title: Sensitivity and specificity of tests to detect eye disease in an older population.
abstract: OBJECTIVE
  To compare the ability of tests of visual function to detect the presence of eye disease.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Three thousand six hundred fifty-four of 4433 (82.4%) eligible residents of an area near Sydney aged 49 years and older had a detailed eye examination, including retinal and lens photography and subsequent grading of eye disease, tests of presenting and corrected visual acuity, contrast sensitivity, screening visual field and intraocular pressure.
  
  
  METHODS
  Receiver operator characteristic (ROC) curves were created and area under the curve compared for each vision test. Sensitivity and specificity were calculated for each test.
  
  
  RESULTS
  No single vision test predicted the presence of eye disease with any consistency. Best-corrected visual acuity or contrast sensitivity had the highest area under the ROC curve for most eye diseases examined but had poor sensitivity and specificity. For glaucoma and diabetic retinopathy there was no difference in area under the curve for any of the tests examined, and no test had a good balance of sensitivity and specificity. Screening tests (performed with presenting correction) did not perform as well as nonscreening tests (those carried out after refraction with best correction).
  
  
  CONCLUSIONS
  Current vision tests are not particularly good at detecting eye disease compared with the "gold standard" of a full eye examination performed by an ophthalmologist. Further work in this area should be carried out before vision screening programs can be recommended for implementation among older people.
authors.affiliation: Institute for International Health, University of Sydney, Sydney, Australia.
authors.forename: R Q
authors.initials: RQ
authors.lastname: Ivers
authors.forename: B
authors.initials: B
authors.lastname: Optom
authors.forename: P
authors.initials: P
authors.lastname: Macaskill
authors.forename: R G
authors.initials: RG
authors.lastname: Cumming
authors.forename: P
authors.initials: P
authors.lastname: Mitchell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015350:Contrast Sensitivity; D003430:Cross-Sectional Studies; D005128:Eye Diseases / Q000175:diagnosis* / Q000453:epidemiology; D005189:False Positive Reactions; D006801:Humans; D007429:Intraocular Pressure; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014787:Vision Tests / Q000379:methods*; D014792:Visual Acuity; D014794:Visual Fields