title: Comparison of the Moorfields classification using confocal scanning laser ophthalmoscopy and subjective optic disc classification in detecting glaucoma in blacks and whites.
abstract: OBJECTIVE
  To compare the diagnostic accuracy of the Moorfields regression classification (MRC) and subjective optic disc evaluation in discriminating early to moderate glaucomatous from nonglaucomatous eyes.
  
  
  METHODS
  Cross-sectional observational study.
  
  
  METHODS
  Two hundred thirty-three patients with glaucoma and 216 normal subjects were included in the analysis. Racial groups were defined by self-description.
  
  
  METHODS
  All subjects underwent confocal scanning laser ophthalmoscopy, stereophotography, and standard perimetry. Glaucoma was defined by visual field defect alone and confirmed with a second visual field test. Stereo photographs were graded as either normal or glaucomatous appearing in a masked fashion by 2 independent graders and adjudicated by a third grader in cases of disagreement. Mean disc area was compared between patients correctly and incorrectly diagnosed with either technique.
  
  
  METHODS
  Sensitivity and specificity of MRC and subjective evaluation of stereophotographs in the detection of glaucomatous visual field loss.
  
  
  RESULTS
  With the MRC, the sensitivity and specificity were higher using the 95% cutoff than using the 99.9% cutoff. Classification based on subjective photo assessment had a greater agreement with the diagnosis of glaucoma than the MRC for blacks (MRC, sensitivity = 62.5%, specificity = 93.2%; Photo, sensitivity = 76.5%, specificity = 91.5%) and whites (MRC, sensitivity = 67.0%, specificity = 92.2%; photo, sensitivity = 78.4%, specificity = 91.9%). Disc area was significantly larger in patients incorrectly diagnosed with the MRC (P = 0.0289).
  
  
  CONCLUSIONS
  Subjective optic disc grading by glaucoma specialists outperformed the MRC with the HRT II in both black and white subjects. Both subjective and objective diagnostic methods were associated with similar sensitivity and specificity between racial groups. The MRC was more likely to provide an incorrect diagnosis in subjects with larger optic discs.
authors.affiliation: Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35233, USA. cgirkin@uab.edu
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Girkin
authors.forename: Julio E
authors.initials: JE
authors.lastname: DeLeon-Ortega
authors.forename: Aiyuan
authors.initials: A
authors.lastname: Xie
authors.forename: Gerald
authors.initials: G
authors.lastname: McGwin
authors.forename: Stella N
authors.initials: SN
authors.lastname: Arthur
authors.forename: Blythe E
authors.initials: BE
authors.lastname: Monheit
mesh_terms: D001741:Black or African American; D003430:Cross-Sectional Studies; D005260:Female; D005901:Glaucoma / Q000175:diagnosis* / Q000208:ethnology; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D018613:Microscopy, Confocal / Q000706:statistics & numerical data; D008875:Middle Aged; D009887:Ophthalmoscopy / Q000706:statistics & numerical data*; D009898:Optic Disk / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000175:diagnosis* / Q000208:ethnology; D010781:Photography; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D014786:Vision Disorders / Q000175:diagnosis / Q000208:ethnology; D014794:Visual Fields; D044465:White People