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Editors Selection IGR 16-4

Glaucoma Screening: Frequency-Doubling Perimetry for Glaucoma Screening

Comment by Chris Johnson on:

66389 Evaluation of Frequency-Doubling Technology Perimetry as a Means of Screening for Glaucoma and Other Eye Diseases Using the National Health and Nutrition Examination Survey, Boland MV; Gupta P; Ko F et al., JAMA ophthalmology, 2016; 134: 57-62

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In this publication, the authors evaluated results from 5,746 participants in the National Health and Nutrition Examination Study (NHANES) who had optic disc photographs taken and had performed the N30-5 visual field screening test for frequency doubling technology (FDT) perimetry. The purpose of this assessment was to determine the potential for optic disc photography or FDT perimetry to be used as a population screening test for glaucoma and other ocular and neurologic diseases. Both of these methods have been used previously as diagnostic procedures for ocular and neurologic diseases and for population based screening studies. The optic disc photographs were evaluated by several glaucoma specialists. The authors found that neither procedure had the sensitivity or specificity that was sufficient to justify its use as a rapid and efficient population based screening procedure. Using a best case (benefit of the doubt) approach for FDT, the authors reported a sensitivity of 80% and a specificity of 83%. Somewhat poorer findings were achieved for optic disc photograph determinations. The authors nicely distinguish between screening (use of a single test) and case finding (more than a single test or a combination of several different tests). Additionally, the authors also indicate that a single diagnostic test procedure does not provide sufficient information to warrant its use as a population based screening procedure (combinations of test results and additional clinical information is needed), and that a meaningful proportion of the participants were not able to complete the FDT test procedure.

To be effective, more attention needs to be directed towards the process of vision screening per se, rather than applying clinically based procedures that may not be appropriate for large scale population screening

In addition to these findings, I believe that there are several other factors that are worthy of consideration: (1) Most screening procedures are based on test procedures that have been developed, refined and validated through careful clinical evaluation studies. There are large differences in clinic-based and population-based screening procedures. Development of population screening methods has not been conducted through evaluation of the general population. (2) Screening procedures are performed in a variety of settings that can have different lighting conditions, distractions and other complications that are less frequent in clinical settings. (3) Interpretation of screening procedures by highly-trained specialists is not cost-effective and difficult to maintain. Immediate automatic electronic evaluation of test results would be more beneficial. (5) Glaucoma and other ocular and neurologic diseases are complex and require the accumulation, interpretation and consolidation of many different diagnostic and clinical assessment procedures. To be effective, more attention needs to be directed towards the process of vision screening per se, rather than applying clinically based procedures that may not be appropriate for large scale population screening. Given the large amount of undetected glaucoma and other diseases affecting the visual pathways throughout the world, vision scientists and clinicians should be encouraged to pursue these issues.

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