Population and high-risk group screening for glaucoma: the Los Angeles Latino Eye Study

To evaluate the ability of various screening tests, both individually and in combination, to detect glaucoma in the general Latino population and high-risk subgroups. The Los Angeles Latino Eye Study is a population-based study of eye disease in Latinos 40 years of age and older. Participants (n = 6...

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Bibliographic Details
Published in:Investigative ophthalmology & visual science 2011-08, Vol.52 (9), p.6257-6264
Main Authors: Francis, Brian A, Varma, Rohit, Vigen, Cheryl, Lai, Mei-Ying, Winarko, Jonathan, Nguyen, Betsy, Azen, Stanley
Format: Article
Language:English
Subjects:
Aged
Area Under Curve
Female
Glaucoma, Open-Angle - diagnosis
Glaucoma, Open-Angle - epidemiology
Hispanic Americans - statistics & numerical data
Humans
Intraocular Pressure
Los Angeles - epidemiology
Male
Optic Nerve Diseases - diagnosis
Optic Nerve Diseases - epidemiology
Reproducibility of Results
Risk Assessment
ROC Curve
Sensitivity and Specificity
Vision Disorders - diagnosis
Vision Disorders - epidemiology
Vision Screening - methods
Visual Field Tests
Visual Fields
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Summary:To evaluate the ability of various screening tests, both individually and in combination, to detect glaucoma in the general Latino population and high-risk subgroups. The Los Angeles Latino Eye Study is a population-based study of eye disease in Latinos 40 years of age and older. Participants (n = 6082) underwent Humphrey visual field testing (HVF), frequency doubling technology (FDT) perimetry, measurement of intraocular pressure (IOP) and central corneal thickness (CCT), and independent assessment of optic nerve vertical cup disc (C/D) ratio. Screening parameters were evaluated for three definitions of glaucoma based on optic disc, visual field, and a combination of both. Analyses were also conducted for high-risk subgroups (family history of glaucoma, diabetes mellitus, and age ≥65 years). Sensitivity, specificity, and receiver operating characteristic curves were calculated for those continuous parameters independently associated with glaucoma. Classification and regression tree (CART) analysis was used to develop a multivariate algorithm for glaucoma screening. Preset cutoffs for screening parameters yielded a generally poor balance of sensitivity and specificity (sensitivity/specificity for IOP ≥21 mm Hg and C/D ≥0.8 was 0.24/0.97 and 0.60/0.98, respectively). Assessment of high-risk subgroups did not improve the sensitivity/specificity of individual screening parameters. A CART analysis using multiple screening parameters-C/D, HVF, and IOP-substantially improved the balance of sensitivity and specificity (sensitivity/specificity 0.92/0.92). No single screening parameter is useful for glaucoma screening. However, a combination of vertical C/D ratio, HVF, and IOP provides the best balance of sensitivity/specificity and is likely to provide the highest yield in glaucoma screening programs.
ISSN:1552-5783
0146-0404
1552-5783
DOI:10.1167/iovs.09-5126