Background/aims To determine the performance of combinations of structural and functional screening tests in detecting sight-threatening eye disease in a cohort of elderly subjects recruited from primary care.
Methods 505 subjects aged ≥60 years underwent frequency doubling technology (FDT) perimetry, iVue optical coherence tomography (iWellness and peripapillary retinal nerve fibre layer (RNFL) scans) and intraocular pressure with the Ocular Response Analyzer, all performed by an ophthalmic technician. The reference standard was a full ophthalmic examination by an experienced clinician who was masked to the index test results. Subjects were classified as presence or absence of sight-threatening eye disease (clinically significant cataract, primary open-angle glaucoma, intermediate or advanced age-related macular degeneration and significant diabetic retinopathy). Univariate and multivariate logistic regression analyses were used to determine the association between abnormal screening test results and the presence of sight-threatening eye disease.
Results 171 subjects (33.8%) had one or more sight-threatening eye diseases. The multivariate analysis found significant associations with any of the target conditions for visual acuity of <6/12, an abnormal FDT and peripapillary RNFL thickness outside the 99% normal limit. The sensitivity of this optimised screening panel was 61.3% (95% CI 53.5 to 68.7), with a specificity of 78.8% (95% CI 74.0 to 83.1), a positive predictive value of 59.5% (95% CI 53.7 to 65.2) and an overall diagnostic accuracy of 72.9% (95% CI 68.8 to 76.8).
Conclusions A subset of screening tests may provide an accurate and efficient means of population screening for significant eye disease in the elderly. This study provides useful preliminary data to inform the development of further larger, multicentre screening studies to validate this screening panel.
- optical coherence tomography, FDT perimetry
- diagnostic accuracy
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Contributors BRF: study design and conception, collection of data, data analysis and interpretation, writing of the manuscript and approval; PD: study design and conception, collection of data, data analysis and approval; AJ, IC and TP: data analysis and interpretation and approval; DFE: study design and conception, data analysis and interpretation, and approval; JGL: study design and conception, data analysis and interpretation, writing of the manuscript and approval.
Funding The study was funded by the College of Optometrists UK.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The study was approved by the research and ethical committee of the Division of Optometry and Visual Science, City, University of London (reference number 189A.4b) and adhered to the tenets of the Declaration of Helsinki. Informed written consent was obtained prior to participation.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.
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