The Heidelberg Retina Tomograph vs clinical impression in the diagnosis of glaucoma.
OBJECTIVE
To compare the sensitivity and the specificity of the Heidelberg Retina Tomograph (HRT) classification of "Glaucoma" or "Normal" with that derived from clinical impression (CI) based on several parameters.


METHODS
Consecutive observational case series.


METHODS
In a retrospective chart review of 200 left eyes of 200 consecutive patients referred to the Glaucoma Service Diagnostic Laboratory of the Wills Eye Hospital, we compared the HRT-based classification of "Glaucoma" or "Normal" with a CI classification of "Definite glaucoma," "Probably glaucoma," "Probably no glaucoma," and "No glaucoma."


RESULTS
The HRT-based diagnosis of "Glaucoma" or "Normal" had an 86% sensitivity and 68% specificity when compared with a clinical impression (CI) of "Definite glaucoma," used as a strict gold standard definition of glaucoma; an 83% sensitivity and 57% specificity when the CI "Definite glaucoma" and "Probably glaucoma" were combined as a more liberal definition of glaucoma; a 76% sensitivity and 69% specificity when the CI "Definite glaucoma," "Probably glaucoma," and "Probably no glaucoma" were combined as the most liberal definition of glaucoma. The HRT diagnosis had an 86% sensitivity and 51% specificity when compared with the groups "Probably glaucoma," "Probably no glaucoma," and "No glaucoma" combined and considered as no glaucoma.


CONCLUSIONS
In this study, HRT-based classification of "Glaucoma" or "Normal" was moderately sensitive, but not very specific when compared with the clinical impression as the gold standard. Clinicians should not rely on the HRT diagnosis alone, but should use it to supplement the impression based on an eye examination and other ancillary tests.
Kesen
Müge R
MR
William & Anna Goldberg Glaucoma Service and Research Laboratories, Retina Service, Wills Eye Hospital, Jefferson Medical College, Philadelphia, Pennsylvania 19107-5598, USA.
Spaeth
George L
GL
Henderer
Jeffrey D
JD
Pereira
Mary Lucy M
ML
Smith
Andrew F
AF
Steinmann
William C
WC
D005188:False Negative Reactions; D005901:Glaucoma / Q000145:classification / Q000175:diagnosis*; D006801:Humans; D007834:Lasers; D008875:Middle Aged; D009887:Ophthalmoscopy / Q000379:methods*; D009898:Optic Disk / Q000473:pathology*; D011237:Predictive Value of Tests; D011336:Probability; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014054:Tomography