Accuracy of optical coherence tomography for diagnosing glaucoma: an overview of systematic reviews

Manuele Michelessi*, Tianjing Li, Alba Miele, Augusto Azuara-Blanco, Riaz Qureshi, Gianni Virgili

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)


Aims: 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. Methods: 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. Results: 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. Conclusions: 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.

Original languageEnglish
Pages (from-to)490-495
Number of pages6
JournalBritish Journal of Ophthalmology
Issue number4
Early online date03 Jun 2020
Publication statusPublished - 01 Apr 2021

Bibliographical note

Funding Information:
Funding The contribution of TL and RQ was supported by the National Eye Institute, National Institutes of Health (grants UG1EY020522).

Funding Information:
Acknowledgements The contribution of the IRCCS Fondazione G.B. Bietti in this paper was supported by the Italian Ministry of Health and by Fondazione Roma. The supporting organisation had no role in the design or conduct of this research. The authors thank Joao Breda, Carlo Cutolo, Panayiota Founti, Gerhard Garhoefer, Andreas Katsanos, Miriam Kolko, Jimmy Le, Francesco Oddone, Marta Pazos, Luis Abegão Pinto, Verena Prokosch, Cedric Schweitze and Andrew Tatham, for their contribution in screening of the systematic reviews.

Publisher Copyright:
© 2021 BMJ Publishing Group. All rights reserved.

Copyright 2021 Elsevier B.V., All rights reserved.


  • diagnostic tests/investigation
  • glaucoma
  • imaging

ASJC Scopus subject areas

  • Ophthalmology
  • Sensory Systems
  • Cellular and Molecular Neuroscience


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