Using optical imaging summary data to detect glaucoma.

PURPOSE: To evaluate the sensitivity and specificity for discriminating between early to moderate glaucomatous and normal eyes using summary data reports from the Heidelberg Retina Tomograph (HRT), the GDx Nerve Fiber Analyzer (GDx), and the Optical Coherence Tomograph (OCT).
DESIGN: Comparative cross-sectional study PARTICIPANTS: One eye each of 50 normal subjects and 39 glaucoma patients with early to moderate visual field damage (mean deviation, -5.04 +/- 3.32 dB; 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 independently. 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% and 68% to 80%, respectively. Agreement (kappa +/- standard error [SE]) between observers one and two, two and three, and one and three was 0.73 +/- 0.07, 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. Agreement (kappa +/- SE) between observers one and two, two and three, and one and 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 0.51 +/- 0.09, respectively.
CONCLUSIONS: When used alone, HRT, GDx, and OCT summary data reports can differentiate between normal and glaucomatous eyes with mild to moderate visual field loss. However, none of the instruments provided sensitivity and specificity that justify summary data reports being used as a screening tool for early to moderate glaucoma.