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J.M. Sparrow, E. Sanford, K.S. Powell, T.J. Peters, P.G. Spry, S. Gray, D. Hume, N.A. Frost, J.S. Durant, S.J. Frankel; Somerset and Avon Eye Studies: Assessment of the Efficiency of Options for Glaucoma Screening . Invest. Ophthalmol. Vis. Sci. 2003;44(13):3412.
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Purpose: To assess the efficiency of alternative population screening strategies for chronic open angle glaucoma (COAG). Methods: Data from the combined Somerset and Avon Eye Studies were used to quantify and compare the ability of both single and multiple tests and other factors to discriminate between individuals with glaucoma and normal subjects. These studies comprised two cross-sectional population studies of 2422 randomly selected individuals in the Bristol area of SW England. All subjects attended a research clinic and underwent full ophthalmological and other assessments. Within this study environment, individuals had been pragmatically categorised into two groups according to COAG likelihood. This classification was pragmatic and conservative, based upon the results of visual field tests, optic nerve head assessment and tonometry. Results: As expected, strong associations were observed between COAG and visual field defects (VFD), intra-ocular pressure (IOP) and increasing optic nerve head cup to disc ratio (CDR) (all p<0.001). The area under the ROC curves were: VFD=0.82, IOP=0.82, CDR=0.76 and AGE=0.75. Multivariable analysis for combinations gave VFD+IOP=0.93, VFD+CDR=0.87, CDR+IOP=0.90 and CDR+IOP+VFD =0.95. Area for AGE+IOP+VFD was 0.94. Conclusions: For single tests, visual field assessment (VFD) and tonometry (IOP) performed better than cup to disc ratio (CDR) and AGE, the latter 2 performing similarly. Combining tests increased discriminatory power. Interestingly, knowledge of AGE+IOP+VFD performed equally well at identification of COAG as the traditional indices of CDR+IOP+VFD combined. This finding has important implications for the design of population based glaucoma screening programmes. Acknowledgement: Somerset and Avon Eye Study Groups.
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