Presented in part at: International Society for Imaging in the Eye First Annual Meeting, May 2–3, 2003; Fort Lauderdale, Florida, and Dutch Ophthalmological Society Annual Meeting, April, 2003; Rotterdam, The Netherlands.
Received 17 December 2003; accepted 19 April 2004. published online 16 September 2004.
Abstract
Purpose
To determine the diagnostic accuracy of the GDx VCC in the diagnosis of glaucoma.
Design
Prospective, comparative, observational, clinic-based case series.
Participants
One eye each of 77 healthy subjects and 162 patients with primary open-angle glaucoma of Caucasian racial origin. Healthy subjects had normal visual fields (VFs), healthy-looking optic discs, and intraocular pressures of ≤21 mmHg in both eyes. Glaucoma patients had a reproducible glaucomatous VF defect and a glaucomatous appearance of the optic disc in at least one eye.
Methods
All subjects were measured with the GDx VCC with an automated variable corneal compensator. We constructed receiver operating characteristic (ROC) curves for all available parameters. Subsequently, we calculated sensitivity, specificity, and multilevel likelihood ratios for the best discriminating parameter in the entire group. In addition, we calculated sensitivity and specificity in patients with mild, moderate, and severe glaucomatous damage separately.
The areas under the ROC curve for TSNIT Average, Superior Average, Inferior Average, TSNIT Std. Dev., and NFI were 0.93, 0.94, 0.90, 0.92, and 0.98, respectively. For the best discriminating parameter NFI, the sensitivity and specificity with a cutoff point of ≥40 were 89.0% and 95.9%, respectively. The multilevel likelihood ratios for glaucoma were 0.07 at NFI values of <35, 1.30 at values between 35 and 44, and 61.50 at values of ≥44. At the cutoff level of ≥40, the sensitivities of the NFI for correctly identifying glaucoma patients with mild, moderate, and severe damage were 83.8%, 92.9%, and 90.1%, respectively.
Conclusions
The GDx VCC allowed easy, rapid, and accurate discrimination between healthy and glaucomatous eyes. The NFI was the best discriminating parameter. The GDx VCC seems to fulfill criteria for a glaucoma screening device.
1Glaucoma Service, The Rotterdam Eye Hospital, Rotterdam, The Netherlands
Correspondence to Nicolaas J. Reus, MD, Glaucoma Service, The Rotterdam Eye Hospital, P.O. Box 70030, NL-3000 LM Rotterdam, The Netherlands.
ABSTRACT