title: Evaluation of Nonmydriatic Hand-held Optic Disc Photography Grading in the Philadelphia Glaucoma Detection and Treatment Project.
abstract: To determine the reproducibility of optic disc photograph grading obtained by a hand-held fundus camera and to determine the diagnostic value of these photographs in detecting patients with glaucoma in a community-based glaucoma-detection program.
  
  
  
  Patients underwent slit-lamp examination by an ophthalmologist who graded each patient's optic discs using 2 methods: cup-to-disc ratio (CDR) and disc damage likelihood scale (DDLS). After a comprehensive glaucoma evaluation, patients were diagnosed as having "glaucoma," "glaucoma suspect," or "no glaucoma." Nonmydriatic, monoscopic optic disc photographs were then taken with a portable digital imaging device. On a different day, the same examiner and a second observer graded the disc photographs in a masked manner and determined a diagnostic impression based only on the disc photographs.
  
  
  
  Of the 1649 patients examined, 119 subjects were randomly selected according to 3 groups of diagnoses: "glaucoma" (n=36), "glaucoma suspect" (n=50), and "no glaucoma" (n=33). For CDR, the intraobserver agreement was 0.71 and the interobserver agreement was 0.69. For disc DDLS, the intraobserver agreement was 0.65 and the interobserver agreement was 0.67. The area under the receiver-operating characteristic distinguishing between normal and glaucoma was 0.88 and 0.86 for CDR and disc DDLS, respectively.
  
  
  
  Nonmydriatic, monoscopic disc photographs obtained by a hand-held camera had only moderate disc grading reproducibility. This could be due to a reduced quality of images, making interpretation more challenging, due to taking photographs through small pupils by a hand-held camera and the high percentage of patients with significant cataracts.
authors.affiliation: Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA.
authors.forename: Michael
authors.initials: M
authors.lastname: Waisbourd
authors.forename: Emily A
authors.initials: EA
authors.lastname: Bond
authors.forename: Timothy
authors.initials: T
authors.lastname: Sullivan
authors.forename: Wanda D
authors.initials: WD
authors.lastname: Hu
authors.forename: Sonya B
authors.initials: SB
authors.lastname: Shah
authors.forename: Jeanne
authors.initials: J
authors.lastname: Molineaux
authors.forename: Harjeet
authors.initials: H
authors.lastname: Sembhi
authors.forename: George L
authors.initials: GL
authors.lastname: Spaeth
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Myers
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Hark
authors.forename: L Jay
authors.initials: LJ
authors.lastname: Katz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003941:Diagnostic Techniques, Ophthalmological / Q000145:classification*; D005260:Female; D005902:Glaucoma, Open-Angle / Q000175:diagnosis*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009184:Mydriatics / Q000008:administration & dosage; D015588:Observer Variation; D009798:Ocular Hypertension / Q000175:diagnosis; D009898:Optic Disk / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000175:diagnosis*; D015143:Philadelphia; D010781:Photography / Q000145:classification* / Q000295:instrumentation; D012372:ROC Curve; D015203:Reproducibility of Results
chemical_list: D009184:Mydriatics