STAR estimates glaucoma risk in a few simple steps

The Scoring Tool for Assessing Risk (STAR) is intended for use in patients with untreated ocular hypertension. It is a cardboard, slide rule-type device featuring two sliding bars (A and B) and three windows.

To use STAR, clinicians first need to gather the following six pieces of patient data:

With that information in hand, the clinician first pulls bar A to match the patient's age with the IOP in the upper window of STAR. Then, leaving bar A alone, bar B is pulled to match the PSD and CCT values in the middle window. Finally, the vertical C/D ratio value is identified according to whether the patient does or does not have diabetes, and then the clinician reads out the estimated 5-year risk of developing glaucoma in the bottom window relative to the patient's vertical C/D ratio. Risk is reported in ranges of 1% to 5%, 6% to 10%, 11% to 15%, 16% to 20%, 21% to 30%, 31% to 40%, 41% to 50%, and >50%.

The second patient had an IOP of 30 mm Hg, a CCT of 510 µm, no diabetes, a PSD of 1.9 dB, and vertical C/D ratio of 0.4. Using STAR, the 5-year risk for that individual is estimated to be between 41% and 50%.

"During follow-up between 1998 and 2003, the first patient showed no signs of progression to glaucoma based on either optic disc appearance or visual field, and the second individual was one of the patients in our study who showed progression to glaucoma based on optic disc changes that occurred during follow-up from 1992 to 1998," Dr. Medeiros said.

–Cheryl Guttman