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

Abstract

Importance: Glaucoma is a significant cause of global blindness and there are, as yet, no effective means of screening.

Objective: To assess the potential role of frequency-doubling technology (FDT) perimetry in screening for glaucoma using data collected as part of the National Health and Nutrition Examination Survey (NHANES).

Design, setting, and participants: Reanalysis of cross-sectional data of 6797 participants in the 2005-2008 cycles of the NHANES, which evaluated a sample of the noninstitutionalized US population with at least light-perception vision. A subset of optic nerve photographs were regraded by 3 glaucoma specialists in December 2012. Each participant underwent visual field testing, including FDT perimetry screening, and had fundus photographs taken.

Main outcomes and measures: Sensitivity and specificity of FDT perimetry to detect glaucoma, macular disease, or decreased visual acuity.

Results: A total of 5746 NHANES participants had optic images originally graded. We regraded 1201 images of 1073 eyes of 548 participants with initial cup-disc ratio (CDR) of 0.6 or greater and 423 images of 360 eyes of 180 randomly selected participants with initial CDR less than 0.6. Diagnoses of glaucoma by disc photograph were 1.6% (3 of 180) in the CDR less than 0.6 group and 31.4% (172 of 548) in the CDR of 0.6 or greater group. The sensitivity of FDT was 33% (95% CI, 0%-87%) and specificity was 77% (95% CI, 71%-84%). For the group with at least 1 CDR of 0.6 or greater, sensitivity of FDT was 66% (95% CI, 59%-73%) and specificity was 70% (95% CI, 66%-75%). When analyzed to give FDT credit for identifying glaucoma, macular disease, or decreased visual acuity, the sensitivity of the test was 80% (95% CI, 77%-83%) and the specificity was 83% (95% CI, 82%-84%). Approximately 25% of the NHANES population was not able to successfully complete FDT testing, representing screening failures and decreasing specificity.

Conclusions and relevance: Using the 2005-2008 waves of the NHANES as a model of population-based screening for eye disease, FDT perimetry lacks both sensitivity and specificity as a means of screening for glaucoma, the presence of retinal disease, or decreased acuity in a population-based setting. Given that no single test of glaucoma has yet been shown to be appropriate in a screening setting, to our knowledge, investigators should consider novel methods of detecting glaucoma or combinations of tests that might work better in a screening setting.