title: Summary of Glaucoma Diagnostic Testing Accuracy: An Evidence-Based Meta-Analysis.
abstract: BACKGROUND
  New glaucoma diagnostic technologies are penetrating clinical care and are changing rapidly. Having a systematic review of these technologies will help clinicians and decision makers and help identify gaps that need to be addressed. This systematic review studied five glaucoma technologies compared to the gold standard of white on white perimetry for glaucoma detection.
  
  
  METHODS
  OVID(®) interface: MEDLINE(®) (In-Process & Other Non-Indexed Citations), EMBASE(®), BIOSIS Previews(®), CINAHL(®), PubMed, and the Cochrane Library were searched. A gray literature search was also performed. A technical expert panel, information specialists, systematic review method experts and biostatisticians were used. A PRISMA flow diagram was created and a random effect meta-analysis was performed.
  
  
  RESULTS
  A total of 2,474 articles were screened. The greatest accuracy was found with frequency doubling technology (FDT) (diagnostic odds ratio (DOR): 57.7) followed by blue on yellow perimetry (DOR: 46.7), optical coherence tomography (OCT) (DOR: 41.8), GDx (DOR: 32.4) and Heidelberg retina tomography (HRT) (DOR: 17.8). Of greatest concern is that tests for heterogeneity were all above 50%, indicating that cutoffs used in these newer technologies were all very varied and not uniform across studies.
  
  
  CONCLUSIONS
  Glaucoma content experts need to establish uniform cutoffs for these newer technologies, so that studies that compare these technologies can be interpreted more uniformly. Nevertheless, synthesized data at this time demonstrate that amongst the newest technologies, OCT has the highest glaucoma diagnostic accuracy followed by GDx and then HRT.
authors.affiliation: Ivey Eye Institute, University of Western Ontario, London, ON, Canada.
authors.forename: Saad
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: Faculty of Medicine, Queen's University, Kingston, ON, Canada.
authors.forename: Zainab
authors.initials: Z
authors.lastname: Khan
authors.affiliation: Ivey Eye Institute, University of Western Ontario, London, ON, Canada.
authors.forename: Francie
authors.initials: F
authors.lastname: Si
authors.affiliation: Ivey Eye Institute, University of Western Ontario, London, ON, Canada.
authors.forename: Alex
authors.initials: A
authors.lastname: Mao
authors.affiliation: Ivey Eye Institute, University of Western Ontario, London, ON, Canada.
authors.forename: Irene
authors.initials: I
authors.lastname: Pan
authors.affiliation: Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Yazdi
authors.affiliation: Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Alexander
authors.initials: A
authors.lastname: Tsertsvadze
authors.affiliation: Ivey Eye Institute, University of Western Ontario, London, ON, Canada.
authors.forename: Cindy
authors.initials: C
authors.lastname: Hutnik
authors.affiliation: Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Moher
authors.affiliation: Ivey Eye Institute, University of Western Ontario, London, ON, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Tingey
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, ON, Canada.
authors.forename: Graham E
authors.initials: GE
authors.lastname: Trope
authors.affiliation: Department of Ophthalmology, University of Alberta, Edmonton, AB, Canada.
authors.forename: Karim F
authors.initials: KF
authors.lastname: Damji
authors.affiliation: Program for the Assessment of Technology and Health (PATH), and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
authors.forename: Jean-Eric
authors.initials: JE
authors.lastname: Tarride
authors.affiliation: Program for the Assessment of Technology and Health (PATH), and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
authors.forename: Ron
authors.initials: R
authors.lastname: Goeree
authors.affiliation: Ivey Eye Institute, University of Western Ontario, London, ON, Canada; Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON, Canada.
authors.forename: William
authors.initials: W
authors.lastname: Hodge
keywords: Diagnostic accuracies; Diagnostic techniques; Glaucoma; Meta-analysis; Systematic review