Sensitivity and specificity of two glaucoma case‐finding strategies for optometrists

Abstract

Current best practice for primary open-angle glaucoma case-finding comprises history-taking, disc examination, intraocular pressure measurement and suprathreshold visual field analysis (SVFA). An alternative case-finding technique was formulated replacing SVFA with computerised quantitative disc assessment, using the Heidelberg retinal tomograph II (HRT II). Each approach was adopted by four optometrists who screened 29 POAG and 37 normal patients. Average sensitivities and specificities were similar in the two groups [sensitivity 71% (SVFA) vs 69% (HRT II); specificity 94% both groups]. Our inclusion of pre-perimetric glaucoma cases limited the sensitivity of the optometrists in this study. There was evidence to suggest that the optometrists tended to miss early changes at the optic disc such as disc haemorrhage, nerve fibre layer defects and subtle neuroretinal thinning.

The clinical effectiveness and cost-effectiveness of screening for open angle glaucoma: a systematic review and economic evaluation

“…186 For the common cut-off, sensitivity ranged from 69% 186 to 95%, 163 while specificity ranged from 81% 163 to 95%. 186 The pooled sensitivity, specificity and DOR from the meta-analysis models for the common cut-off were 86% (95% CrI 55 to 97%), 89% (95% CrI 66 to …”

“…21,72,99,100,106,112,115,[154][155][156][157][158][159][160][161][162][163][164][165][166][167][168][169][170] Twenty studies were representative of a glaucoma suspect population referred from primary care, of which eight were cohort studies 22,171-177 and 12 were case-control studies. [178][179][180][181][182][183][184][185][186][187][188][189][190][191] …”

“…The earliest study took place in 1963 21 and the latest in 2003/04, 156,176 while 21 studies gave no indication of the period in which they were carried out. Thirteen studies took place in the USA, 22,158,159,162,166,168,170,172,175,181,[187][188][189] nine in the UK, 21,164,176,177,180,182,186,190,191 four in Australia, 115,157,163,173 two each in Italy, 106,174 The Netherlands, 169,183 Spain 99,179 and Sweden, 100,171 one each in Belgium, 155 Canada, 156 Greece, 112 India 161 and Norway, 154 and one in Canada and Finland. 178 Twenty-six studies gave details of the gender of their participants, 51% of whom were women.…”

“…All three studies were judged to be free from both partial and differential verification bias. 156,163,186 In all three studies the index test and the reference standard test were interpreted without knowledge of each other's results. 156,163,186 The studies by Harasymowycz and colleagues 156 and Robin and colleagues 163 met the criteria specified for higher quality studies.…”

“…In the population-based studies by Harasymowycz and colleagues 156 and Robin and colleagues 163 the tests were carried out by an ophthalmic photographer and "appropriately trained staff ", respectively, while in the case-control study by Ieong and colleagues 186 the tests were carried out by optometrists and earlystage glaucoma was targeted. The study by Harasymowycz and colleagues 156 focused on groups at high risk of developing glaucoma (people of Caribbean or African descent, or older than 50 years of age, or with a family history of OAG).…”