual MD for COA participants. External validation used a cohort of glaucoma patients drawn from university clinical practices. Main Outcome Measures: Change in visual field as measured in MD in decibels (dB). Results: Regressing the actual MD against the predicted produced an R ² of 0.68 for the right eye and 0.63 for the left. The model predicted ending MD for right eyes of 65% of participants and for 63% of left eyes within 3 dB of actual results at 7 years. In external validation the model had an R ² of 0.79 in the right eye and 0.77 in the left at 5 years. Conclusions: The COA model is a validated tool for clinicians, patients, and health policy makers seeking to understand longitudinal changes in MD in people with glaucoma. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.