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Comment & Response
August 2016

Use of Multiple Tests Improves Screening for Glaucoma—Reply

Author Affiliations
  • 1Division of Health Sciences Informatics, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 2Web Editor, JAMA Ophthalmology
  • 3Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 4Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
JAMA Ophthalmol. 2016;134(8):948. doi:10.1001/jamaophthalmol.2016.1552

In Reply We thank Dr Taylor for taking the time to comment on our evaluation of FDT perimetry as the sole means of screening for glaucoma using the National Health and Nutrition Examination Survey population.

We do not have a single, repeatable, easily interpreted test for the presence of glaucoma. To determine whether instruments measuring optic nerve function are effective in diagnosing glaucoma, most studies have relied on a measure of optic nerve structure to serve as the gold standard for diagnosis, and vice versa. We designed our evaluation to be as rigorous as possible given the available data. We did not only rely on the cup-disc ratio determined by the fundus photograph reading center to diagnose glaucoma but instead had 3 glaucoma experts reach consensus based on the overall appearance of the nerve. While some additional data relevant to glaucoma were collected by the National Health and Nutrition Examination Survey, we were limited by the design of the ophthalmic and vision assessment that was performed during those particular phases of the study.

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