Precision of the Retinal Tomograph as a Screening Device

 

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Abstract

Purpose: To assess the diagnostic accuracy of the Heidelberg Retinal Tomograph 3 (HRT3) as a screening device in comparison with the reference standard of Octopus standard automated perimetry results (SAP) combined with clinical findings. Methods: All patients underwent screening examinations and investigations within a single day. Abnormal screening results were classified as follows: The HRT3: Either “borderline” or “outside normal limits” using the global Moorfields classification (MFC); SAP and clinical exam: A mean defect > 2.4 dB or “outside normal limits” clear text analysis of SAP; and one of the following i) IOP > 21 mmHg, ii) Van Herrick < ¼, iii) cup disc ratio > 0.55, iv) optic nerve head abnormality, v) narrow iridocorneal angle or vi) evidence of peripheral anterior synechiae on gonioscopy. Results: The mean age of the participants was 59.9 years (± 14.8 [21, 91]). Twenty-three subjects (16 %) were classified as abnormal on SAP and clinical exam. The HRT3 classification had a sensitivity of 30 % (95 % CI [16 %, 51 %]) with associated specificity of 58 % (95 % CI [49 %, 66 %]). Of the sixty subjects classified as borderline or outside normal limits with the HRT MFC global result, seven subjects were also abnormal according to SAP and clinical exam. Conclusion: The results suggest that the HRT3 may not be suitable as a sole screening device; however, further investigation is necessary.

Zusammenfassung

Einleitung: Ziel der Studie war die Einschätzung der diagnostischen Sicherheit des Heidelberg Retinal Tomograph 3 (HRT3) als Screeninginstrument im Vergleich zu den Resultaten der standardisierten, automatischen Perimetrie des Octopus (SAP), als aktuellem Referenzstandard, in Kombination mit klinischen Befunden. Methodik: Alle Patienten erhielten am gleichen Tag eine Screeninguntersuchung und Abklärungen. Abnormale Screeningresultate wurden wie folgt eingeteilt: Kriterium 1: Im HRT3: entweder „borderline“ oder „outside normal limits“, in der globalen Moorfields-Klassifikation (MFC); Kriterium 2: ein mittlerer Defekt von > 2.4 dB oder „outside normal limits“ in der Klartextanalyse des SAP; und einer der folgenden Punkte i) IOD > 21 mmHg, ii) Van Herrick-Einteilung < ¼, iii) Papillenexkavation > 0.55, iv) glaukomsuspekte Papillenveränderungen, v) enger Kammerwinkel oder vi) Nachweis von peripheren anterioren Synechien in der klinischen Untersuchung. Resultate: Das Durchschnittsalter der Teilnehmer lag bei 59,9 Jahren (± 14,8 [21, 91]). 23 Personen (16 %) wurde als abnormal durch das Kriterium 1 bewertet. Das Kriterium 1 hatte eine Sensivität von 30 % (95 % CI [16 %, 51 %]) mit einer Spezifität von 58 % (95 % CI [49 %, 66 %]). Von den 60 Personen, die durch das HRT-MFC als „borderline“ oder „outside normal limits“ klassifiziert wurden, waren 7 Personen ebenfalls abnormal gemäß dem Kriterium 1. Konklusion: Die Resultate dieser Studie deuten darauf hin, dass das HRT3 nicht als alleiniges Screeninginstrument geeignet ist, es sind jedoch weitere Untersuchungen nötig.

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