HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (5) Citing Articles via Google Scholar Google Scholar Articles by Medeiros, F. A. Articles by Weinreb, R. N. Search for Related Content PubMed PubMed Citation Articles by Medeiros, F. A. Articles by Weinreb, R. N.

The Effects of Study Design and Spectrum Bias on the Evaluation of Diagnostic Accuracy of Confocal Scanning Laser Ophthalmoscopy in Glaucoma

From the Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, California.

PURPOSE. To assess the effects of study design and spectrum bias on the evaluation of diagnostic accuracy of confocal scanning laser ophthalmoscopy (CSLO) in glaucoma.

METHODS. Analysis 1 included 67 eyes with glaucomatous visual field loss and 56 eyes of normal volunteers. Estimates of diagnostic accuracy in this analysis were compared to those obtained from analysis 2, which included a cohort of patients with suspected glaucoma, but without visual field loss at the time of CSLO imaging. For analysis 2, 40 eyes with progressive glaucomatous optic disc change were included in the glaucoma group and 43 eyes without any evidence of progressive damage to the optic nerve that were observed untreated for an average time of 9.01 ± 3.09 years were included in the normal group. Areas under the receiver operating characteristic (ROC) curves (AUC) were used to evaluate diagnostic accuracy of CSLO parameters.

RESULTS. There was a statistically significant difference between the performance of the parameter with largest AUC, discriminant function Bathija, in analysis 1 (AUC = 0.91) compared with its performance in analysis 2 (AUC = 0.71; P = 0.002). For the contour-line–independent parameter glaucoma probability score, a statistically significant difference was also observed in the performance obtained in analysis 1 (AUC = 0.89) compared with analysis 2 (AUC = 0.65; P < 0.001).

CONCLUSIONS. Estimates of diagnostic accuracy of CSLO in glaucoma can be largely different depending on the population studied and the reference standard used to define disease. Diagnostic accuracy estimates obtained from case–control studies including well-defined groups of subjects with or without disease may not be applicable to the clinically relevant population.

This article has been cited by other articles:

				L. M. Alencar, C. Bowd, R. N. Weinreb, L. M. Zangwill, P. A. Sample, and F. A. Medeiros Comparison of HRT-3 Glaucoma Probability Score and Subjective Stereophotograph Assessment for Prediction of Progression in Glaucoma Invest. Ophthalmol. Vis. Sci., May 1, 2008; 49(5): 1898 - 1906. [Abstract] [Full Text] [PDF]