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Accuracy of optical coherence tomography for diagnosing glaucoma: an overview of systematic reviews
  1. Manuele Michelessi1,
  2. Tianjing Li2,
  3. Alba Miele3,
  4. Augusto Azuara-Blanco4,
  5. Riaz Qureshi5,
  6. Gianni Virgili3
  1. 1 IRCCS—Fondazione Bietti, Rome, Italy
  2. 2 Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
  3. 3 Eye Clinic, Department of NEUROFARBA, University of Florence, Florence, Italy
  4. 4 Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, UK
  5. 5 Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
  1. Correspondence to Dr Manuele Michelessi, IRCCS—Fondazione Bietti, Rome 00198, Italy; manuele_michelessi{at}


Aims To assess the diagnostic accuracy (DTA) of optical coherence tomography (OCT) for detecting glaucoma by systematically searching and appraising systematic reviews (SRs) on this issue.

Methods We searched a database of SRs in eyes and vision maintained by the Cochrane Eyes and Vision United States on the DTA of OCT for detecting glaucoma. Two authors working independently screened the records, abstracted data and assessed the risk of bias using the Risk of Bias in Systematic Reviews checklist. We extracted quantitative DTA estimates as well as qualitative statements on their relevance to practice.

Results We included four SRs published between 2015 and 2018. These SRs included between 17 and 113 studies on OCT for glaucoma diagnosis. Two reviews were at low risk of bias and the other two had two to four domains at high or unclear risk of bias with concerns on applicability. The two reliable SRs reported the accuracy of average retinal nerve fibre layer (RNFL) thickness and found a sensitivity of 0.69 (0.63 to 0.73) and 0.78 (0.74 to 0.83) and a specificity of 0.94 (0.93 to 0.95) and 0.93 (0.92 to 0.95) in 57 and 50 studies, respectively. Only one review included a clear specification of the clinical pathway. Both reviews highlighted the limitations of primary DTA studies on this topic.

Conclusions The quality of published DTA reviews on OCT for diagnosing glaucoma was mixed. Two reliable SRs found moderate sensitivity at high specificity for average RNFL thickness in diagnosing manifest glaucoma. Our overview suggests that the methodological quality of both primary and secondary DTA research on glaucoma is in need of improvement.

  • glaucoma
  • imaging
  • diagnostic tests/investigation

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  • Contributors MM and GV: conceptualisation. MM, TL, AA-B, GV and RQ: design and planning. TL and RQ: methodology. MM, AM, QR and GV: data curation. MM: writing-original draft. All authors: writing-review editing. TL, AA-B and GV: supervision. All authors: final approval.

  • Funding The contribution of TL and RQ was supported by the National Eye Institute, National Institutes of Health (grants UG1EY020522).

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement Data are available upon reasonable request.

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