March 2012
Volume 53, Issue 14
Free
ARVO Annual Meeting Abstract  |   March 2012
Comparing the Evaluation of Optic Disc Edema Using Serial Digital Optic Disk Photographs and Automated Alteration Flicker
Author Affiliations & Notes
  • Ryan M. St Clair
    Ophthalmology, Weill Cornell Medical College, New York, New York
  • Marc J. Dinkin
    Ophthalmology, Weill Cornell Medical College, New York, New York
  • Nathan M. Radcliffe
    Ophthalmology, Weill Cornell Medical College, New York, New York
  • George Parlitsis
    Ophthalmology, Weill Cornell Medical College, New York, New York
  • Charles Kim
    Ophthalmology, Weill Cornell Medical College, New York, New York
  • Footnotes
    Commercial Relationships  Ryan M. St Clair, None; Marc J. Dinkin, None; Nathan M. Radcliffe, None; George Parlitsis, None; Charles Kim, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science March 2012, Vol.53, 3920. doi:
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      Ryan M. St Clair, Marc J. Dinkin, Nathan M. Radcliffe, George Parlitsis, Charles Kim; Comparing the Evaluation of Optic Disc Edema Using Serial Digital Optic Disk Photographs and Automated Alteration Flicker. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3920.

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

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Abstract

Purpose: : Accurate assessment of optic disc edema is necessary when managing a range of optic nerve pathology, including papilledema, ischemic optic neuropathy, optic neuritis, and papillitis. Here, we compare inter-observer agreement using a novel automated alternation flicker technology with side-by side digital photography inspection for evaluation of optic disc edema.

Methods: : Patients with optic disc edema and at least one pair of serial digital optic disc photographs were included, for a total of 68 photos of 24 eyes from 12 patients. Using side-by-side digital photograph comparison, optic disc edema was judged to have improved, remained stable, or worsened by a single observer during the course of regular clinical care. Next, the photographs were grouped into 42 sequential pairs. 3 graders, masked to image chronology, then evaluated the photograph pairs using automated alternation flicker (EyeIC, Narberth, PA, USA) as stable, improved, or worsened. The order of patients was randomized. Inter-observer agreement was assessed using the kappa statistic. Agreement between the masked observers using automated alternation flicker and the observer using side-by-side comparison was assessed using the kappa statistic.

Results: : The three masked observers demonstrated near-perfect agreement when evaluating optic disc edema as improved, stable, or worsened using automatic alternation flicker (Overall agreement 92%, fixed-marginal kappa 0.84). The three masked observers using automated alternation flicker showed only fair agreement with the observer using side-by-side comparison (overall agreement 71%, fixed-marginal kappa 0.40) More cases of worsened optic disc edema were identified by the automated alternation flicker observers (n=2 for all three observers) than by the side-by-side digital image comparison observer (n=0). Similar numbers of stable (n=16, 16, 13) and improved (n=24, 24, 27) optic disc edema were identified by the automated alternation flicker group compared to the side-by-side image comparison observer (n=15 stable, n=27 improved).

Conclusions: : Automated alternation flicker has a high degree of inter-observer agreement when used to evaluate optic disc edema, and only a fair level of agreement with side-by-side image comparison. Automated alternation flicker may be a more accurate tool for identifying changes in optic nerve head edema during serial exams than side-by-side digital optic nerve photograph comparison.

Keywords: neuro-ophthalmology: optic nerve • neuro-ophthalmology: diagnosis • optic disc 
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