Using optical imaging summary data to detect glaucoma

Purpose: To evaluate the sensitivity and specificity for discriminating bet ween early to moderate glaucomatous and normal eyes using summary data repo rts from the Heidelberg Retina Tomograph (HRT), the GDx Nerve Fiber Analyze r (GDx), and the Optical Coherence Tomograph (OCT). Design: Comparative cross-sectional study. Participants: One eye each of 50 normal subjects and 39 glaucoma patients w ith early to moderate visual field damage (mean deviation, -5.04 +/- 3.32 d B; range, -0.85 to -13.2 dB). Methods: Three experienced graders masked to patient identity and diagnosis evaluated each summary data report from the HRT, GDx, and OCT independentl y. Main Outcome Measures: Each summary report was classified as either normal or glaucomatous. Sensitivity and specificity are reported for each grader, and agreement between graders is reported. Results: For the HRT, sensitivity and specificity ranged from 64% to 75% an d 68% to 80%, respectively. Agreement (kappa +/- standard error [SE]) betwe en observers one and two, two and three, and one and three was 0.73 +/- 0.0 7, 0.77 +/- 0.07, and 0.67 +/- 0.08, respectively. For the GDx, sensitivity and specificity ranged from 72% to 82% and 56% to 82%, respectively. Agree ment (kappa +/- SE) between observers one and two, two and three, and one a nd three was 0.66 +/- 0.08, 0.66 +/- 0.08, and 0.50 +/- 0.09, respectively. For the OCT, sensitivity and specificity ranged from 76% to 79% and 68% to 81%, respectively. Agreement (kappa +/- SE) between observers one and two, two and three, and one and three was 0.73 +/- 0.07, 0.58 +/- 0.08, and 0.5 1 +/- 0.09, respectively. Conclusions: When used alone, HRT GDx, and OCT summary data reports can dif ferentiate between normal and glaucomatous eyes with mild to moderate visua l field loss. However, none of the instruments provided sensitivity and spe cificity that justify summary data reports being used as a screening tool f or early to moderate glaucoma. Ophthalmology 2001;108:1812-1818 (C) 2001 by the American Academy of Ophthalmology.