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Diagnostic performance of modern imaging instruments in glaucoma screening
  1. Elina Karvonen1,2,
  2. Katri Stoor1,2,
  3. Marja Luodonpää1,2,
  4. Pasi Hägg1,2,
  5. Timo Lintonen1,2,
  6. Johanna Liinamaa1,2,
  7. Anja Tuulonen3,
  8. Ville Saarela1,2
  1. 1 Department of Ophthalmology, Oulu University Hospital, Oulu, Finland
  2. 2 PEDEGO Research Unit and Medical Reserch Center, Oulu University Faculty of Medicine, Oulu, Finland
  3. 3 Tays Eye Centre, Tampere University Hospital, Tampere, Finland
  1. Correspondence to Dr Elina Karvonen, Department of Ophthalmology, Oulu University Hospital,Oulu, Finland;elina.karvonen{at}


Aim To evaluate the applicability of imaging devices (spectral-domain optical coherence tomography (Cirrus SD-OCT), scanning laser polarimetry (GDx) and scanning laser ophthalmoscopy (Heidelberg Retinal Tomograph, HRT3)) for glaucoma screening in a middle-aged unselected population.

Methods Participants of the population-based Northern Finland Birth Cohort Eye Study, aged 45 to 49 years, underwent a comprehensive eye examination including modern imaging with five methods (retinal nerve fibre layer (RNFL) and macular ganglion cell layer +inner plexiform layer (GCIPL) analysis and their combination with SD-OCT, GDx and HRT). The performance of the automated classification of the imaging devices was assessed using a clinical glaucoma diagnosis as reference, that is, the ‘2 out of 3’ rule based on the evaluation of optic nerve head and RNFL photographs and visual fields.

Results We examined 6060 eyes of 3039 subjects; in the clinical evaluation, glaucomatous damage was found in 33 subjects (1.1%) in 43 eyes. The following sensitivities were obtained; RNFL analysis (53%), GCIPL analysis (50%), OCT combination analysis (61%), GDx (56%) and HRT (31%) with corresponding specificities of 95%, 92%, 90%, 88% and 96%. The area under the curve values were 0.76, 0.73, 0.75, 0.75 and 0.73, respectively. Post-test probabilities of glaucoma after positive imaging finding with each of these methods in this unselected population were 11%, 7%, 6%, 5% and 7%, respectively.

Conclusion Screening capabilities of the OCT, GDx and HRT were rather similar. The accuracy of all evaluated parameters was only moderate and thus screening with these parameters alone is not reliable.

  • glaucoma
  • screening
  • imaging
  • optical coherence tomography (OCT)
  • scanning laser polarimetry (GDx)
  • scanning laser ophthalmoscopy (HRT)

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  • Contributors EK was the responsive author. EK, KS, ML, PH and AT were involved in the diagnostic protocol. TL assisted in data management and analyses. JL and VS supervise the NFBC Eye Study. AT and VS designed the study and contributed to editing the manuscript.

  • Funding NFBC 1966 received financial support from the University of Oulu Grant no.24000692, Oulu University Hospital Grant no.24301140, ERDF European Regional Development Fund Grant no.539/2010 A31592 and the Competitive State Research Financing of the Expert Responsibility Area of Tampere University Hospital. NFBC Eye Study was supported by Glaukooma Tukisäätiö Lux Foundation and Silmäsäätiö Foundation.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Ethical Committee of Northern Ostrobothnian Hospital District.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.