Elsevier

Ophthalmology

Volume 117, Issue 2, February 2010, Pages 290-297
Ophthalmology

Original article
Diagnostic Ability of Heidelberg Retina Tomography in Detecting Glaucoma in a Population Setting: The Singapore Malay Eye Study

https://doi.org/10.1016/j.ophtha.2009.07.018Get rights and content

Objective

To evaluate the performance of the Heidelberg Retina Tomograph II (HRT II, Heidelberg Engineering, Heidelberg, Germany) in diagnosing glaucoma in a population setting.

Design

Population-based cross-sectional study.

Participants

Of 3280 Malay persons aged 40 to 80 years who participated in the survey, 112 subjects (124 eyes) with glaucoma and a subset of 196 bilaterally normal subjects (392 eyes) were included for the evaluation of diagnostic ability of HRT II.

Methods

All glaucomatous and normal eyes underwent standardized ophthalmic assessment (including automated perimetry) and HRT II. Glaucoma was defined according to International Society for Geographical and Epidemiological Ophthalmology criteria. Area under the curve (AUC) receiver operating characteristic (ROC), sensitivity, and specificity were used to evaluate the diagnostic performance of HRT II algorithms. Marginal logistic regression models were used to evaluate the influence of optic disc size on the results of HRT II algorithms.

Main Outcome Measures

The HRT II algorithms: linear discriminant functions (LDFs) by Mikelberg et al (LDF1), Burk et al (LDF2), Bathija et al (LDF3), and Moorfields regression analysis (MRA). The MRA was subdivided into MRA1 with “borderline” outcomes as positive and MRA2 with “borderline” outcomes as negative.

Results

Subjects with cataract, visual impairment, astigmatism, and greater negative spherical equivalent, and of older age were more likely to yield lower quality images. For analyses by eye, AUCs were 0.789, 0.704, 0.755, 0.754, and 0.762 for MRA1, MRA2, LDF1, LDF2, and LDF3, respectively. At 85% specificity, sensitivities were 62.1%, 65.3%, and 66.9% for LDF1, LDF2, and LDF3, respectively. At 95% specificity, these figures decreased to 31.5%, 42.7%, and 45.2%, respectively. The sensitivity and specificity were 71.0% and 86.7% for MRA1 and 43.6% and 97.2% for MRA2, respectively. Similar estimates were found for analyses by person. Larger optic disc size was associated with increased sensitivity and false-positive rate for MRA1, LDF1, and LDF2. LDF1 and LDF3 were least affected by optic disc area, but the sensitivities were moderate and the false-positive rates were high across different optic disc areas.

Conclusions

The current HRT II algorithms are of limited value for population-based glaucoma screening in the Malay population and do not account adequately for optic disc size.

Financial Disclosure(s)

The authors have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Population Sampling

The Singapore Malay Eye Study (SiMES) examined 3280 persons (78.7% response) of Malay ethnicity aged 40 to 80 years between August 2004 and June 2006.4, 15 The methods for this survey and recruitment process have been described in detail.16 Ethics approval was obtained from the institutional review board of the Singapore Eye Research Institute, Singapore, and the study was conducted in accordance with the World Medical Association's Declaration of Helsinki. Informed written consent was obtained

Results

Of the 3280 participants, HRT II was performed on 3131 subjects, of whom 75 were unable to complete the test (mostly because of cataract, poor fixation and visual acuity, or strabismus) and 8 had optic disc abnormalities (6 with myelinated nerve fibers, 1 with flame hemorrhage, and 1 with Bergmeister papilla). Of the remaining 3048 subjects (5908 eyes), acceptable HRT images were obtained from 4921 eyes of 2775 participants (both eyes of 2146 participants, right eyes of 316 participants, and

Discussion

Screening for glaucoma remains a controversial issue.30, 31, 32 This is partly attributable to the absence of an effective screening tool, the relatively low prevalence of the late stages of the disease, and the uncertainty about whether screening would benefit visual function and improve quality of life for those diagnosed with glaucoma. Our previous report of Singapore Malays showed that 3.8% of persons had glaucoma and that more than 90% of cases with glaucoma were previously undiagnosed.4,

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    Manuscript no. 2009-87.

    Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

    Supported by the National Medical Research Council Grants No 0796/2003 and Biomedical Research Council Grant No 501/1/25-5.

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