Diagnostic Accuracy of Technologies for Glaucoma Case-Finding in a Community Setting

Area of Science:

• Ophthalmology
• Diagnostic Imaging
• Public Health

Background:

• Primary open-angle glaucoma (POAG) is a leading cause of irreversible blindness worldwide.
• Early detection and accurate diagnosis are crucial for effective management and prevention of vision loss.
• Several diagnostic tools exist, but their comparative performance in community settings requires further evaluation.

Purpose of the Study:

• To evaluate the case-finding performance of Frequency Doubling Technology Perimeter (FDT), Moorfields Motion Displacement Test (MMDT), iVue optical coherence tomography (OCT), and Ocular Response Analyzer (ORA) for primary open-angle glaucoma (POAG).
• To assess the diagnostic accuracy of these tests individually and in combination.

Main Methods:

• A cross-sectional, observational, community-based study involving 505 subjects aged 60 years and older.
• Four index tests (FDT, MMDT, iVue OCT, ORA) were performed by a masked technician.
• Reference standard was a masked ophthalmic examination to classify subjects into POAG, glaucoma suspect, ocular hypertension, or non-POAG/non-ocular hypertension categories.

Main Results:

• The best-performing OCT parameter (inferior quadrant RNFL thickness) showed higher sensitivity (83%) for POAG detection compared to FDT (62%) and MMDT (58%) at 90% specificity.
• Individual tests demonstrated acceptable accuracy, but visual-function tests (FDT, MMDT) had low specificity when used alone.
• Combining RNFL thickness analysis with visual function tests significantly improved the post-test probability of diagnosing glaucoma suspect/POAG.

Conclusions:

• Individual diagnostic tests offer acceptable accuracy for POAG detection.
• The low specificity of visual-function tests limits their use in isolation for POAG diagnosis.
• Combining retinal nerve fiber layer (RNFL) thickness measurements from OCT with visual function tests enhances case detection for POAG.