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Assessment of a race-specific normative HRT-III database to differentiate glaucomatous from normal eyes.
J Glaucoma. 2006 Dec; 15(6):548-51.JG

Abstract

PURPOSE

To determine if a new, normative, race-specific database enhances the ability of confocal scanning laser ophthalmoscopy to differentiate normal from glaucomatous eyes.

METHODS

One eye of eligible normal and glaucoma patients was enrolled. All subjects underwent a complete ophthalmologic examination, standard achromatic perimetry (SITA-SAP, 24-2), and confocal scanning laser ophthalmoscopy [Heidelberg retinal tomograph (HRT-II)] within 1 month of enrollment. Racial groups were defined by self-report. Glaucoma was defined by the existence of reproducible SAP loss (pattern standard deviation <5% and/or Glaucoma Hemifield Test outside normal limits) on 2 consecutive fields. Normal subjects had 2 normal visual fields (pattern standard deviation >5% and Glaucoma Hemifield Test within 97% normal limits) and a normal clinical examination. HRT-II examinations were exported to the HRT-III software, which includes a large race-specific normative database consisting of 733 white and 215 black eyes. Moorfields regression analysis (MRA) for the most abnormal optic disc sector was compared between the HRT-II (MRA2) and the HRT-III software before (MRA3-B) and after (MRA3-A) adjustment for race. Sectors outside the 99.9% confidence interval limits ("outside normal limits") were determined to be abnormal.

RESULTS

We enrolled 124 black (52 glaucoma, 72 normal) and 96 white (32 glaucoma, 64 normal) subjects. Mean age was 51+/-13 years and 50+/-16 years for blacks and whites, respectively (P = 0.45). Visual field mean deviation was -7.3+/-6.7 db for glaucomatous eyes and -0.4+/-1.1 db for normal eyes (P < 0.001). Sensitivity and specificity for the HRT-II was 71.9% and 95.3%, respectively, for white subjects and 50.0% and 98.6%, respectively, for black subjects. Using the expanded HRT-III database, analysis yielded a sensitivity of 81.3% and specificity of 93.8% for whites and a sensitivity of 71.2% and specificity of 86.1% for blacks. After an adjustment for black ethnicity was made in the HRT-III program, the sensitivity and specificity for blacks was 65.4% and 90.3%, respectively.

CONCLUSIONS

A new, larger, race-specific HRT-III database increases sensitivity while maintaining specificity for whites and increases sensitivity but decreases specificity for blacks. New software and databases based on race require careful scrutiny before use in clinical practice.

Authors+Show Affiliations

Department of Ophthalmology, New York University School of Medicine, Valhalla, NY, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17106370

Citation

Zelefsky, Joseph R., et al. "Assessment of a Race-specific Normative HRT-III Database to Differentiate Glaucomatous From Normal Eyes." Journal of Glaucoma, vol. 15, no. 6, 2006, pp. 548-51.
Zelefsky JR, Harizman N, Mora R, et al. Assessment of a race-specific normative HRT-III database to differentiate glaucomatous from normal eyes. J Glaucoma. 2006;15(6):548-51.
Zelefsky, J. R., Harizman, N., Mora, R., Ilitchev, E., Tello, C., Ritch, R., & Liebmann, J. M. (2006). Assessment of a race-specific normative HRT-III database to differentiate glaucomatous from normal eyes. Journal of Glaucoma, 15(6), 548-51.
Zelefsky JR, et al. Assessment of a Race-specific Normative HRT-III Database to Differentiate Glaucomatous From Normal Eyes. J Glaucoma. 2006;15(6):548-51. PubMed PMID: 17106370.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Assessment of a race-specific normative HRT-III database to differentiate glaucomatous from normal eyes. AU - Zelefsky,Joseph R, AU - Harizman,Noga, AU - Mora,Ricardo, AU - Ilitchev,Elena, AU - Tello,Celso, AU - Ritch,Robert, AU - Liebmann,Jeffrey M, PY - 2006/11/16/pubmed PY - 2006/12/13/medline PY - 2006/11/16/entrez SP - 548 EP - 51 JF - Journal of glaucoma JO - J Glaucoma VL - 15 IS - 6 N2 - PURPOSE: To determine if a new, normative, race-specific database enhances the ability of confocal scanning laser ophthalmoscopy to differentiate normal from glaucomatous eyes. METHODS: One eye of eligible normal and glaucoma patients was enrolled. All subjects underwent a complete ophthalmologic examination, standard achromatic perimetry (SITA-SAP, 24-2), and confocal scanning laser ophthalmoscopy [Heidelberg retinal tomograph (HRT-II)] within 1 month of enrollment. Racial groups were defined by self-report. Glaucoma was defined by the existence of reproducible SAP loss (pattern standard deviation <5% and/or Glaucoma Hemifield Test outside normal limits) on 2 consecutive fields. Normal subjects had 2 normal visual fields (pattern standard deviation >5% and Glaucoma Hemifield Test within 97% normal limits) and a normal clinical examination. HRT-II examinations were exported to the HRT-III software, which includes a large race-specific normative database consisting of 733 white and 215 black eyes. Moorfields regression analysis (MRA) for the most abnormal optic disc sector was compared between the HRT-II (MRA2) and the HRT-III software before (MRA3-B) and after (MRA3-A) adjustment for race. Sectors outside the 99.9% confidence interval limits ("outside normal limits") were determined to be abnormal. RESULTS: We enrolled 124 black (52 glaucoma, 72 normal) and 96 white (32 glaucoma, 64 normal) subjects. Mean age was 51+/-13 years and 50+/-16 years for blacks and whites, respectively (P = 0.45). Visual field mean deviation was -7.3+/-6.7 db for glaucomatous eyes and -0.4+/-1.1 db for normal eyes (P < 0.001). Sensitivity and specificity for the HRT-II was 71.9% and 95.3%, respectively, for white subjects and 50.0% and 98.6%, respectively, for black subjects. Using the expanded HRT-III database, analysis yielded a sensitivity of 81.3% and specificity of 93.8% for whites and a sensitivity of 71.2% and specificity of 86.1% for blacks. After an adjustment for black ethnicity was made in the HRT-III program, the sensitivity and specificity for blacks was 65.4% and 90.3%, respectively. CONCLUSIONS: A new, larger, race-specific HRT-III database increases sensitivity while maintaining specificity for whites and increases sensitivity but decreases specificity for blacks. New software and databases based on race require careful scrutiny before use in clinical practice. SN - 1057-0829 UR - https://www.unboundmedicine.com/medline/citation/17106370/Assessment_of_a_race_specific_normative_HRT_III_database_to_differentiate_glaucomatous_from_normal_eyes_ L2 - https://doi.org/10.1097/01.ijg.0000212289.00917.a8 DB - PRIME DP - Unbound Medicine ER -