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Editors Selection IGR 8-1

Screening Tests

Comment by Thierry Zeyen on:

22330 Screening tests for detecting open-angle glaucoma: Systematic review and meta-analysis, Mowatt G; Burr JM; Cook JA et al., Investigative Ophthalmology and Visual Science, 2008; 49: 5373-5385

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Open-angle glaucoma (OAG) is the most common cause of irreversible blindness. The challenge of screening for OAG is to find people with the disease at a stage where the diagnosis is not in doubt and at risk of becoming blind if left untreated. Ideally, a screening test should be easy to administer and to interpret, portable, quick and acceptable to the patient and sufficiently valid to distinguish between those who do and do not have OAG. This paper by Mowatt et al. (1311).) is the first systematic review of screening and diagnostic tests in OAG. The review was based on a highly sensitive electronic search and strict inclusion and exclusion criteria, including 40 studies enrolling more than 48.000 people. FDT (C-20-1), HRT II and oculokinetic perimetry were identified as having the best diagnostic performance. Ophthalmoscopy, standard automated perimetry, retinal photography and Goldmann applanation tonometry had relatively poor performance as single tests.No reports on GDx VCC, OCT or SWAP were identified that met the inclusion criteria (reviewing reports up to 2005). The findings are based on heterogenic data of limited quality (only eight studies met the specified criteria for higher quality studies) and should therefore be interpreted with caution. The authors rightfully point out two other potential sources of bias. First, some studies (e.g., recruiting their participants through media advertising) had a significantly higher prevalence of OAG than expected in a screening population, and will therefore report an improved sensitivity and specificity. Second, 20 of the 40 studies included were hospital-based, which by nature is an enriched population likely to include a disproportionate number of participants with high IOP and previous experience in taking tests, potentially leading to overly optimistic performance estimates. Given these limitations, no test or group of tests was clearly superior for glaucoma screening in this review.

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