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Surv Ophthalmol. 2017 Jul - Aug;62(4):446-461. doi: 10.1016/j.survophthal.2017.01.001. Epub 2017 Jan 14.

Diagnostic accuracy of imaging devices in glaucoma: A meta-analysis.

Author information

1
Department of Pediatrics, Obstetrics, Gynecology and Preventive Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Ophthalmology Department, Hospital de l'Esperança-Parc de Salut Mar, Barcelona, Spain. Electronic address: mail@monicafallon.com.
2
Servei d'Estadística (Statistics Department), Universitat Autònoma de Barcelona, Barcelona, Spain.
3
Ophthalmology Department, Hospital de l'Esperança-Parc de Salut Mar, Barcelona, Spain; Department of Medicine, Institut Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.
4
Ophthalmology Department, Hospital de l'Esperança-Parc de Salut Mar, Barcelona, Spain; Department of Medicine, Institut Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Glaucoma Department, Institut Català de la Retina (ICR), Barcelona, Spain; Research Department, Institut Català de la Retina (ICR), Barcelona, Spain; Research Line on Epidemiology and Health Services, Universitat Internacional de Catalunya (UIC), Barcelona, Spain.

Abstract

Imaging devices such as the Heidelberg retinal tomograph-3 (HRT3), scanning laser polarimetry (GDx), and optical coherence tomography (OCT) play an important role in glaucoma diagnosis. A systematic search for evidence-based data was performed for prospective studies evaluating the diagnostic accuracy of HRT3, GDx, and OCT. The diagnostic odds ratio (DOR) was calculated. To compare the accuracy among instruments and parameters, a meta-analysis considering the hierarchical summary receiver-operating characteristic model was performed. The risk of bias was assessed using quality assessment of diagnostic accuracy studies, version 2. Studies in the context of screening programs were used for qualitative analysis. Eighty-six articles were included. The DOR values were 29.5 for OCT, 18.6 for GDx, and 13.9 for HRT. The heterogeneity analysis demonstrated statistically a significant influence of degree of damage and ethnicity. Studies analyzing patients with earlier glaucoma showed poorer results. The risk of bias was high for patient selection. Screening studies showed lower sensitivity values and similar specificity values when compared with those included in the meta-analysis. The classification capabilities of GDx, HRT, and OCT were high and similar across the 3 instruments. The highest estimated DOR was obtained with OCT. Diagnostic accuracy could be overestimated in studies including prediagnosed groups of subjects.

KEYWORDS:

biomedical enhancement; diagnostic imaging; glaucoma; meta-analysis; optic nerve

[Indexed for MEDLINE]

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