the impact of definition of primary open-angle glaucoma on the cross-sectional assessment of diagnostic validity of Heidelberg retinal tomography.
OBJECTIVE
To evaluate the impact of different definitions of primary open angle glaucoma (POAG) on assessment of the diagnostic validity of Heidelberg Retinal Tomography (HRT).


METHODS
Retrospective, cross-sectional study.


METHODS
A search of medline (1992-2003) led to the retrieval of 181 papers containing definitions of POAG, including the eight visual field (VF)-based definitions used for this study. A sample of 193 normal subjects, 222 patients with suspected POAG, and 103 with POAG underwent HRT and the 24 II Humphrey VF examinations to assess the diagnostic validity of HRT. POAG was defined on the basis of Glaucoma Hemifield Test (GHT) "out of normal limits" associated with corrected pattern standard deviation (CPSD) > 2 dB and intraocular pressure (IOP) > or =22 mm Hg. The VFs were re-analyzed and categorized according to the other eight definitions of POAG: IOP formed part of all the definitions, whereas the appearance of the optic disk did not. The sensitivity and specificity of each scenario were calculated by standard procedures.


RESULTS
The definitions of POAG found in the literature included 17 IOP criteria, more than 15 optic disk criteria, and more than 30 VF criteria. The sensitivity of HRT ranged from 0.51 to 0.80, and its specificity from 0.94 and 0.95 when the patients with suspected POAG were excluded; diagnostic validity was much lower and still variable when the POAG suspects were included with the normal or the POAG groups.


CONCLUSIONS
The most commonly used VF-based definitions of POAG led to substantial differences in the sensitivity and specificity of HRT when using the same large sample of normal subjects and POAG patients. A standard definition of POAG is needed to make diagnostic investigations more accurate and comparable.
Miglior
Stefano
S
Department of Ophthalmology, University of Milan Bicocca, Department of Neurosciences and Biomedical Technologies, Policlinico di Monza, Via Amati 111, 20052 Monza, Milan, Italy. stefano.miglior@unimib.it
Guareschi
Magda
M
Romanazzi
Filippo
F
Albe
Elena
E
Torri
Valter
V
Orzalesi
Nicola
N
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D005902:Glaucoma, Open-Angle / Q000175:diagnosis*; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension / Q000175:diagnosis; D009887:Ophthalmoscopy / Q000379:methods*; D009898:Optic Disk / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000175:diagnosis*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014054:Tomography / Q000379:methods; D014794:Visual Fields