Development of a Corneal Biomechanical Risk Score for Visual Field Progression in Primary Open-Angle Glaucoma

Precis: This study developed and internally validated an exploratory risk score model based on four Corvis-ST parameters to predict visual field progression in POAG. The model demonstrated acceptable predictive and risk-stratification performance. Purpose: To develop a risk score model based on corneal biomechanical properties for predicting visual field (VF) progression in patients with primary open-angle glaucoma (POAG). Methods: This prospective clinical cohort study included POAG patients with a follow-up period exceeding 18 months and at least six reliable visual field examinations. The initial screening of relevant factors was identified using a dual-screening strategy that combined LASSO-Cox regression model and univariate Cox regression models. Then staged Cox regression models and Kaplan-Meier survival analysis were applied to evaluate the association between these factors and VF progression. Based on these analyses, a weighted integer risk score model was developed, and patients were stratified into low-risk, medium-risk, and high-risk groups. Results: A total of 129 patients were included, 46.5% of eyes showed progression, with a median progression time of 45 months. The final model incorporated velocity of applanation 1 (A1V), length of applanation 2 (A2L), time of applanation 2 (A2T), and pachymetry-adjusted intraocular pressure (IOP pachy). The risk score model predicted the outcome with a C-index of 0.701 (95% confidence interval [CI]: 0.620 - 0.760). It successfully stratified patients into groups with markedly different progression rates (Low: 17.2%, Medium: 45.7%, High: 76.7%; P < 0.001). Conclusions: This internally validated, exploratory risk score based on four corneal biomechanical parameters stratified POAG patients by risk of VF progression. Further validation is needed to determine its clinical utility.