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Editors Selection IGR 9-3
Visual function: Sequence bias in photographs
Comment by Joseph Caprioli on:
11671 Knowledge of chronology of optic disc stereophotographs influences the determination of glaucomatous change, Altangerel U; Bayer A; Henderer JD et al., Ophthalmology, 2005; 112: 40-43
The interpretation of disc photographs performed qualitatively remains the mainstay of structural evaluation of the optic nerve in glaucoma. No study has shown quantitative measurements with any of the following techniques to be superior to the qualitative evaluation of photographs by an experienced examiner: these quantitative techniques include confocal laser ophthalmoscopy, nerve fiber layer polarimetry, and optical coherence tomography. This conclusion is particularly true of sequential, longitudinal evaluation.
Caution against 'sequence bias' should be exercised when judging longitudinal optic disc photographyThe current study by Altangerel et al. (Spaeth Group)(148) addresses the important question of 'sequence bias' in the evaluation of the optic disc longitudinally. This is probably most important with respect to reading disc photos in clinical trials, but is certainly pertinent to the routine care of glaucoma patients. The study reveals a (not unexpected) observer bias: agreement between readers is improved when the temporal sequence of the photographs is known. Reading the photographs in a random order reduces this agreement. This study suggests that in clinical trials, disc photos might be better read in a random, masked order. The implication for clinical practice is that caution against 'sequence bias' should be exercised by the examining clinician.
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