title: Identifying early glaucomatous changes. Comparison between expert clinical assessment of optic disc photographs and confocal scanning ophthalmoscopy.
abstract: OBJECTIVE
  To compare the ability of expert clinicians, using qualitative assessment of stereoscopic optic disc photographs, and confocal scanning laser ophthalmoscope imaging to discriminate between healthy persons and patients with early glaucoma.
  
  
  METHODS
  Comparative instrument validation study.
  
  
  METHODS
  Seventy-two healthy persons and 51 patients with early glaucoma (average visual field mean deviation, -3.6 dB). Early glaucoma was defined as a history of ocular hypertension and a reproducible visual field defect scoring 5 or less in the Advanced Glaucoma Intervention Study classification, regardless of optic disc appearance.
  
  
  METHODS
  Stereoscopic optic nerve head (ONH) photography and Heidelberg Retina Tomograph (HRT) imaging, (Heidelberg Engineering GmbH, Dossenheim, Germany).
  
  
  METHODS
  Ability of clinical assessment of stereoscopic ONH photographs and analysis of HRT parameters, taking into account the optic disc size, to detect early glaucomatous optic disc changes.
  
  
  RESULTS
  The specificity of the majority opinion of five observers to detect early glaucomatous optic disc changes was 94.4%, with a sensitivity of 70.6%. Using the HRT analysis, the specificity was 95.8% and the sensitivity was 84. 3%.
  
  
  CONCLUSIONS
  Heidelberg Retina Tomograph image analysis that takes into account the optic disc size is more sensitive than clinical assessment of stereoscopic optic disc photographs in distinguishing between healthy persons and patients with early glaucoma.
authors.affiliation: Glaucoma Unit, Moorfields Eye Hospital, London, UK. Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: G
authors.initials: G
authors.lastname: Wollstein
authors.forename: D F
authors.initials: DF
authors.lastname: Garway-Heath
authors.forename: L
authors.initials: L
authors.lastname: Fontana
authors.forename: R A
authors.initials: RA
authors.lastname: Hitchings
mesh_terms: D000368:Aged; D005104:Expert Testimony; D005260:Female; D005902:Glaucoma, Open-Angle / Q000175:diagnosis*; D006801:Humans; D007429:Intraocular Pressure; D007834:Lasers; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension / Q000175:diagnosis; D009887:Ophthalmoscopy / Q000379:methods*; D009898:Optic Disk / Q000473:pathology*; D010781:Photography / Q000379:methods*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014054:Tomography / Q000379:methods; D014792:Visual Acuity; D058609:Visual Field Tests; D014794:Visual Fields