Article Text

Detection of glaucoma using operator-dependent versus operator-independent classification in the Heidelberg retinal tomograph-III
  1. N Harizman1,
  2. J R Zelefsky2,
  3. E Ilitchev1,
  4. C Tello1,
  5. R Ritch1,
  6. J M Liebmann3
  1. 1Departments of Ophthalmology, New York Eye and Ear Infirmary, New York, New York, USA
  2. 2Department of Ophthalmology, New York University School of Medicine, New York, USA
  3. 3Manhattan Eye, Ear and Throat Hospital, Manhattan, New York, USA
  1. Correspondence to: J M Liebmann Department of Ophthalmology, New York University School of Medicine, 310 East 14th Street, Suite 304, New York, NY 10003, USA; jml18{at}


Objective: To compare the abilities of a new Glaucoma Probability Scoring (GPS) system and Moorfields regression analysis (MRA) to differentiate between glaucomatous and normal eyes using Heidelberg retinal tomograph (HRT)-III software and race-specific databases.

Methods: In this prospective study, one eye (refractive error ⩽5 D) each of consecutive normal patients and those with glaucoma was enrolled. All patients underwent a full eye examination, standard achromatic perimetry (Swedish Interactive Threshold Algorithm-standard automated perimetry (SITA-SAP), program 24-2) and confocal scanning laser ophthalmoscopy (HRT-II) within 1 month. Normal patients had two normal visual fields in both eyes (pattern standard deviation (PSD) >5% and Glaucoma Hemifield Test within 97% normal limits) and a normal clinical examination. Glaucoma was defined on the basis of SITA-SAP visual field loss (PSD<5% or Glaucoma Hemifield Test outside normal limits) on two consecutive visual fields. HRT-II examinations were exported to the HRT-III software (V.3.0), which uses an enlarged race-specific database, consisting of 733 eyes of white people and 215 eyes of black people. Race-adjusted MRA for the most abnormal sector (operator-dependent contour line placement) was compared with the global race-adjusted GPS (operator independent). MRA sectors outside the 99.9% confidence interval limits (outside normal limits) and GPS ⩾0.64 were considered abnormal.

Results: 136 normal patients (72 black and 64 white patients) and 84 patients with glaucoma (52 black and 32 white patients) were enrolled (mean age 50.4 (SD 14.4) years). The average visual field mean deviation was −0.4 (SD 1.1) db for the normal group and −7.3 (SD 6.7) db for the glaucoma group (p<0.001). Mean GPS values were 0.21 (SD 0.23) and 0.73 (SD 0.27) for normal and glaucomatous eyes, respectively (p<0.001). Sensitivity and specificity values were 77.1% and 90.3% for GPS, and 71.4% and 91.9% for MRA, respectively.

Conclusions: In this cohort, GPS software sensitivity and specificity values are similar to those of MRA, which requires placement of an operator-dependent contour line. The development of software to detect glaucoma without a contour line is critical to improving the potential use of HRT as a tool for glaucoma detection and screening.

  • GPS, Glaucoma Probability Score
  • HRT, Heidelberg retinal tomograph
  • MFC, Moorfields classification
  • MRA, Moorfields regression analysis
  • RNFL, retinal nerve fibre layer

Statistics from


  • Published Online First 26 July 2006

  • Funding: This study was supported in part by the Shelley and Steven Einhorn Research Fund of the New York Glaucoma Research Institute, New York, USA.

  • Competing interests: None.

  • Presented in part at the Annual Meeting of the Association for Research in Vision and Ophthalmology, Fort Lauderdale, Florida, USA, May 2006.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.