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Aspects of technology-based case-finding for eye disease

Fidalgo, B. M. R. (2020). Aspects of technology-based case-finding for eye disease. (Unpublished Doctoral thesis, City, University of London)


The aim of this thesis by prospective publication was to evaluate the comparative accuracy of screening technologies for the detection of COAG and other sight-threatening eye diseases.

It incorporates 4 peer-reviewed publications:

1). Methodology and reporting of diagnostic accuracy studies of automated perimetry in glaucoma: evaluation using a standardised approach (Ophthalmic Physiol Opt. 2015; 35(3):315-23). This publication reported on an evaluation of the methodological and reporting quality of diagnostic accuracy studies of perimetry in glaucoma and determined whether there had been any improvement since the publication of the Standards for Reporting of Diagnostic. Accuracy (STARD) guidelines in 2003. The main findings were that methodological and reporting quality was sub-optimal and appeared not to have improved substantially following the development of the STARD guidance.

2). Development and validation of a new glaucoma screening test using temporally modulated flicker (Ophthalmic Physiol Opt. 2018; 38(6):617-628). This publication described the psychometric characteristics and diagnostic accuracy of the Accelerator 4-Alternative Forced-Choice Flicker Test prototype (A4FTp) for detecting Chronic open angle glaucoma (COAG). The performance of the A4FTp was also compared with standard screening tests of ocular structure and function (Frequency Doubling Technology (FDT) perimetry and iVue Spectral Domain Optical Coherence Tomography (SD-OCT). The time taken to complete the A4FTp was relatively short and initial results are promising. The diagnostic accuracy for the A4FTp was comparable to those of the FDT and SD-OCT for detecting COAG and we concluded that with further refinement the A4FTp could have role in glaucoma detection in the future.

3). Diagnostic accuracy of technologies for glaucoma case finding in a community setting (Ophthalmology. 2015;122(12):2407-15). This publication described a cross sectional, observational, community-based study to evaluate the diagnostic performance of the FDT, Moorfields Motion Displacement Test (MMDT), iVue SD-OCT and ocular response analyzer (ORA) used alone or in combination, for the detection of COAG. Diagnostic performance of individual tests gave acceptable accuracy for COAG detection. The best performing parameter was inferior RNFL thickness recorded using the SD-OCT. Although the low specificity of visual-function tests precluded their use in isolation, an acceptable performance was achieved by combining RNFL thickness analysis with visual function tests

4). Role of advanced technology in the detection of sight-threatening eye disease in a UK community setting (BMJ Open Ophthalmology 2019; 4:e000347). This publication extended the analysis described above to determine the performance of same screening tests for detecting sight-threatening eye disease in a cohort of elderly subjects recruited from primary care. The main finding was that a subset of screening tests (FDT, SD-OCT, together with a recorded visual acuity <6/12) was the most effective in detecting significant eye disease in this elderly population. The study provided useful preliminary data to inform the development of further larger, multi-center screening studies to validate this screening panel.

The work described in this thesis makes a useful contribution to the evidence base on the use of imaging and visual function technologies to identify COAG and other sight-threatening eye diseases in at-risk populations and provides clear directions for future research this area.

Publication Type: Thesis (Doctoral)
Subjects: R Medicine > RE Ophthalmology
Departments: Doctoral Theses
School of Health & Psychological Sciences > School of Health & Psychological Sciences Doctoral Theses
School of Health & Psychological Sciences > Optometry & Visual Sciences
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