Purpose: To compare the abilities of confocal scanning laser
ophthalmoscopy (HRT), scanning laser polarimetry (GDx), optical coherence
tomography (OCT), short-wavelength automated perimetry (SWAP) and frequency
doubling technology perimetry (FDT) to detect glaucoma classified in two ways,
(1) based on optic disc appearance and, (2) based on standard automated
perimetry (SAP). Methods: One eye
from 94 subjects was examined. Glaucoma by disc appearance (n=51) was based on stereophotograph
evaluation. Glaucoma by SAP result (n=42) required a repeatable abnormal
result. Healthy eyes (n=38) had both normal appearing optic discs and SAP
results. Areas under the ROC curve, sensitivity, and specificity values were
calculated for each diagnosis. Results: Several summary measures from each
instrument had similar areas under the ROC curve. The largest ROC curve area was found for OCT inferior
quadrant thickness (0.91 and 0.89, for diagnosis based on SAP and diagnosis
based on disc appearance, respectively), followed by FDT number of total
deviation plot points < 5% (0.88 and 0.87), HRT RNFL thickness
temporal/inferior region (0.85 and 0.82), SWAP number of points < 1% (0.83
and 0.81), and GDx discriminant function (0.80 and 0.82). ROC curve areas were
not significantly different among the best parameter from each instrument for
diagnosis based on disc appearance. For diagnosis based on SAP, ROC curve area
was significantly larger for the best parameter from OCT than GDx. Agreement
for classifying
eyes as glaucomatous was limited.
Conclusion: Limited diagnostic agreement among instruments suggests that
combining techniques may improve diagnostic precision.