June 2013
Volume 54, Issue 15
ARVO Annual Meeting Abstract  |   June 2013
Utilization of Novel Technology to Improve Accuracy and Efficiency of Assessing Progression of Glaucomautous Changes in Serial Fundus Photos
Author Affiliations & Notes
  • Ozgur Ozkan
    Ophthalmology, University of South Carolina/Palmetto Health, Columbia, SC
  • Reginald Barnes
    Ophthalmology, Georgetown University/Washington Hospital Center, Washington, DC
  • Bethany Markowitz
    Ophthalmology, University of South Carolina/Palmetto Health, Columbia, SC
  • Footnotes
    Commercial Relationships Ozgur Ozkan, EyeIC, Inc (F); Reginald Barnes, EYEIC, Inc (F); Bethany Markowitz, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 4838. doi:
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      Ozgur Ozkan, Reginald Barnes, Bethany Markowitz; Utilization of Novel Technology to Improve Accuracy and Efficiency of Assessing Progression of Glaucomautous Changes in Serial Fundus Photos. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4838.

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      © ARVO (1962-2015); The Authors (2016-present)

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Color fundus photos are used to assess for glaucomatous changes to the optic nerve head. Alternating Animation Flicker (AAF) is a novel technology that automatically and precisely aligns two images of the same fundus. The software then alternates between the two images to create an animation such that differences appear as motion. This study compares accuracy and time to assessment (TTA) for progression of optic nerve head changes evaluated with AAF compared to traditional side-by-side fundus photos.


Eight residents were shown five side-by-side serial, color fundus images of optic nerves heads and six animated gif’s of AAF’s generated from color fundus images focusing on the optic nerves heads of glaucoma patients. Both sets of images contained similarly graded difficulty-level images and one non-progressive nerve head that had no glaucomatous changes. All participating residents were given identical instructions to note any glaucomatous changes (including cup-to-disc ratio changes, notching, Drance hemorrhages, retinal nerve fiber layer changes, etc.). Times were recorded from initial side-by-side images viewed and from the animated gif presented to completion of written findings. Written responses were graded by giving one point for each glaucomatous change accurately identified.


The average number of correctly identified glaucomatous changes by side-by-side analysis was 2.375 (SD=1.49) out of 12 (19.8%) for the ophthalmology residents’ readings. In comparison, the mean number of correctly identified changes utilizing AAF was 8 (SD=1.41) out of 11 (72.7%), correlating to a 2.7 fold increase in accuracy (P<1.45 x 10-6). See table 1. The mean TTA by traditional analysis was 22.5 sec (SD=4.8 sec). The mean TTA using AAF generated animated gif’s was 14.9 sec (SD=2.4 sec). The overall improvement in time to completion of assessment was 7.6 seconds or a 66.2% time savings (P<=3.4 x 10-6). See table 2.


Evaluations of fundus photos remain the gold standard for evaluating optic nerve changes in glaucoma. Multiple studies have already shown significant inter-observer variability in evaluating side-by-side serial fundus photos. Alternating Animation Flicker (AAF) significantly improved the accuracy and efficiency of residents in their analysis of glaucomatous changes over time in fundus photographs.

Keywords: 550 imaging/image analysis: clinical • 629 optic nerve  

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