Abstract
BackgroundDigital optic disc photographs are integral to remote telehealth ophthalmology, yet no quality control standards exist for the brightness setting of the images. This study evaluated the relationship between brightness setting and cup/disc ratio (c/d) grading among glaucoma specialists.MethodsOptic disc photographs obtained during routine examinations under anesthesia were collected to construct an image library. For each optic disc, photographs were obtained at 3 light intensity settings: dark, medium, and bright. From the image library, photograph triads (dark, medium and bright) of 50 eyes (50 patients) were used to construct the study set. Nine glaucoma specialists evaluated the c/d of the study set photographs in randomized order. The relationships between the brightness levels and the c/d grading as well as graders’ years in practice and variability were evaluated.ResultsThe c/d were graded as significantly larger in bright photographs when compared to photographs taken at the medium light intensity (0.53 vs 0.48, P < 0.001) as well as those taken at the dark setting (0.47, P < 0.001). In addition, no relationship was found between ophthalmologists’ years in practice and the variability of their c/d grading (P = 0.76).ConclusionImage brightness affects c/d grading of nonstereoscopic disc photographs. The brighter intensity is associated with larger c/d grading. Photograph brightness may be an important factor to consider when evaluating digital disc photographs.
Highlights
Digital optic disc photographs are integral to remote telehealth ophthalmology, yet no quality control standards exist for the brightness setting of the images
We evaluated the effect of light brightness setting on c/d grading of nonstereoscopic disc images among glaucoma specialists with varying levels of experience
Across all of the photographs evaluated by the 9 glaucoma specialists, the mean c/d was 0.50
Summary
Digital optic disc photographs are integral to remote telehealth ophthalmology, yet no quality control standards exist for the brightness setting of the images. This study evaluated the relationship between brightness setting and cup/disc ratio (c/d) grading among glaucoma specialists. The use of color disc photography as a glaucoma screening tool was first championed by Lichter et al in 1976 [1], and several subsequent studies comparing color disc photography to clinical examination has shown photographs to have excellent specificity and modest sensitivity in detecting glaucoma [2]. The 2019 SARS-CoV-2 pandemic (COVID-19) has galvanized renewed interest and efforts for telehealth ophthalmologic care. Nonstereoscopic disc photography is an imaging modality that. McSoley et al BMC Ophthalmology (2021) 21:431
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