Br J OphthalmolJune 202015 citations

Accuracy of optical coherence tomography for diagnosing glaucoma: an overview of systematic reviews.

Michelessi Manuele, Li Tianjing, Miele Alba, Azuara-Blanco Augusto, Qureshi Riaz, Virgili Gianni

View on PubMed DOI: 10.1136/bjophthalmol-2020-316152

AI Summary

This overview of systematic reviews found that OCT's average retinal nerve fiber layer thickness shows moderate sensitivity but high specificity for diagnosing glaucoma, highlighting the need for improved study quality.

Abstract

Aims

To assess the diagnostic accuracy (DTA) of optical coherence tomography (OCT) for detecting glaucoma by systematically searching and appraising systematic reviews (SRs) on this issue.

Methods

We searched a database of SRs in eyes and vision maintained by the Cochrane Eyes and Vision United States on the DTA of OCT for detecting glaucoma. Two authors working independently screened the records, abstracted data and assessed the risk of bias using the Risk of Bias in Systematic Reviews checklist. We extracted quantitative DTA estimates as well as qualitative statements on their relevance to practice.

Results

We included four SRs published between 2015 and 2018. These SRs included between 17 and 113 studies on OCT for glaucoma diagnosis. Two reviews were at low risk of bias and the other two had two to four domains at high or unclear risk of bias with concerns on applicability. The two reliable SRs reported the accuracy of average retinal nerve fibre layer (RNFL) thickness and found a sensitivity of 0.69 (0.63 to 0.73) and 0.78 (0.74 to 0.83) and a specificity of 0.94 (0.93 to 0.95) and 0.93 (0.92 to 0.95) in 57 and 50 studies, respectively. Only one review included a clear specification of the clinical pathway. Both reviews highlighted the limitations of primary DTA studies on this topic.

Conclusions

The quality of published DTA reviews on OCT for diagnosing glaucoma was mixed. Two reliable SRs found moderate sensitivity at high specificity for average RNFL thickness in diagnosing manifest glaucoma. Our overview suggests that the methodological quality of both primary and secondary DTA research on glaucoma is in need of improvement.

MeSH Terms

GlaucomaHumansIntraocular PressureNerve FibersOptic DiskReproducibility of ResultsTomography, Optical CoherenceVisual Fields

Shields Classification

Ch. 4Optic Nerve, Retina, and Choroid

Ch. 27Management of the Glaucoma Patient

Key Concepts5

Two reliable systematic reviews on the diagnostic accuracy of optical coherence tomography (OCT) for detecting glaucoma reported a sensitivity of 0.69 (0.63 to 0.73) and 0.78 (0.74 to 0.83) for average retinal nerve fibre layer (RNFL) thickness.

DiagnosisReviewOverview of Systematic Reviewsn=57 and 50 studies respectivelyCh5Ch12

Two reliable systematic reviews on the diagnostic accuracy of optical coherence tomography (OCT) for detecting glaucoma found a specificity of 0.94 (0.93 to 0.95) and 0.93 (0.92 to 0.95) for average retinal nerve fibre layer (RNFL) thickness.

DiagnosisReviewOverview of Systematic Reviewsn=57 and 50 studies respectivelyCh5Ch12

The quality of published diagnostic accuracy (DTA) reviews on optical coherence tomography (OCT) for diagnosing glaucoma was mixed, with two reliable systematic reviews finding moderate sensitivity at high specificity for average retinal nerve fibre layer (RNFL) thickness in diagnosing manifest glaucoma.

DiagnosisReviewOverview of Systematic Reviewsn=Four systematic reviewsCh5Ch12

The methodological quality of both primary and secondary diagnostic accuracy (DTA) research on glaucoma is in need of improvement, as highlighted by an overview of systematic reviews.

MethodologyReviewOverview of Systematic Reviewsn=Four systematic reviewsCh28

Four systematic reviews published between 2015 and 2018 were included in an overview of systematic reviews assessing the diagnostic accuracy of optical coherence tomography (OCT) for detecting glaucoma.