Diagnostic accuracy of optical coherence tomography for diagnosing glaucoma: secondary analyses of the GATE study

Virgili, G. et al. (2018) Diagnostic accuracy of optical coherence tomography for diagnosing glaucoma: secondary analyses of the GATE study. British Journal of Ophthalmology, 102(5), pp. 604-610. (doi:10.1136/bjophthalmol-2017-310642) (PMID:28855198)

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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 specificity at 0.95, the sensitivity 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.

Item Type:Articles
Additional Information:The GATE study was funded by the National Institute of Health Research HTA programme (09/22/111).
Keywords:Diagnostic tests/investigation, glaucoma, imaging.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Boachie, Mr Charles
Authors: Virgili, G., Michelessi, M., Cook, J., Boachie, C., Burr, J., Banister, K., Garway-Heath, D. F., Bourne, R. R.A., Asorey Garcia, A., Ramsay, C. R., and Azuara-Blanco, A.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:British Journal of Ophthalmology
Publisher:BMJ Publishing Group
ISSN:0007-1161
ISSN (Online):1468-2079
Published Online:30 August 2017
Copyright Holders:Copyright © 2017 The Authors
First Published:First published in British Journal of Ophthalmology 102(5): 604-610
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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