Population and high-risk group screening for glaucoma: the Los Angeles Latino Eye Study.
OBJECTIVE
To evaluate the ability of various screening tests, both individually and in combination, to detect glaucoma in the general Latino population and high-risk subgroups.


METHODS
The Los Angeles Latino Eye Study is a population-based study of eye disease in Latinos 40 years of age and older. Participants (n = 6082) underwent Humphrey visual field testing (HVF), frequency doubling technology (FDT) perimetry, measurement of intraocular pressure (IOP) and central corneal thickness (CCT), and independent assessment of optic nerve vertical cup disc (C/D) ratio. Screening parameters were evaluated for three definitions of glaucoma based on optic disc, visual field, and a combination of both. Analyses were also conducted for high-risk subgroups (family history of glaucoma, diabetes mellitus, and age ≥65 years). Sensitivity, specificity, and receiver operating characteristic curves were calculated for those continuous parameters independently associated with glaucoma. Classification and regression tree (CART) analysis was used to develop a multivariate algorithm for glaucoma screening.


RESULTS
Preset cutoffs for screening parameters yielded a generally poor balance of sensitivity and specificity (sensitivity/specificity for IOP ≥21 mm Hg and C/D ≥0.8 was 0.24/0.97 and 0.60/0.98, respectively). Assessment of high-risk subgroups did not improve the sensitivity/specificity of individual screening parameters. A CART analysis using multiple screening parameters-C/D, HVF, and IOP-substantially improved the balance of sensitivity and specificity (sensitivity/specificity 0.92/0.92).


CONCLUSIONS
No single screening parameter is useful for glaucoma screening. However, a combination of vertical C/D ratio, HVF, and IOP provides the best balance of sensitivity/specificity and is likely to provide the highest yield in glaucoma screening programs.
Doheny Eye Institute and the Department of Ophthalmology, University of Southern California, Los Angeles, California 90033, USA.
Brian A
BA
Francis
Rohit
R
Varma
Cheryl
C
Vigen
Mei-Ying
MY
Lai
Jonathan
J
Winarko
Betsy
B
Nguyen
Stanley
S
Azen
D000368:Aged; D019540:Area Under Curve; D005260:Female; D005902:Glaucoma, Open-Angle / Q000175:diagnosis* / Q000453:epidemiology; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D007429:Intraocular Pressure; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D009901:Optic Nerve Diseases / Q000175:diagnosis* / Q000453:epidemiology; D012372:ROC Curve; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014786:Vision Disorders / Q000175:diagnosis* / Q000453:epidemiology; D015351:Vision Screening / Q000379:methods*; D058609:Visual Field Tests; D014794:Visual Fields
Br J Ophthalmol. 1996 May;80(5):389-93
8695555
Am J Epidemiol. 1983 Aug;118(2):166-91
6349332
Am J Epidemiol. 1991 Nov 15;134(10):1102-10
1746520
Surv Ophthalmol. 2000 Mar-Apr;44(5):367-408
10734239
Arch Ophthalmol. 2007 Oct;125(10):1402-6
17923550
Surv Ophthalmol. 1983 Nov-Dec;28(3):194-205
6422575
Arch Ophthalmol. 2002 Jun;120(6):714-20; discussion 829-30
12049575
Am J Ophthalmol. 2000 Mar;129(3):328-33
10704548
Arch Ophthalmol. 2002 Jun;120(6):701-13; discussion 829-30
12049574
Invest Ophthalmol Vis Sci. 2008 Dec;49(12):5373-85
18614810
N Engl J Med. 1991 Nov 14;325(20):1412-7
1922252
Ophthalmology. 2004 Aug;111(8):1439-48
15288969
Am J Ophthalmol. 2002 Oct;134(4):529-37
12383809
Arch Ophthalmol. 2004 Jan;122(1):17-21
14718289
JAMA. 1991 Jul 17;266(3):369-74
2056646
Optom Vis Sci. 1999 Aug;76(8):537-43
10472959
Ophthalmology. 2004 Jun;111(6):1121-31
15177962
Ann Behav Med. 2003 Dec;26(3):172-81
14644693
Am J Ophthalmol. 2002 Mar;133(3):327-32
11860968
Ophthalmology. 2007 Jan;114(1):27-32
17070580
Am J Ophthalmol. 1998 Jun;125(6):819-29
9645719
Ophthalmology. 1992 Feb;99(2):215-21
1553210
Am J Ophthalmol. 2001 Feb;131(2):188-97
11228294
Arch Ophthalmol. 1999 Nov;117(11):1479-84
10565516