Diagnostic performance of modern imaging instruments in glaucoma screening. Issue 10 (16th January 2020)

• Record Type: Journal Article
• Authors: Karvonen, Elina; Stoor, Katri; Luodonpää, Marja; Hägg, Pasi; Lintonen, Timo; Liinamaa, Johanna; Tuulonen, Anja; Saarela, Ville
• Is Part Of: British journal of ophthalmology. Volume 104:Issue 10(2020)
• Page Start: 1399
• Page End: 1405
• Publication Date: 2020-01-16
• Subjects: glaucoma -- screening -- imaging -- optical coherence tomography (OCT) -- scanning laser polarimetry (GDx) -- scanning laser ophthalmoscopy (HRT); Ophthalmology -- Periodicals; 617.7
• DOI: 10.1136/bjophthalmol-2019-314795
• Languages: English
• ISSNs: 0007-1161

Abstract

Abstract : Aim: To evaluate the applicability of imaging devices (spectral-domain optical coherence tomography (Cirrus SD-OCT), scanning laser polarimetry (GDx) and scanning laser ophthalmoscopy (Heidelberg Retinal Tomograph, HRT3)) for glaucoma screening in a middle-aged unselected population. Methods: Participants of the population-based Northern Finland Birth Cohort Eye Study, aged 45 to 49 years, underwent a comprehensive eye examination including modern imaging with five methods (retinal nerve fibre layer (RNFL) and macular ganglion cell layer +inner plexiform layer (GCIPL) analysis and their combination with SD-OCT, GDx and HRT). The performance of the automated classification of the imaging devices was assessed using a clinical glaucoma diagnosis as reference, that is, the '2 out of 3' rule based on the evaluation of optic nerve head and RNFL photographs and visual fields. Results: We examined 6060 eyes of 3039 subjects; in the clinical evaluation, glaucomatous damage was found in 33 subjects (1.1%) in 43 eyes. The following sensitivities were obtained; RNFL analysis (53%), GCIPL analysis (50%), OCT combination analysis (61%), GDx (56%) and HRT (31%) with corresponding specificities of 95%, 92%, 90%, 88% and 96%. The area under the curve values were 0.76, 0.73, 0.75, 0.75 and 0.73, respectively. Post-test probabilities of glaucoma after positive imaging finding with each of these methods in this unselected population were 11%, 7%, 6%, 5% and 7%, respectively. Conclusion: Screening capabilities of the OCT, GDx and HRT were rather similar. The accuracy of all evaluated parameters was only moderate and thus screening with these parameters alone is not reliable.