Evaluation of the high specificity Screening Program (C-20-1) of the Frequency Doubling Technology (FDT) perimeter in clinical practice

Methodology and reporting of diagnostic accuracy studies of automated perimetry in glaucoma: evaluation using a standardised approach

PURPOSE

To evaluate methodological and reporting quality of diagnostic accuracy studies of perimetry in glaucoma and to determine whether there had been any improvement since the publication of the Standards for Reporting of Diagnostic Accuracy (STARD) guidelines.

METHODS

A systematic review of English language articles published between 1993 and 2013 reporting the diagnostic accuracy of perimetry in glaucoma. Articles were appraised for methodological quality using the 14-item Quality assessment tool for diagnostic accuracy studies (QUADAS) and evaluated for quality of reporting by applying the STARD checklist.

RESULTS

Fifty-eight articles were appraised. Overall methodological quality of these studies was moderate with a median number of QUADAS items rated as 'yes' equal to nine (out of a maximum of 14) (IQR 7-10). The studies were often poorly reported; median score of STARD items fully reported was 11 out of 25 (IQR 10-14). A comparison of the studies published in 10-year periods before and after the publication of the STARD checklist in 2003 found quality of reporting had not substantially improved.

CONCLUSIONS

Methodological and reporting quality of diagnostic accuracy studies of perimetry is sub-optimal and appears not to have improved substantially following the development of the STARD reporting guidance. This observation is consistent with previous studies in ophthalmology and in other medical specialities.

Influence of diabetes on the validity glaucoma screening by frequency doubling perimetry: a hospital-based study in Oman

BACKGROUND

A hospital-based study was conducted in 2007 in Oman to determine the validity of frequency doubling perimetry (FDP). The authors have compared the ability of FDP to detect glaucoma among patients with and without diabetes.

METHODS

This was a validity study of the screening procedure. An ophthalmologist and an optometrist examined Omani persons >30 years of age with and without diabetes. They determined glaucomatous field changes by using FDP. The glaucoma specialist labeled the eye and the person as suffering from glaucoma if two criteria were present: (1) optic cup disc and other retinal changes suggestive of glaucoma and (2) field changes on automated perimeter suggestive of glaucoma. Ocular pressure was measured with a Tono-Pen (Medtronic Ophthalmics, Jacksonville, FL). We calculated the validity of glaucoma screening by FDP among persons both with diabetes and without diabetes.

RESULTS

We examined 111 eyes of 56 Omani patients (55 eyes of 28 patients with diabetes and 56 eyes of 28 persons without diabetes). Two persons had a history of glaucoma in both eyes. Glaucoma screening by FDP detected five eyes (two eyes of patients with diabetes and three eyes of persons without diabetes) with glaucoma. The specificity of glaucoma screening among those with and without diabetes was 97.4% and 97.3%, respectively. The sensitivity was 6% and 11%, respectively, in these two groups.

CONCLUSIONS

Validity of glaucoma screening by FDP is not different among those with and without diabetes. In countries with high rates of diabetes, FDP could be used as a first-level screening tool for glaucoma.