IRCCS-Fondazione Bietti, Rome, Italy
Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Br J Ophthalmol. 2021 Apr;105(4):490-495. doi: 10.1136/bjophthalmol-2020-316152. Epub 2020 Jun 3.
To assess the diagnostic accuracy (DTA) of optical coherence tomography (OCT) for detecting glaucoma by systematically searching and appraising systematic reviews (SRs) on this issue.
We searched a database of SRs in eyes and vision maintained by the Cochrane Eyes and Vision United States on the DTA of OCT for detecting glaucoma. Two authors working independently screened the records, abstracted data and assessed the risk of bias using the Risk of Bias in Systematic Reviews checklist. We extracted quantitative DTA estimates as well as qualitative statements on their relevance to practice.
We included four SRs published between 2015 and 2018. These SRs included between 17 and 113 studies on OCT for glaucoma diagnosis. Two reviews were at low risk of bias and the other two had two to four domains at high or unclear risk of bias with concerns on applicability. The two reliable SRs reported the accuracy of average retinal nerve fibre layer (RNFL) thickness and found a sensitivity of 0.69 (0.63 to 0.73) and 0.78 (0.74 to 0.83) and a specificity of 0.94 (0.93 to 0.95) and 0.93 (0.92 to 0.95) in 57 and 50 studies, respectively. Only one review included a clear specification of the clinical pathway. Both reviews highlighted the limitations of primary DTA studies on this topic.
The quality of published DTA reviews on OCT for diagnosing glaucoma was mixed. Two reliable SRs found moderate sensitivity at high specificity for average RNFL thickness in diagnosing manifest glaucoma. Our overview suggests that the methodological quality of both primary and secondary DTA research on glaucoma is in need of improvement.
通过系统检索和评价有关光学相干断层扫描（OCT）检测青光眼的诊断准确性（DTA）的系统评价（SR），评估 OCT 检测青光眼的诊断准确性。
我们在由 Cochrane Eyes and Vision United States 维护的眼部和视力数据库中检索了关于 OCT 检测青光眼的 DTA 的 SR。两名作者独立筛选记录、提取数据，并使用系统评价偏倚风险清单评估偏倚风险。我们提取了定量 DTA 估计值以及关于其与实践相关性的定性陈述。
我们纳入了 2015 年至 2018 年发表的 4 篇 SR。这些 SR 纳入了 17 至 113 项关于 OCT 诊断青光眼的研究。其中 2 篇 SR 的偏倚风险较低，另外 2 篇 SR 有 2 至 4 个领域存在高或不明确的偏倚风险，适用性存在问题。这 2 篇可靠的 SR 报告了平均视网膜神经纤维层（RNFL）厚度的准确性，在 57 项和 50 项研究中分别发现了 0.69（0.63 至 0.73）和 0.78（0.74 至 0.83）的敏感性和 0.94（0.93 至 0.95）和 0.93（0.92 至 0.95）的特异性。只有一篇综述明确规定了临床路径。两篇综述都强调了关于这个主题的原始 DTA 研究的局限性。
已发表的关于 OCT 诊断青光眼的 DTA 综述的质量参差不齐。两篇可靠的 SR 发现，在诊断显性青光眼时，平均 RNFL 厚度的敏感性较高，特异性较高。我们的综述表明，原发性和继发性 DTA 研究在青光眼方面的方法学质量均有待提高。
