Sensitivity and specificity of tests to detect eye disease in an older population

Objective: To compare the ability of tests of visual function to detect the presence of eye disease. Design: Cross-sectional study. Participants: Three thousand six hundred fifty-four of 4433 (82.4%) eligibl e residents of an area near Sydney aged 49 years and older had a detailed e ye examination, including retinal and lens photography and subsequent gradi ng of eye disease, tests of presenting and corrected visual acuity, contras t sensitivity, screening visual field and intraocular pressure. Main Outcome Measures: Receiver operator characteristic (ROC) curves were c reated and area under the curve compared for each vision test. Sensitivity and specificity were calculated for each test. Results: No single vision test predicted the presence of eye disease with a ny consistency. Best-corrected visual acuity or contrast sensitivity had th e highest area under the ROC curve for most eye diseases examined but had p oor sensitivity and specificity. For glaucoma and diabetic retinopathy ther e was no difference in area under the curve for any of the tests examined, and no test had a good balance of sensitivity and specificity. Screening te sts (performed with presenting correction) did not perform as well as nonsc reening tests (those carried out after refraction with best correction). Conclusions: Current vision tests are not particularly good at detecting ey e disease compared with the "gold standard" of a full eye examination perfo rmed by an ophthalmologist. Further work in this area should be carried out before vision screening programs can be recommended for implementation amo ng older people. Ophthalmology 2001;108:968-975 (C) 2001 by the American Ac ademy of Ophthalmology.