Welcome to the Glaucoma Prediction Score (GPS)! We hope that you find it a useful resource and enjoy participating.

The Glaucomascore GPS project is a work in progress. The goal is to establish a valid, practical means of predicting an individuals risk for developing Glaucoma at any one point in time at which they are examined. The individuals risk factors are entered on the site. These are subjected to a weighted scoring system. This makes a prediction as to whether the individual is Unlikely to have Glaucoma; a Glaucoma suspect or is likely to have Glaucoma. This is reported as a statement and a numeric score is allocated based on the particular collection of risk factors present. The possible scores range from 0-40.

The risk factors are: Age, race, trauma, reduced visual acuity, myopia, IOP, IOP difference, Cup-to-disc ratio (CDR), CDR difference between eyes, Optic disc: pit,notch,haemorhage, ISNT rule, Peripapillary atrophy and central corneal thickness.

The primary objective is to assist a referring practitioner to refer the correct individuals for workup. This decision has significant direct financial and emotional cost.
Secondary objectives are:
- to empower the patient by providing an understandable score in the dis-ease vs. patient contest. \\\" So how am I doing, Doc?\\\"
- to support trainees and junior staff who may not have access to consultant cover with a consultant opinion
- to provide correlation of the score with High-tech measures that are not universally available (Humphrey 24-2 GHT and HRT ll Moorfields analysis)
- to try to identify patients at risk and better detect early disease.
- to provide a score that may detect progress over time.

The individual validates the test on the basis of their own working diagnosis. The data is captured on a cumulative data base and individual data base. These can be selectively searched. The individual and cumulative accuracy is reflected on the Dashboard in the statistics section.

The East London Glaucoma Prediction Score (ELGPS) validated the cut offs for decision making based on the first 400 cases with an established ophthalmologist management diagnosis. This \\\"Gold Standard\\\" was based on full access to clinical notes and special investigations: Humphreys and FDT fields; HRT ll and OCT.

The recommended optimal numeric cut offs for ELGPS and recommendations are:
0-4 = Unlikely to have Glaucoma.
5-7 = Borderline Glaucoma Suspect. Observe for progress at Primary level.
8-10 = Glaucoma Suspect. Refer to Ophthalmology for management.
11 and more = Glaucoma.
Correlations with High-tech measures:
11 or more = High likelihood that Humphrey 24-2 GHT will be outside normal limits ( Se=80%; Sp=84%).
12 or more = Moderately high likelihood that HRT ll Moorfields Analysis will be outside normal limits (Se=71.6%; Sp=65%).

Patients and communities have difficulty understanding Glaucoma. This is particularly true in the early stages where functional damage may not be appreciable. Sport has made the concept of a score understandable worldwide. The GPS provides a foothold for understanding an otherwise nebulous concept. Patients need to understand the concepts of detection, progression, rate of progression and stabilization to understand the need to comply with treatment. Patients who know their score subjectively report better levels of understanding. They are empowered to explain the situation better to their support group and family.

The fact that the internet is now available off a cellular telephone means that the site is available at the coal face in the clinic. We have favorable reports from Medical officers who manage Glaucoma without access to High-tech and consultant cover. They find that the score provides a useful second opinion as to what the level of risk may be. Many patients are managed without visual fields and HRT. The correlation between a score of 11 and the HFA being outside normal limits is extremely useful in this setting.

The scoring system allows an objective measure of progression. The standardized score may give useful information to patients who \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\"pop up\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\" in another clinical setting. The only reversible element of the score is IOP. The other elements generally deteriorate. The site allows patients to re-screened over time. The individual patient score is allocated a color code: green-orange-red for unlikely-glaucoma suspect-glaucoma. This is available in a specific patient (reference number) analysis. It may be that this can be used as a measure of progression in the low tech setting. \\\\\\\"The poor mans OCT.\\\\\\\"

Ophthalmologists help is required as part of an international collaboration to load cases where the diagnosis is known onto the site. This will help grow the data base and provide better levels of evidence for the validation process. This will provide the leadership necessary for those who are not blessed with access to Glaucoma Specialist knowlege and technology.

Thank you for reading this far. If you wish to find out more, please make enquiry at elgps@eyecentre.co.za . We will request information that will enable us to send a link to the active site.




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