Sensitivity and specificity of tests to detect eye disease in an older population

doi:10.1016/S0161-6420(00)00649-7

Ophthalmology

Volume 108, Issue 5, May 2001, Pages 968-975

https://doi.org/10.1016/S0161-6420(00)00649-7 Get rights and content

Abstract

Objective

To compare the ability of tests of visual function to detect the presence of eye disease.

Design

Cross-sectional study.

Participants

Three thousand six hundred fifty-four of 4433 (82.4%) eligible residents of an area near Sydney aged 49 years and older had a detailed eye examination, including retinal and lens photography and subsequent grading of eye disease, tests of presenting and corrected visual acuity, contrast sensitivity, screening visual field and intraocular pressure.

Main outcome measures

Receiver operator characteristic (ROC) curves were created and area under the curve compared for each vision test. Sensitivity and specificity were calculated for each test.

Results

No single vision test predicted the presence of eye disease with any consistency. Best-corrected visual acuity or contrast sensitivity had the highest area under the ROC curve for most eye diseases examined but had poor sensitivity and specificity. For glaucoma and diabetic retinopathy there was no difference in area under the curve for any of the tests examined, and no test had a good balance of sensitivity and specificity. Screening tests (performed with presenting correction) did not perform as well as nonscreening tests (those carried out after refraction with best correction).

Conclusions

Current vision tests are not particularly good at detecting eye disease compared with the “gold standard” of a full eye examination performed by an ophthalmologist. Further work in this area should be carried out before vision screening programs can be recommended for implementation among older people.

Section snippets

Methods

The Blue Mountains Eye Study is a population-based survey of vision and common eye diseases in an urban population making up two post-code areas in the Blue Mountains area, west of Sydney, Australia. Details of the survey methods and procedures have been described elsewhere.1, 2, 3, 13 All noninstitutionalized residents aged 49 years or older were identified in a door-to-door census. Of 4433 eligible residents, 3654 (82.4%) attended the eye examination. A detailed eye examination was performed,

Results

Table 1 presents the sensitivity and specificity for each of the screening tests of visual function at appropriate thresholds. For all eye diseases combined, presenting reading acuity appeared to have the highest sensitivity, with values approaching 100%, when categorized at 20/40 or worse. For each individual eye disease, high specificities were found for all visual acuity variables at 20/60 or worse. In the case of glaucoma, raised IOP had high specificity but low sensitivity. There was no

Discussion

The eye is a complex organ, and disease affects different parts of the visual system. Tests of visual function detect abnormalities in specific parts of the visual system and therefore one test of visual function could not be expected to have good sensitivity or specificity for all eye diseases when compared with a complete eye examination by an ophthalmologist. However, visual acuity is often used as a screening test for visual dysfunction in general practice. We found that, in most cases, the

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^☆: This study was supported by the Australian National Health and Medical Research Council (NHMRC) and the Save Sight Institute, University of Sydney. RQ Ivers was supported by a NHMRC (Public Health) Research Scholarship.

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Sensitivity and specificity of tests to detect eye disease in an older population☆

Abstract

Objective

Design

Participants

Main outcome measures

Results

Conclusions

Section snippets

Methods

Results

Discussion

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Vision Res

Am J Ophthalmol

Visual impairment in nursing home residentsthe Blue Mountains Eye Study

Med J Aust

Visual impairment and falls in older adultsthe Blue Mountains Eye Study

J Am Geriatr Soc

Screening for ophthalmic disease in older subjects using visual acuity and contrast sensitivity

Ophthalmology