Diagnostic Accuracy and Detection Rate of Glaucoma Screening with Optic Disk Photos, Optical Coherence Tomography Images, and Telemedicine.

Alfonso Anton,Karen Nolivos,Evangelos Tsiroukis,Antonio Morilla-Grasa,Vladimir Poposki,Miriam Eleonora Ayala,Marta Pazos,Xavier Castells,Oscar Peral,Elena Martínez-Prats,Merce Comas,Gianluca Fatti

doi:10.3390/jcm11010216

Abstract

Purpose: The aim of this study was to evaluate the diagnostic accuracy of optical coherence tomography (OCT) and retinography in the detection of glaucoma through a telemedicine program. Methods: A population-based sample of 4113 persons was randomly selected. The screening examination included a fundus photograph and OCT images. Images were evaluated on a deferred basis. All participants were then invited to a complete glaucoma examination, including gonioscopy, visual field, and dilated fundus examination. The detection rate, sensitivity, specificity, and positive and negative predictive values were calculated. Results: We screened 1006 persons. Of these, 201 (19.9%) were classified as glaucoma suspects; 20.4% were identified only by retinographs, 11.9% only by OCT images, and 46.3% by both. On ophthalmic examination at the hospital (n = 481), confirmed glaucoma was found in 58 (12.1%), probable glaucoma in 76 (15.8%), and ocular hypertension in 10 (2.1%), and no evidence of glaucoma was found in 337 (70.0%). The detection rate for confirmed or probable glaucoma was 9.2%. Sensitivity ranged from 69.4% to 86.2% and specificity from 82.1% to 97.4%, depending on the definition applied. Conclusions: The combination of OCT images and fundus photographs yielded a detection rate of 9.2% in a population-based screening program with moderate sensitivity, high specificity, and predictive values of 84–96%.

Highlights

Glaucoma is among the first causes of blindness, and it is estimated that it will affect111 million people by 2040 [1]
A 2008 systematic review and meta-analysis on different screening tests for glaucoma found no single test or combination of tests that was significantly superior to the others [6]
A Delphi analysis on glaucoma screening performed in 2012 suggested that six different combinations of intraocular pressure (IOP) measurements plus a functional test and a structural test seemed to be a good pairing for glaucoma screening, but none of them had optimal results [5]

Summary

Introduction

Glaucoma is among the first causes of blindness, and it is estimated that it will affect. 111 million people by 2040 [1]. The prevalence of glaucoma in Spain is 2.1% in individuals older than 40 years [2], which is similar to that in other Caucasian populations [3,4]. Glaucoma screening may be cost effective if performed in high-risk populations [5]. The ideal choice or combination of tests for glaucoma screening is still unknown [6].

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Conclusion