The St Kitts Eye Study: Design and Initial Findings

The St Kitts Eye Study (SKES) group aims to design an eye screening program in the Caribbean. We report on initial findings from the first phase of the study which investigated tests for glaucoma screening.

ARVO 2009 Annual Meeting, Fort Lauderdale, FL Program#/Poster#: 4080/A336

P H Artes, M T Nicolela, Y Agoumi, G Sharpe, B C Chauhan, and the St. Kitts Eye Study (SKES) Group
Purpose
Fig 2) ROC curves show the diagnostic performance (sensitivity, vertical axis; false-positive rate, horizontal axis) with different diagnostic criteria (numbers on the multicoloured curve). Points close to the top left corner indicate good separation between participants with and without glaucoma, points on the diagonal line indicate chance performance. The area under the curve (AUROC) gives an overall measure of diagnostic accuracy. For one selected criterion, we give the 95% confidence intervals for the specificity (thick grey line). Distributions of test outcomes in non-glaucomatous participants are shown by histograms (inset). The heavy black line on the x-axis indicates the range within which 95% of test results fell. For comparison only, the sensitivity and specificity of the Glaucoma Hemifield Test (part of the clinical examination) are shown by star symbols for the 3 visual field screening tests (panels b,c,d below).
Fig 2a) Diagnostic performance of the HRT with the Moorfields Regression Analysis (MRA). False-positive classifications were often observed in large but healthy optic discs.

Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Canada

215 residents of St Kitts (116 women, 99 men, mean age 57 y, range 50 – 87 y) underwent an extensive protocol of screening and validation tests (mean, 3.5 hours). Screening tests included suprathreshold perimetry with the HFA 76-point 3-zone test, Matrix FDT2 24-2-1% test, and Moorfields Motion Displacement Test (MDT) performed on one eye. HRT was performed on both eyes. Independent of the screening tests, each participant underwent a full clinical examination of both eyes including threshold perimetry (SITA Std 24-2), dilated stereo fundus photography (Nidek AFC230/210), gonioscopy, Goldmann applanation tonometry, and dilated slit-lamp biomicroscopy of anterior and posterior segments. Diagnoses of glaucoma were based on the clinical examination, in the presence of definite glaucomatous visual field and optic disc abnormality. Clinicians were masked to the results of the screening tests. Nearly all participants (n=208, 97%) completed the program. There were 22 (10%) participants with glaucoma (mean MD, -7.4 dB, range -25.1 to -4.3 dB). For the evaluation of the screening tests, data from 12 (6%) participants were excluded because of other pathology (eg dense cataract). Diagnostic performances (area under the ROC curve, AUROC) ranged from 0.68 (IOP) to 0.86 (MDT) (Fig. 2a-d). The suprathreshold MDT promises to be an efficient and easyto-use screening test. However, in isolation none of the tests provided the high specificity and sensitivity needed for a large scale screening program. The data will now be analysed to derive the most efficient combination of tests.

Methods

Fig 1) IOP in participants with (black) and without glaucoma (red), and ROC curve of different IOP cut-off values (inset).

Conclusions
Fig 2b) The 76-point 3-zone age-related suprathreshold strategy Fig 2c) The data of the Matrix perimeter shows a long tail of performs similar to the Glaucoma Hemifield Test with SITA Standard poor results (inset histogram); several non-glaucoma participants (open and filled stars, part of the validating clinical examination). appeared to have losses at more than 20 points (heavy black line). Fig 2d) The MDT performed best. With 3 missed points, it had significantly higher specificity than the Glaucoma Hemifield Test (grey bar shows 95% confidence interval on false-positive rate).

Acknowledgements

The team (P Artes, Y Agoumi, C Beattie, B & T Byron, B Chauhan, A Crouse, S Durling, M Nicolela & G Sharpe) thank E Newton and C Griffin (Ministry of Health, St. Kitts & Nevis) and Drs V Audain and R P LeBlanc (Halifax) for help and support. The study was supported by the St. Kitts-Nevis-Anguilla National Bank, the QEII Eye Care Centre, and by Allergan, Pfizer, and Merck. Heidelberg Engineering, Innova, Carl Zeiss and Keeler loaned or donated instruments.

Design: P Artes & H Hultsch (Leipzig) version 04 May 2009

Results

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