Screening for glaucoma in high-risk populations using optical coherence tomography.
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.
Li
Gisèle
G
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada. gisele.li@umontreal.ca
Fansi
Alvine Kamdeu
AK
Boivin
Jean-François
JF
Joseph
Lawrence
L
Harasymowycz
Paul
P
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