title: Diagnostic Accuracy of Technologies for Glaucoma Case-Finding in a Community Setting.
abstract: OBJECTIVE
  To assess case-finding performance of the Frequency Doubling Technology Perimeter (FDT) (Carl Zeiss Meditec, Inc., Dublin, CA), Moorfields Motion Displacement Test (MMDT) (Moorfields Eye Hospital, London, UK), iVue optical coherence tomography (OCT) (Optovue Inc., Fremont, CA), and ocular response analyzer (ORA) (Reichert Ophthalmic Instruments, Depew, NY), alone or combined, for primary open-angle glaucoma (POAG).
  
  
  METHODS
  Cross-sectional, observational, community-based study.
  
  
  METHODS
  A total of 505 subjects aged ≥60 years recruited from a community setting using no predefined exclusion criteria.
  
  
  METHODS
  Subjects underwent 4 index tests conducted by a technician unaware of subjects' ocular status. FDT and MMDT were used in suprathreshold mode. iVue OCT measured ganglion cell complex and retinal nerve fiber layer (RNFL) thickness. Reference standard was full ophthalmic examination by an experienced clinician who was masked to index test results. Subjects were classified as POAG (open drainage angle, glaucomatous optic neuropathy, and glaucomatous field defect), glaucoma suspect, ocular hypertension, or non-POAG/nonocular hypertension.
  
  
  METHODS
  Test performance evaluated the individual as the unit of analysis. Diagnostic accuracy was assessed using predefined cutoffs for abnormality, generating sensitivity, specificity, and likelihood ratios. Continuous data were used to derive estimates of sensitivity at 90% specificity and partial area under the receiver operating characteristic curve (AUROC) plots from 90% to 100% specificity.
  
  
  RESULTS
  From the reference standard examination, 26 subjects (5.1%) had POAG and 32 subjects (6.4%) were glaucoma suspects. Sensitivity (95% confidence interval) at 90% specificity for detection of glaucoma suspect/POAG combined was 41% (28-55) for FDT, 35% (21-48) for MMDT, and 57% (44-70) for best-performing OCT parameter (inferior quadrant RNFL thickness); for POAG, sensitivity was 62% (39-84) for FDT, 58% (37-78) for MMDT, and 83% (68-98) for inferior quadrant RNFL thickness. Partial AUROC was significantly greater for inferior RNFL thickness than visual-function tests (P < 0.001). Post-test probability of glaucoma suspect/POAG combined and definite POAG increased substantially when best-performing criteria were combined for FDT or MMDT, iVue OCT, and ORA.
  
  
  CONCLUSIONS
  Diagnostic performance of individual tests gave acceptable accuracy for POAG detection. Low specificity of visual-function tests precludes their use in isolation, but case detection improves by combining RNFL thickness analysis with visual function tests.
authors.affiliation: Centre for Public Health Research, School of Health Sciences, City University London, United Kingdom.
authors.forename: Priya L
authors.initials: PL
authors.lastname: Dabasia
authors.affiliation: Centre for Public Health Research, School of Health Sciences, City University London, United Kingdom.
authors.forename: Bruno R
authors.initials: BR
authors.lastname: Fidalgo
authors.affiliation: Centre for Public Health Research, School of Health Sciences, City University London, United Kingdom.
authors.forename: David F
authors.initials: DF
authors.lastname: Edgar
authors.affiliation: National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom.
authors.forename: David F
authors.initials: DF
authors.lastname: Garway-Heath
authors.affiliation: Centre for Public Health Research, School of Health Sciences, City University London, United Kingdom. Electronic address: j.g.lawrenson@city.ac.uk.
authors.forename: John G
authors.initials: JG
authors.lastname: Lawrenson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019058:Community Networks; D003430:Cross-Sectional Studies; D003941:Diagnostic Techniques, Ophthalmological / Q000592:standards*; D005260:Female; D005902:Glaucoma, Open-Angle / Q000175:diagnosis*; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology; D009798:Ocular Hypertension / Q000175:diagnosis*; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012165:Retinal Ganglion Cells / Q000473:pathology; D012680:Sensitivity and Specificity; D041623:Tomography, Optical Coherence / Q000379:methods; D058609:Visual Field Tests / Q000379:methods; D014794:Visual Fields