ARVO 2009 Annual Meeting, Fort Lauderdale, FL

Program#/Poster#: 4080/A336

The St Kitts Eye Study: Design and Initial Findings

P H Artes, M T Nicolela, Y Agoumi, G Sharpe, B C Chauhan, and the St. Kitts Eye Study (SKES) Group
Purpose Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Canada
The St Kitts Eye Study (SKES) group aims to design an eye
screening program in the Caribbean. We report on initial findings Fig 2)
from the first phase of the study which investigated tests for ROC curves show the diagnostic performance
(sensitivity, vertical axis; false-positive rate, horizontal
glaucoma screening.
Methods
axis) with different diagnostic criteria (numbers on
the multicoloured curve). Points close to the top left
215 residents of St Kitts (116 women, 99 men, mean age 57 y, corner indicate good separation between participants
with and without glaucoma, points on the diagonal
range 50 – 87 y) underwent an extensive protocol of screening line indicate chance performance. The area under
and validation tests (mean, 3.5 hours). Screening tests included the curve (AUROC) gives an overall measure of
diagnostic accuracy.
suprathreshold perimetry with the HFA 76-point 3-zone test, Matrix For one selected criterion, we give the 95% confidence
FDT2 24-2-1% test, and Moorfields Motion Displacement Test intervals for the specificity (thick grey line).
(MDT) performed on one eye. HRT was performed on both eyes. Distributions of test outcomes in non-glaucomatous
participants are shown by histograms (inset). The
Independent of the screening tests, each participant underwent a heavy black line on the x-axis indicates the range
full clinical examination of both eyes including threshold perimetry within which 95% of test results fell.

(SITA Std 24-2), dilated stereo fundus photography (Nidek AFC-
230/210), gonioscopy, Goldmann applanation tonometry, and
dilated slit-lamp biomicroscopy of anterior and posterior segments.
Fig 1) IOP in participants with (black) and without glaucoma
(red), and ROC curve of different IOP cut-off values (inset).
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.

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.
Results

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

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).
Conclusions
The suprathreshold MDT promises to be an efficient and easy-
Fig 2b) The 76-point 3-zone age-related suprathreshold strategy Fig 2c) The data of the Matrix perimeter shows a long tail of Fig 2d) The MDT performed best. With 3 missed points, it had
to-use screening test. However, in isolation none of the tests performs similar to the Glaucoma Hemifield Test with SITA Standard poor results (inset histogram); several non-glaucoma participants significantly higher specificity than the Glaucoma Hemifield Test
(open and filled stars, part of the validating clinical examination). appeared to have losses at more than 20 points (heavy black line). (grey bar shows 95% confidence interval on false-positive rate).
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. 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
Acknowledgements Bank, the QEII Eye Care Centre, and by Allergan, Pfizer, and Merck. Heidelberg Engineering, Innova, Carl Zeiss and Keeler loaned or donated instruments.