Glaucoma Probability Score vs Moorfields Classification in Normal, Ocular Hypertensive, and Glaucomatous Eyes JAVIER MORENO-MONTAÑÉS, ALFONSO ANTÓN, NOELIA GARCÍA, LORETO MENDILUCE, ELEONORA AYALA, AND ANGELES SEBASTIÁN ● PURPOSE: To evaluate the Heidelberg Retina Tomograph III (HRT III) glaucoma probability score in differenti- ating normal from pathologic eyes and to compare the glaucoma probability score with Moorfields regression analysis (MRA). ● DESIGN: Prospective cross-sectional study. ● METHODS: Fifty-nine normal, 40 hypertensive, and 83 glaucomatous eyes were examined with Swedish interac- tive threshold algorithm standard 24-2 visual fields and HRT III. Sensitivity and specificity were evaluated using global and sectorial glaucoma probability score and MRA compared with damage in visual fields. Areas under receiver operating characteristic (ROC) curves were evaluated. Agreement between MRA and glaucoma prob- ability score was calculated using the  coefficient. Glaucoma probability score was considered to be displaced when a symbol was outside and the opposite symbol was inside the optic disk. ● RESULTS: MRA sensitivity and specificity were 39.8% and 93.2% (most specific criteria) and 68.7% and 83.1% (least specific criteria), respectively. Glaucoma probabil- ity score sensitivity and specificity were 71.1% and 69.5% (most specific criteria) and 85.5% and 54.2% (least specific criteria), respectively. Visual field param- eters were related to the global (P  .001) and sectorial (P < .05) glaucoma probability score. A displaced glau- coma probability score was found in 35 eyes, but with unchanged glaucoma probability score sensitivity and specificity. Areas under the ROC curves of glaucoma probability score was 0.77. The  coefficient was 0.34. ● CONCLUSIONS: Glaucoma probability score analysis tends to be more sensitive but less specific than MRA. Glaucoma probability score did not differentiate normal and hypertensives eyes. When displaced, glaucoma prob- ability score sensitivity and specificity were unchanged. MRA and glaucoma probability score agreement was low. Glaucoma probability score is advantageous over MRA in early-stage glaucoma. (Am J Ophthalmol 2008;145: 360 –368. © 2008 by Elsevier Inc. All rights reserved.) Glaucoma is an important cause of blindness worldwide. 1 The evaluation of morphologic parameters of the optic nerve as changes in the optic disk is crucial for early detection of glaucoma and often precedes visual field loss. 2–5 Some com- ponents of the optic disk (the cup, neuroretinal rim, or the size of the disk) are major determinants of glaucomatous damage. 6–8 The Heidelberg Retinal Tomograph (HRT; Heidelberg Engineering GmBH, Dossenheim, Germany) is a confocal scanning laser ophthalmoscope that acquires 3-dimen- sional topographic images of the optic disk and surround- ing retina. The HRT was developed to provide objective and reproducible analysis of optic disk morphologic param- eters, 9,10 allowing optic disk analysis and its topographic measurements to detect structural damage up to eight years earlier than expert assessment of stereo disk photography or visual field loss. 11 One algorithm of the HRT is the Moorfields regression analysis (MRA), which was devel- oped to improve the diagnostic ability of HRT by consid- ering the differences in the area of the optic disk in the quantitative evaluation of the rim area. 7,12 The advantage of the MRA is that it uses global and sectorial rim sector area estimates adjusted for optic disk size and age to improve specificity. The MRA technique discriminates between glaucomatous and normal eyes with high sensi- tivity and specificity. 7,12 However, the MRA diagnostic analysis depends on the position of a manually placed contour line to outline the area of the optic disk, and the contour lines drawn by different examiners vary consider- ably. 13 The new generation of the HRT, HRT III (software V.3.0.), provides the well-known MRA algorithm and a new one that does not rely on a manually drawn contour line. This algorithm, the glaucoma probability score (GPS), based on the technique of Swindale and associates, uses two measurements of the peripapillary retinal nerve fiber layer (RNFL) shape (horizontal and vertical RNFL curvature) and three measurements of the optic nerve head shape (cup size, cup depth, and rim steepness) for input Accepted for publication Sep 11, 2007. From the Department of Ophthalmology, Clínica Universitaria, Uni- versidad de Navarra, Pamplona, Spain (J.M.-M., N.G., L.M.); the Glaucoma Department, Institut Catalá de la Retina, Barcelona, Spain (A.A., E.A.); the Glaucoma Unit, Hospital de la Esperanza y el Mar (IMAS), Universidad Autónoma de Barcelona, Barcelona, Spain (A.A., E.A.); and Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain (A.S.). Inquiries to Javier Moreno-Montañés, Department of Ophthalmology, Clínica Universitaria, Universidad de Navarra, Apartado 4209, 31080 Pamplona, Spain; e-mail: jmoreno@unav.es © 2008 BY ELSEVIER INC.ALL RIGHTS RESERVED. 360 0002-9394/08/$34.00 doi:10.1016/j.ajo.2007.09.006