title: Screening for glaucoma in high-risk populations using optical coherence tomography.
abstract: OBJECTIVE
  To estimate the diagnostic accuracy of Stratus optical coherence tomography (OCT) for glaucoma screening in high-risk populations.
  
  
  METHODS
  Cross-sectional evaluation of a diagnostic test for screening.
  
  
  METHODS
  Three hundred thirty-three community-based volunteer participants with risk factors for glaucoma.
  
  
  METHODS
  The optic nerve and peripapillary retinal nerve fiber layer (RNFL) of participants' eyes were scanned using the Stratus OCT. Based on an ophthalmologic examination and frequency doubling perimetry, eyes were classified into 4 categories: normal, possible glaucoma, probable glaucoma, and definitive glaucoma.
  
  
  METHODS
  The sensitivities, specificities, positive and negative likelihood ratios of the RNFL, optic disc parameters, and their combinations were calculated.
  
  
  RESULTS
  The right eyes were retained for analyses. After excluding eyes with missing data or with poor quality scans, the data of 210 right eyes were analyzed. Six eyes had definitive glaucoma. Combining the best performing optic nerve head parameters (cup diameter or cup/disc vertical ratio or cup/disc area ratio) and RNFL parameters (superior average or inferior average or overall average) using AND-logic resulted in a sensitivity of 67% (95% confidence interval [CI], 24%-94%), specificity of 96% (95% CI, 92%-98%), a positive likelihood ratio of 17.08 (95% CI, 7.06-41.4), and a negative likelihood ratio of 0.35 (95% CI, 0.11-1.08).
  
  
  CONCLUSIONS
  When adequate quality scans may be obtained, the Stratus has moderate sensitivity and high specificity for definitive glaucoma. Specificity is increased when parameters from both the optic nerve head and RNFL scans are combined.
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada. gisele.li@umontreal.ca
authors.forename: Gisèle
authors.initials: G
authors.lastname: Li
authors.forename: Alvine Kamdeu
authors.initials: AK
authors.lastname: Fansi
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Boivin
authors.forename: Lawrence
authors.initials: L
authors.lastname: Joseph
authors.forename: Paul
authors.initials: P
authors.lastname: Harasymowycz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005189:False Positive Reactions; D005260:Female; D005902:Glaucoma, Open-Angle / Q000175:diagnosis*; D006801:Humans; D007429:Intraocular Pressure; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D009798:Ocular Hypertension / Q000175:diagnosis; D009898:Optic Disk / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000175:diagnosis*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012165:Retinal Ganglion Cells / Q000473:pathology*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D041623:Tomography, Optical Coherence / Q000379:methods*; D055815:Young Adult