title: Automated alternation flicker for the detection of optic disc haemorrhages.
abstract: OBJECTIVE
  Optic disc haemorrhages are associated with active glaucomatous neurodegeneration and ongoing visual field loss. We sought to determine whether automated alternation flicker enhances the detection of disc haemorrhages in serial images from patients with glaucoma when compared to side-by-side photographic evaluation and single-image display.
  
  
  METHODS
  Serial sets of optic nerve photographs of 394 eyes from 234 patients followed for glaucoma at the authors' institutions were included in this study. Eyes with disc haemorrhages were graded for difficulty level and randomized along with nondisc haemorrhage control images into one of three presentation groups (automated alternation flicker, side-by-side or single image). Seven graders viewed all images and assessed for the presence or absence of disc haemorrhages.
  
  
  RESULTS
  The sensitivity of automated alternation flicker for disc haemorrhage detection (0.878) was higher than side-by-side (0.705; p = 0.002) and single photographs (0.757; p = 0.01). There was no specificity difference between pairs of presentation groups (all p ≥ 0.7).
  
  
  CONCLUSIONS
  Automated alternation flicker was a more sensitive method for disc haemorrhage detection than the current clinical standards and may have an important role in the management of glaucoma.
authors.affiliation: Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Zeba A
authors.initials: ZA
authors.lastname: Syed
authors.forename: Nathan M
authors.initials: NM
authors.lastname: Radcliffe
authors.forename: Carlos Gustavo
authors.initials: CG
authors.lastname: De Moraes
authors.forename: Scott D
authors.initials: SD
authors.lastname: Smith
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Liebmann
authors.forename: Robert
authors.initials: R
authors.lastname: Ritch
mesh_terms: D002983:Clinical Competence; D003941:Diagnostic Techniques, Ophthalmological; D004501:Education, Medical; D004503:Education, Medical, Graduate; D006801:Humans; D007396:Internship and Residency; D008875:Middle Aged; D009885:Ophthalmology / Q000193:education; D009898:Optic Disk / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000175:diagnosis*; D012166:Retinal Hemorrhage / Q000175:diagnosis*; D012680:Sensitivity and Specificity