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Editors Selection IGR 7-2

Disc Evaluation: Disc photography

Comment by Douglas Anderson on:

22581 Agreement among glaucoma specialists in assessing progressive disc changes from photographs in open-angle glaucoma patients, Jampel HD; Friedman D; Quigley H et al., American Journal of Ophthalmology, 2009; 147: 39-44

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This article by Jampel et al. (168) ends: "Until computerized imaging systems are shown to be superior to serial disc photographs, serial disc photographs are probably the best standard that we have, but we must be aware of their limitations.' The main conclusion expressed, however, is that inter-observer agreement is sufficiently poor that disc photo comparison is a dubious basis for diagnostic and management decisions. Of 155 eyes with stereoscopic photographs taken 5 to 50 (median 26) months apart, 89 (57%) were unchanged and 2 had changed by unanimous agreement of independent readings by three ophthalmologists.. That left 64 eyes (41%) that one or sometimes two thought the disc had changed. The three found different proportions of change: 7%, 11%, and 28%. With adjudication, only 8 eyes seemed certain to have changed in addition to the 2 with initial unanimous agreement. Of these, the change was worsening in 6 eyes and improvement in 4 eyes (only one convincingly genuine with a substantial surgical lowering of intraocular pressure). HRT and visual field tests also showed deterioration or improvement in similar proportions, with as low agreement about who had changed as when three ophthalmologists independently examined serial photographs. Comparison was made to published findings of Coleman and associates and to the OHTS data, in which the most minute changes were sought because there was an untreated group. In this and previous studies, low rates of agreement may result from excessively diligent efforts to detect subtle changes. Apparent slight improvement or deterioration may result from photographic differences, such as pictures taken in different phases of venous pulsation or through different locations of the pupil. The lesson, perhaps, is that disc progression is uncertain unless the change is substantial.

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