title: Combining rim area to disc area asymmetry ratio and Moorfields regression analysis of confocal scanning laser ophthalmoscopy for glaucoma screening.
abstract: OBJECTIVE
  To determine the utility of combining rim area to disc area asymmetry ratio (RADAAR) and Moorfields regression analysis (MRA) to detect primary open-angle glaucoma (POAG) using confocal scanning laser ophthalmoscopy (CSLO) (Heidelberg retina tomograph 3 (HRT3)) in high-risk populations.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Subjects with high risk for developing POAG.
  
  
  METHODS
  Subjects underwent HRT, frequency doubling technology perimetry (FDT), and complete ophthalmic examination. Based on an ophthalmologic examination and FDT results of the worse eye, subjects were classified into 4 categories: normal, possible glaucoma, probable glaucoma, and definite glaucoma. Main outcome measures included sensitivities (Se), specificities (Sp), positive and negative predictive values (PPV, NPV), and positive and negative likelihood ratios (PLR, NLR) of the MRA, RADAAR, and combined MRA- RADAAR tests.
  
  
  RESULTS
  Of 375 subjects, 11 were classified as having definite glaucoma. Depending on the reference standard, range results for Se, Sp, PPV, NPV, PLR, and NLR were, respectively, 57.7% to 100%; 55.1% to 85.4%; 6.3% to 39%; 92.6% to 100%; 1.97 to 4.9; 0 to 0.49 for MRA; 11.5% to 27.3%; 98.1% to 98.8%; 30% to 60%; 87.4% to 97.8%; 9.29 to 14.1; and 0.74 to 0.89 for RADAAR; and 57.7% to 90.9%; 81.3% to 85.1%; 12.8% to 38.5%; 92.6% to 99.7%; 3.87 to 4.85; 0.11 to 0.50 for combination MRA-RADAAR.
  
  
  CONCLUSIONS
  When using HRT in populations at high risk for glaucoma, RADAAR had a higher specificity than MRA in identifying glaucoma. When patients were classified as borderline on MRA, combining RADAAR values decreased the number of false-positives as well, and may be recommended when high specificity is required.
authors.affiliation: Department of Ophthalmology, Centre de Recherche de l'Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Canada.
authors.forename: Alvine A
authors.initials: AA
authors.lastname: Kamdeu Fansi
authors.forename: Hélène
authors.initials: H
authors.lastname: Boisjoly
authors.forename: Miguel
authors.initials: M
authors.lastname: Chagnon
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Harasymowycz
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D005189:False Positive Reactions; D005260:Female; D005902:Glaucoma, Open-Angle / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D007834:Lasers; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000592:standards; D008875:Middle Aged; D009887:Ophthalmoscopy / Q000379:methods* / Q000592:standards; D009898:Optic Disk / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000453:epidemiology / Q000473:pathology*; D012015:Reference Standards; D012044:Regression Analysis; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014054:Tomography / Q000379:methods*