title: A pilot study to detect glaucoma with confocal scanning laser ophthalmoscopy compared with nonmydriatic stereoscopic photography in a community health screening.
abstract: OBJECTIVE
  To assess the efficacy and practical usefulness of the Heidelberg Retina Tomograph II (HRT II) compared with nonmydriatic stereoscopic photography in a public glaucoma screening.
  
  
  METHODS
  We examined 1173 local residents, aged 40 years or older, who visited a community health screening in Komatsu City. Initial glaucoma screening consisted of noncontact pneumotonometry, nonmydriatic stereoscopic fundus photography, and HRT II. When glaucoma was suspected, the subjects were referred for a definitive examination, in which slit-lamp biomicroscopic examination, Goldmann applanation tonometry, Humphrey 30-2 test, gonioscopy, and optic nerve head evaluation were performed.
  
  
  RESULTS
  A total of 97.2% (2279/2345) of the nonmydriatic stereoscopic optic disc photographs could be interpreted and 93.4% (2189/2345) were good images. HRT II measurements were successful in 99.0% (2322/2345) of eyes, and acceptable images were obtained in 91.9% (2154/2345) of eyes. On the basis of clinical diagnoses, 94 eyes of 60 participants were diagnosed with glaucoma. The sensitivity of nonmydriatic stereoscopic photographs for personal-level analysis and eye-level analysis was 95.8% and 95.5%, respectively. Using Moorfield's regression analysis, HRT sensitivity and specificity were 72.3% to 91.5% and 84.0% to 93.1%, respectively, for personal-level analysis, and 60.3% to 72.6% and 89.7% to 95.6%, respectively, for eye-level analysis.
  
  
  CONCLUSIONS
  Although HRT II did not detect glaucoma as well as optic nerve stereophotographs in this Japanese population, it may play a role in community health screening.
authors.affiliation: Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan. eye-shin@med.kanazawa-u.ac.jp
authors.forename: Shinji
authors.initials: S
authors.lastname: Ohkubo
authors.forename: Hisashi
authors.initials: H
authors.lastname: Takeda
authors.forename: Tomomi
authors.initials: T
authors.lastname: Higashide
authors.forename: Tsugihisa
authors.initials: T
authors.lastname: Sasaki
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Sugiyama
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005902:Glaucoma, Open-Angle / Q000175:diagnosis*; D006068:Gonioscopy; D006801:Humans; D007429:Intraocular Pressure; D007834:Lasers; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009887:Ophthalmoscopy / Q000379:methods*; D009898:Optic Disk / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000175:diagnosis*; D010781:Photography / Q000379:methods*; D010865:Pilot Projects; D015995:Prevalence; D012680:Sensitivity and Specificity; D014065:Tonometry, Ocular; D014794:Visual Fields