April 2011
Volume 52, Issue 14
Free
ARVO Annual Meeting Abstract  |   April 2011
Summary of Glaucoma Testing Accuaracy: A Comprehensive Systematic Review of Clinical Studies
Author Affiliations & Notes
  • William G. Hodge
    Ivey Eye Institute, University of Western Ontario, London, Ontario, Canada
  • Zainab Khan
    Ophthalmology, Queen's University, Kingston, Ontario, Canada
  • Kevin Warrian
    Ivey Eye Institute, University of Western Ontario, London, Ontario, Canada
  • Francie Si
    Ivey Eye Institute, University of Western Ontario, London, Ontario, Canada
  • Cindy Hutnik
    Ivey Eye Institute, University of Western Ontario, London, Ontario, Canada
  • Alex Mao
    Ivey Eye Institute, University of Western Ontario, London, Ontario, Canada
  • Irene Pan
    Ivey Eye Institute, University of Western Ontario, London, Ontario, Canada
  • David Moher
    Chalmers Systematic Review Center, University of Ottawa, Ottawa, Ontario, Canada
  • Ron Goeree
    Program for the Assessment in Technology in Health, McMaster University, Hamilton, Ontario, Canada
  • Fatemeh Yazdi
    Chalmers Systematic Review Center, University of Ottawa, Ottawa, Ontario, Canada
  • Footnotes
    Commercial Relationships  William G. Hodge, None; Zainab Khan, None; Kevin Warrian, None; Francie Si, None; Cindy Hutnik, None; Alex Mao, None; Irene Pan, None; David Moher, None; Ron Goeree, None; Fatemeh Yazdi, None
  • Footnotes
    Support  Canadian Institute for Health Research
Investigative Ophthalmology & Visual Science April 2011, Vol.52, 246. doi:https://doi.org/
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      William G. Hodge, Zainab Khan, Kevin Warrian, Francie Si, Cindy Hutnik, Alex Mao, Irene Pan, David Moher, Ron Goeree, Fatemeh Yazdi; Summary of Glaucoma Testing Accuaracy: A Comprehensive Systematic Review of Clinical Studies. Invest. Ophthalmol. Vis. Sci. 2011;52(14):246. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: : A plethora of studies now exist that evaluate imaging technologies for glaucoma. However there are many new studies weekly and assimilating this information into a useful synthesis is now overdue for both clinicians and policy makers. We undertook this task to assimilate the studies from 3 new technologies OCT, HRT and GDx compared to the gold standard of optic disc photography and white on white visual field.

Methods: : Standard Information retrieval methods, inclusion and exclusion criteria, study selection methods, screening and data abstraction and analysis were performed as per the Agency for Health Care Research and Quality Systematic Review Protocols. 1035 articles were screened and after exclusions based on our a priori protocol, 303 atricles were used for data extraction. The QUORUM Statement was used to assess quality and a PRISMA flow diagram was generated. Inter-rater reliability was rated with the kappa statistic. Synthesized sensitivity, specificity and diagnostic odds ratios (DOR) were calculated vs the gold standard methods. Both point estimates and 95% confidence intervals were created. ROC curves were also aggregated whenever possible. A test for heterogeneity was performed-I2.

Results: : Both OCT (DOR 29.8 95% CI: 21.7,40.8) and GDx (DOR: 28.3, 95% CI: 21.6, 36.8) had similar accuracy compared to white on white perimetry but HRT lagged behind (DOR:20.9, 95% CI: 16.2, 27.2). Stratified data by new technology (Stratus OCT, OCT 2000, OCT1, GDx VCC, GDx FCC, HRT 1, 2 and 3) showed similar results to the overall results for each technology. Of importance, the I2 was well over 50% for all technologies and all categories.

Conclusions: : The synthesized data favors GDx and OCT over HRT for diagnostic accuracy in glaucoma compared to a gold standard of white on white visual field. However all I2values are high indicating great heterogeneity in terms of chosen cutoffs and their values. Hence a more agreed upon uniform methodology to assess each technology consistently is needed and content experts in this field should work toward this goal.

Keywords: clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials • optic disc • aqueous 
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