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. 2016 Aug 1;11(8):e0158824.
doi: 10.1371/journal.pone.0158824. eCollection 2016.

The Evonik-Mainz Eye Care-Study (EMECS): Development of an Expert System for Glaucoma Risk Detection in a Working Population

Jochen Wahl  1   2 , Lorenz Barleon  2   3 , Peter Morfeld  4   5 , Andrea Lichtmeß  6 , Sibylle Haas-Brähler  7 , Norbert Pfeiffer  2
Affiliations

The Evonik-Mainz Eye Care-Study (EMECS): Development of an Expert System for Glaucoma Risk Detection in a Working Population

Jochen Wahl et al. PLoS One. .

Abstract

Purpose: To develop an expert system for glaucoma screening in a working population based on a human expert procedure using images of optic nerve head (ONH), visual field (frequency doubling technology, FDT) and intraocular pressure (IOP).

Methods: 4167 of 13037 (32%) employees between 40 and 65 years of Evonik Industries were screened. An experienced glaucoma expert (JW) assessed papilla parameters and evaluated all individual screening results. His classification into "no glaucoma", "possible glaucoma" and "probable glaucoma" was defined as "gold standard". A screening model was developed which was tested versus the gold-standard. This model took into account the assessment of the ONH. Values and relationships of CDR and IOP and the FDT were considered additionally and a glaucoma score was generated. The structure of the screening model was specified a priori whereas values of the parameters were chosen post-hoc to optimize sensitivity and specificity of the algorithm. Simple screening models based on IOP and / or FDT were investigated for comparison.

Results: 111 persons (2.66%) were classified as glaucoma suspects, thereof 13 (0.31%) as probable and 98 (2.35%) as possible glaucoma suspects by the expert. Re-evaluation by the screening model revealed a sensitivity of 83.8% and a specificity of 99.6% for all glaucoma suspects. The positive predictive value of the model was 80.2%, the negative predictive value 99.6%. Simple screening models showed insufficient diagnostic accuracy.

Conclusion: Adjustment of ONH and symmetry parameters with respect to excavation and IOP in an expert system produced sufficiently satisfying diagnostic accuracy. This screening model seems to be applicable in such a working population with relatively low age and low glaucoma prevalence. Different experts should validate the model in different populations.

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Conflict of interest statement

Competing Interests: Evonik Industries provided an unrestricted grant for this study. Evonik Industries provided some of the equipment, qualified personnel, transportation and accommodation. The interest of Evonik Industries was to supply preventive health care for their employees. Evonik Industries have no business activity in ophthalmology. PM and SH are employed by Evonik Industries. There are no patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Algorithm for the classification of single eyes into ‘no glaucoma suspect’, ‘possible’ and ‘probable’ glaucoma suspect.
Glaucoma suspect is defined in the text, for the glaucoma score definition see Table 1.
See this image and copyright information in PMC

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