Diagnostic accuracy of Optical Coherence Tomography for diagnosing glaucoma: secondary analyses of the GATE study

Gianni Virgili, Manuele Michelessi, Jonathan Cook, Charles Boachie, Jennifer Burr, Kathryn Ruth Banister, David Garway-Heath, Rupert R. A. Bourne, Almudena Asorey, Craig Robert Ramsay, Augusto Azuara-Blanco (Corresponding Author)

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Abstract

Background/Aims: To assess the diagnostic performance of retinal nerve fiber layer (RNFL) data of optical coherence tomography (OCT) for detecting glaucoma.

Methods: Secondary analyses of a prospective, multicenter diagnostic study (GATE) referred to hospital eye services in the United Kingdom. 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 (ROC) 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, 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, 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.
Original languageEnglish
Pages (from-to)604-610
Number of pages7
JournalBritish Journal of Ophthalmology
Volume102
Early online date30 Aug 2017
DOIs
Publication statusPublished - 2018

Keywords

  • Glaucoma
  • Imaging
  • Diagnostic tests/Investigation

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    Virgili, G., Michelessi, M., Cook, J., Boachie, C., Burr, J., Banister, K. R., Garway-Heath, D., Bourne, R. R. A., Asorey, A., Ramsay, C. R., & Azuara-Blanco, A. (2018). Diagnostic accuracy of Optical Coherence Tomography for diagnosing glaucoma: secondary analyses of the GATE study. British Journal of Ophthalmology, 102, 604-610. https://doi.org/10.1136/bjophthalmol-2017-310642