D721

Performance of the ethnicity-specific Moorfields Regression Analysis

and Quantile Regression Analysis in the Saint Kitts Eye Study (SKES)
Kenneth F Roberts, Sadhana V Kulkarni, Paul H Artes Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Canada
1.0 50
ROC area:

Moorfields Regression Analysis - Caucasian

 
Purpose
  4
0.80 [0.67, 0.93]

overall
40
 


0.8 1 3
To determine if ethnicity-specific normative data improve the diagnostic performance  

nasal-inferior
21


2 30
of the Moorfields Regression Analysis (MRA) in an Afro-Caribbean population, and to

temporal-inferior
nasal-superior

global
4 3
0.6 


temporal-superior
sensitivity

nasal
65
compare the results to those obtained with Quantile Regression. 1 7 20 13 18

temporal
8
9
0.4 10
13 11 15
 
10 11
11

Methods
9 9
8 3
0.2 1 3
4
3  
12 0
v
156 residents of St. Kitts (17 with glaucoma) were examined with the Heidelberg Retina 13

4

Tomograph (HRT3) as part of the St Kitts Eye Study. The data were analysed with
2 0.0
1,2 1,2
0.0 0.2 0.4 0.6 0.8 1.0
Caucasian (MRA-c) and African (MRA-a) normative limits available in the commercial false-positive rate
 

software, and with limits derived using quantile regression in a Caucasian dataset (QRA). 1
1.0 50
             
ROC area:  
0.75 [0.61, 0.89]

Moorfields Regression Analysis - African

Fig 2) Ordinal scores ranging from 0 to 14 for MRA-c, MRA-a, and QRA. In each of the 6 sectors and the global disc, “borderline” and “outside
Results
40
0.8 normal limits” were scored as 1 and 2, respectively, and added. The diameter of the circles is proportional to the disc area. a) the African MRA

overall
gives more conservative (less sensitive, more specific) results than the Caucasian MRA. b) Quantile regression is often more conservative than
With specificity fixed at 90%, the sensitivities of the MRA-c (53%) and the MRA-a (52%) 1 30

nasal-inferior
19
the Caucasian MRA, but particularly so with large discs (see the extreme examples).
2

temporal-inferior
0.6

nasal-superior

global
were similar (p>0.1). There was close agreement between the diagnostic classifications

sensitivity
543

temporal-superior

nasal
6 20
Photo Rim/Cup MRA-Cauc MRA-African Quantile Reg
13

of MRA-c and MRA-a (kappa = 0.90), but the MRA-a was more conservative (more
16

0.4

temporal
12 7
8 11
10
1
12

specific but less sensitive) than the MRA-c (Wilcoxon, p<0.001, Fig 2). 11
8
8
7

aa aa aa
5

0.2
1

With both MRA-c and MRA-a, the odds of a “borderline” or “outside normal limits”
3 3
0
2
12
v
aaa aa a aa a
classification increased with optic disc size (14% and 13%, respectively, for each 0.1 0.0
13
aa aa aa
mm increase in disc area, p<0.001).
2
0.0 0.2 0.4 0.6 0.8 1.0

When the limits of QRA were applied, the overall diagnostic performance remained false-positive rate 1.22 mm2

similar (sensitivity at 90% specificity, 56%, ROC area=0.77, Fig 1c). However, QRA 1.0
ROC area:
0.77 [0.64, 0.91]
50
2 aa aa aa
removed the large false-positive rate with large discs, rendering specificity independent 0.8
40
aa a aa a aa a

overall
Quantile Regression Analysis
of optic disc size (p = 0.81). 1
30 21
aa aa aa
0.6 2

nasal-superior
temporal-superior
sensitivity
4 3

nasal-inferior
1.24 mm2
Conclusions

temporal-inferior
5 20

nasal

global
3
6
0.4 15

ARVO 2010 Annual Meeting Fort Lauderdale, Program Number 2732

9

temporal
The MRA with African reference data was slightly more conservative than the
8 10
! !
9
11 7
11

10 6 r r a a
Caucasian MRA, but its overall performance was not distinctly better. Both versions of
6
5 1 5
4
0.2
1
2
0
! a
11
v r r a r r a r
the MRA exhibited a similar disc-size related bias towards lesser specificity with larger
12
13

discs. Normative limits derived from a Caucasian population with quantile regression
0.0
r r r ! ! a
0.0 0.2 0.4 0.6 0.8 1.0 3.72 mm2
performed equally well but removed the disc-size-related bias, providing similar false-positive rate
4
Caucasian
Caucasian Caucasian Caucasian

specificity throughout the range of disc sizes. ! r ! r a a

Fig 1)
Receiver operating curves (ROC) for the Moorfields Regression Analyses (a, Caucasian;
b, African) and Quantile Regression (c). These curves show the trade-off between sen-
r r r r a a ! ! !
1) Artes PH & Crabb DP. Estimating Normative Limits of Heidelberg Retina Tomograph Optic Disc Rim Area with Quantile Regression. IOVS 2010;51:355-361. sitivity and false-positive rates (1-specificity) for all possible decision criteria (numbers
2) Artes et al, Invest. Ophthalmol. Vis. Sci. 2009 50: E-Abstract 4080. http://www.scribd.com/doc/14946158/ArtesARVO09-StKitts on the curves). In b and c, the MRA-Caucasian curve is shown in grey for comparison.
Insets give the false-positive rates for each of the 6 sectors and the global classification,
r r a ! ! !
4.43 mm2
as well as the overall false-positive rates with “outside normal limits” (red) and “bor-
derline” (yellow) criteria. Fig 3) Examples of extreme disc Caucasian
sizes. Caucasian
Examples 1 and 2 are very small discs with good agreement
Caucasian
AfricanAfrican
Caucasian between the three analyses. Examples 3
African
African
and 4 are large healthy discs in which MRA-c and MRA-a give a much worse classification than QRA (false-positives).