Diagnostic accuracy of optical coherence tomography for diagnosing glaucoma: secondary analyses of the GATE study.
Virgili Gianni, Michelessi Manuele, Cook Jonathan, Boachie Charles, Burr Jennifer, Banister Katie, Garway-Heath David F, Bourne Rupert R A, Asorey Garcia Almudena, Ramsay Craig R
AI Summary
OCT's RNFL data for glaucoma diagnosis showed moderate accuracy (AUC 0.83-0.88). While useful, its sensitivity/specificity are limited, even with added factors, suggesting it's a supportive, not standalone, diagnostic tool.
Abstract
Background/aims: To assess the diagnostic performance of retinal nerve fibre layer (RNFL) data of optical coherence tomography (OCT) for detecting glaucoma.
Methods
Secondary analyses of a prospective, multicentre diagnostic study (Glaucoma Automated Tests Evaluation (GATE)) referred to hospital eye services in the UK were conducted. We included data from 899 of 966 participants referred to hospital eye services with suspected glaucoma or ocular hypertension. We used both eyes' data and logistic regression-based receiver operator characteristics analysis to build a set of models to measure the sensitivity and specificity of the average and inferior quadrant RNFL thickness data of OCT. The reference standard was expert clinician examination including automated perimetry. The main outcome measures were sensitivity at 0.95 specificity and specificity at 0.95 sensitivity and the corresponding RNFL thickness thresholds. We explored the possibility of accuracy improvement by adding measures of within-eye and between-eye variation, scan quality, intraocular pressure (IOP) and age.
Results
Glaucoma was diagnosed in at least one eye in 17% of participants. Areas under the curve were between 0.83 and 0.88. When specificity was fixed at 0.95, the sensitivity was between 0.38 and 0.55, and the highest values were reached with models including the inferior quadrant rather than the average RNFL thickness. Fixing sensitivity at 0.95, the specificity was between 0.36 and 0.58. The addition of age, refractive error, IOP or within-subject variation did not improve the accuracy.
Conclusion
RNFL thickness data of OCT can be used as a diagnostic test, but accuracy estimates remain moderate even in exploratory multivariable modelling of aiming to improve accuracy.
MeSH Terms
Shields Classification
Key Concepts6
In a secondary analysis of the GATE study, which included 899 of 966 participants referred to hospital eye services in the UK with suspected glaucoma or ocular hypertension, the diagnostic accuracy of retinal nerve fibre layer (RNFL) data of optical coherence tomography (OCT) for detecting glaucoma, as measured by areas under the curve, was between 0.83 and 0.88.
In a secondary analysis of the GATE study, which included 899 of 966 participants referred to hospital eye services in the UK with suspected glaucoma or ocular hypertension, when specificity was fixed at 0.95, the sensitivity of retinal nerve fibre layer (RNFL) data of optical coherence tomography (OCT) for detecting glaucoma was between 0.38 and 0.55, with the highest values reached with models including the inferior quadrant rather than the average RNFL thickness.
In a secondary analysis of the GATE study, which included 899 of 966 participants referred to hospital eye services in the UK with suspected glaucoma or ocular hypertension, when sensitivity was fixed at 0.95, the specificity of retinal nerve fibre layer (RNFL) data of optical coherence tomography (OCT) for detecting glaucoma was between 0.36 and 0.58.
In a secondary analysis of the GATE study, which included 899 of 966 participants referred to hospital eye services in the UK with suspected glaucoma or ocular hypertension, the addition of age, refractive error, intraocular pressure (IOP), or within-subject variation did not improve the diagnostic accuracy of retinal nerve fibre layer (RNFL) data of optical coherence tomography (OCT) for detecting glaucoma.
In a secondary analysis of the GATE study, which included 899 of 966 participants referred to hospital eye services in the UK with suspected glaucoma or ocular hypertension, retinal nerve fibre layer (RNFL) thickness data of optical coherence tomography (OCT) can be used as a diagnostic test for glaucoma, but accuracy estimates remain moderate even with exploratory multivariable modelling.
In a secondary analysis of the GATE study, which included 899 of 966 participants referred to hospital eye services in the UK with suspected glaucoma or ocular hypertension, glaucoma was diagnosed in at least one eye in 17% of participants.
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