Screening Tests for Detecting Open-Angle Glaucoma: Systematic Review and Meta-analysis

• Published in: Investigative ophthalmology & visual science 2008-12, Vol.49 (12), p.5373-5385
• Main Authors: Mowatt, Graham, Burr, Jennifer M, Cook, Jonathan A, Siddiqui, M. A. Rehman, Ramsay, Craig, Fraser, Cynthia, Azuara-Blanco, Augusto, Deeks, Jonathan J, OAG Screening Project
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Diagnostic Techniques, Ophthalmological; Eye and associated structures. Visual pathways and centers. Vision; False Positive Reactions; Fundamental and applied biological sciences. Psychology; Glaucoma and intraocular pressure; Glaucoma, Open-Angle - diagnosis; Humans; Intraocular Pressure; Medical sciences; Ophthalmology; Ophthalmoscopy; Predictive Value of Tests; Reproducibility of Results; Sensitivity and Specificity; Tomography; Tonometry, Ocular; Vertebrates: nervous system and sense organs; Visual Field Tests
• ISSN: 0146-0404; 1552-5783; 1552-5783
• DOI: 10.1167/iovs.07-1501

To assess the comparative accuracy of potential screening tests for open angle glaucoma (OAG). Medline, Embase, Biosis (to November 2005), Science Citation Index (to December 2005), and The Cochrane Library (Issue 4, 2005) were searched. Studies assessing candidate screening tests for detecting OAG in persons older than 40 years that reported true and false positives and negatives were included. Meta-analysis was undertaken using the hierarchical summary receiver operating characteristic model. Forty studies enrolling over 48,000 people reported nine tests. Most tests were reported by only a few studies. Frequency-doubling technology (FDT; C-20-1) was significantly more sensitive than ophthalmoscopy (30, 95% credible interval [CrI] 0-62) and Goldmann applanation tonometry (GAT; 45, 95% CrI 17-68), whereas threshold standard automated perimetry (SAP) and Heidelberg Retinal Tomograph (HRT II) were both more sensitive than GAT (41, 95% CrI 14-64 and 39, 95% CrI 3-64, respectively). GAT was more specific than both FDT C-20-5 (19, 95% CrI 0-53) and threshold SAP (14, 95% CrI 1-37). Judging performance by diagnostic odds ratio, FDT, oculokinetic perimetry, and HRT II are promising tests. Ophthalmoscopy, SAP, retinal photography, and GAT had relatively poor performance as single tests. These findings are based on heterogeneous data of limited quality and as such are associated with considerable uncertainty. No test or group of tests was clearly superior for glaucoma screening. Further research is needed to evaluate the comparative accuracy of the most promising tests.