title: Diagnostic accuracy of imaging devices in glaucoma: A meta-analysis.
abstract: Imaging devices such as the Heidelberg retinal tomograph-3 (HRT3), scanning laser polarimetry (GDx), and optical coherence tomography (OCT) play an important role in glaucoma diagnosis. A systematic search for evidence-based data was performed for prospective studies evaluating the diagnostic accuracy of HRT3, GDx, and OCT. The diagnostic odds ratio (DOR) was calculated. To compare the accuracy among instruments and parameters, a meta-analysis considering the hierarchical summary receiver-operating characteristic model was performed. The risk of bias was assessed using quality assessment of diagnostic accuracy studies, version 2. Studies in the context of screening programs were used for qualitative analysis. Eighty-six articles were included. The DOR values were 29.5 for OCT, 18.6 for GDx, and 13.9 for HRT. The heterogeneity analysis demonstrated statistically a significant influence of degree of damage and ethnicity. Studies analyzing patients with earlier glaucoma showed poorer results. The risk of bias was high for patient selection. Screening studies showed lower sensitivity values and similar specificity values when compared with those included in the meta-analysis. The classification capabilities of GDx, HRT, and OCT were high and similar across the 3 instruments. The highest estimated DOR was obtained with OCT. Diagnostic accuracy could be overestimated in studies including prediagnosed groups of subjects.
authors.affiliation: Department of Pediatrics, Obstetrics, Gynecology and Preventive Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Ophthalmology Department, Hospital de l'Esperança-Parc de Salut Mar, Barcelona, Spain. Electronic address: mail@monicafallon.com.
authors.forename: Monica
authors.initials: M
authors.lastname: Fallon
authors.affiliation: Servei d'Estadística (Statistics Department), Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Oliver
authors.initials: O
authors.lastname: Valero
authors.affiliation: Ophthalmology Department, Hospital de l'Esperança-Parc de Salut Mar, Barcelona, Spain; Department of Medicine, Institut Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Pazos
authors.affiliation: Ophthalmology Department, Hospital de l'Esperança-Parc de Salut Mar, Barcelona, Spain; Department of Medicine, Institut Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Glaucoma Department, Institut Català de la Retina (ICR), Barcelona, Spain; Research Department, Institut Català de la Retina (ICR), Barcelona, Spain; Research Line on Epidemiology and Health Services, Universitat Internacional de Catalunya (UIC), Barcelona, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Antón
mesh_terms: D003941:Diagnostic Techniques, Ophthalmological / Q000592:standards*; D005901:Glaucoma / Q000175:diagnosis*; D006801:Humans; D012372:ROC Curve; D015203:Reproducibility of Results; D012160:Retina / Q000000981:diagnostic imaging*
keywords: biomedical enhancement; diagnostic imaging; glaucoma; meta-analysis; optic nerve