title: Agreement of New Automated Matched Alternation Flicker using Undilated Fundus Photography for the Detection of Glaucomatous Structural Change.
abstract: To determine the agreement among glaucoma experts and general ophthalmologists regarding detection of glaucomatous structural changes using a new automated matched alternation flicker (AMAF) method with fundus photographs (FPs) of undilated eyes.
  
  
  
  Sixty-six pairs of FPs of normal tension glaucoma patients were collected. FPs were taken at intervals of more than 12 months. Alternating flicker images were created using a new AMAF application. In a blinded manner, two glaucoma experts and two general ophthalmologists compared the presence of glaucomatous structural changes using either the AMAF method or the side-by-side comparison method. The interobserver and intraobserver agreements were compared using the Bland and Altman plot analysis.
  
  
  
  The glaucoma experts detected more glaucoma progression using the AMAF method (average, 50.7%) compared with the side-by-side method (average, 32.5%). General ophthalmologists detected more glaucomatous progression with the AMAF method (average, 40.9%) than with the side-by-side method (average, 25.0%). The AMAF method showed fair to substantial interreader agreement (k = 0.511-0.724) and fair to perfect intrareader agreement (k = 0.631-0.943). Interreader and intrareader agreements using the AMAF method were better for the glaucoma experts compared with the general ophthalmologists.
  
  
  
  The AMAF method showed more changes in FPs than the classical side-by-side comparison method. Regarding inter- and intrareader agreements, agreement for the glaucoma experts was best using the AMAF method, but for the general ophthalmologists agreement was best using the side-by-side comparison method.
authors.affiliation: a Department of Ophthalmology , Ajou University School of Medicine , Suwon , Korea.
authors.forename: Il Suk
authors.initials: IS
authors.lastname: Yun
authors.affiliation: b Department of Ophthalmology , CHA Bundang Medical Center, CHA University , Seongnam , Korea.
authors.forename: Seungsoo
authors.initials: S
authors.lastname: Rho
authors.affiliation: a Department of Ophthalmology , Ajou University School of Medicine , Suwon , Korea.
authors.forename: Seran
authors.initials: S
authors.lastname: Jang
authors.affiliation: a Department of Ophthalmology , Ajou University School of Medicine , Suwon , Korea.
authors.forename: Jaehong
authors.initials: J
authors.lastname: Ahn
authors.affiliation: c Department of Digital Media , Ajou University , Suwon , Korea.
authors.forename: Jung-Ju
authors.initials: JJ
authors.lastname: Choi
authors.affiliation: d Department of Ophthalmology , DMC Bundang Jesaeng General Hospital , Seongnam , Korea.
authors.forename: Marvin
authors.initials: M
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D003941:Diagnostic Techniques, Ophthalmological; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D057066:Low Tension Glaucoma / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009898:Optic Disk / Q000473:pathology*; D010781:Photography / Q000379:methods*; D012372:ROC Curve; D015203:Reproducibility of Results; D012160:Retina / Q000473:pathology*; D012189:Retrospective Studies
keywords: Automated matched alternation flicker; fundus photography; interreader agreement; intrareader agreement; progression of glaucoma