Developing a Predictive Model for Glaucoma Progression in Patients Attending Teaching Hospitals in South West Nigeria

Predicting glaucoma progression in individual patients is a critical unmet clinical need that would enable personalised treatment intensity and reduce irreversible vision loss. Yet no predictive model exists that is calibrated for the specific clinical characteristics of Nigerian glaucoma patients, who present with younger age, higher IOP, and more advanced disease at diagnosis. This study develops and internally validates a predictive model for glaucoma progression in patients attending teaching hospitals in South West Nigeria. A five-year retrospective-prospective cohort study will be conducted at University College Hospital Ibadan and Lagos University Teaching Hospital. Baseline data including age, IOP, central corneal thickness, optic disc cup-to-disc ratio, baseline visual field mean deviation, pattern standard deviation, and retinal nerve fibre layer thickness on OCT will be collected. Progression will be defined by validated criteria using perimetric and structural end-points. Candidate predictors will be entered into a Cox proportional hazards regression model, and model performance will be assessed using calibration plots and the c-statistic. Internal validation will use bootstrap resampling. Published glaucoma progression models from high-income countries perform poorly when tested in African populations due to different baseline risk factor distributions. Developing a Nigeria-specific model fills a critical clinical gap and has immediate utility in stratifying patients for aggressive versus standard treatment at the study centres. The model will be embedded in a clinical decision support tool for ophthalmology registrars. Recommendations will address multi-centre external validation across additional Nigerian geopolitical zones and planned prospective updating of model parameters. Keywords: glaucoma progression, predictive model, Cox regression, visual field, South West Nigeria