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M.A. R. Siddiqui, G. Mowatt, J. Burr, J. Cook, C. Ramsay, A. Azuara–Blanco, for OAG Screening Project Group; Systematic Review of the Diagnostic Accuracy of Frequency Doubling Technology as a Screening Test for Open Angle Glaucoma (OAG) . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3977.
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To evaluate the diagnostic accuracy of Frequency Doubling Technology (FDT) as a screening test for OAG. The secondary objectives were to explore the performance of the FDT test in different population subgroups e.g. age, race, IOP level, family history.
Electronic search strategies, designed to be highly sensitive, were undertaken on the major databases: Medline (1966 onwards) Embase (1980 onwards) SCI (1981 onwards), Biosis (1985 onwards) and the Cochrane Library as well as on the full text of major ophthalmic journals (1998 onwards). Two reviewers screened titles and abstracts identified by the search strategy and independently assessed full text copies of reports deemed to be potentially relevant. The included studies were quality assessed using a modified version of QUADAS. Suitability and homogeneity of data to do summary estimates and summary receiver operating characteristic (SROC) curve meta–analysis was assessed. Main outcome measures (1) The absolute numbers of true positives, false positives, false negatives and true negatives, or numbers from which they can be computed, such as the sensitivity and specificity values (2) Number of incomplete tests (3) Number of people with other ocular pathologies e.g. cataract, retinal diseases.
Search of the electronic databases identified 175 potentially relevant studies. After detailed evaluation 8 studies were included in the review, of which four were population–based and 4 were hospital–based. The diagnostic performance of FDT was highly variable. Sensitivities ranged from 7% to 100% and specificities from 26% to 100%. None of the studies reported diagnostic performance of FDT in subgroups. Incomplete test results ranged from 1.35% to 13.75%. Four studies did not report incomplete results. Out of 4 population–based studies 2 reported other significant ocular disease detected (3/243 and 5/296) by screening.
For the UK National Screening Committee to consider screening for glaucoma, one of the main criteria to be met is a valid and acceptable test for glaucoma diagnosis. FDT is a viable option, as it is portable, objective, cheap, and rapid. Due to the strong heterogeneous nature of the data and the small number of studies we are unable to conclude whether FDT is also an accurate test. A high quality population–based study using pre–defined cut–offs is needed to evaluate diagnostic performance of FDT in a community setting.
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