Digital versus film stereo-photography for assessment of the optic nerve head in glaucoma and glaucoma suspect patients

Murat Hasanreisoglu, Ethan Priel, Lili Naveh, Moshe Lusky, Dov Weinberger, Yoav Benjamini, Dan D. Gaton*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


PURPOSE:: One of the leading methods for optic nerve head assessment in glaucoma remains stereoscopic photography. This study compared conventional film and digital stereoscopy in the quantitative and qualitative assessment of the optic nerve head in glaucoma and glaucoma suspect patients. METHODS:: Fifty patients with glaucoma or suspected glaucoma underwent stereoscopic photography of the optic nerve head with a 35-mm color slide film and a digital camera. Photographs/images were presented in random order to 3 glaucoma specialists for independent analysis using a standardized assessment form. Findings for the following parameters were compared among assessors and between techniques: cup/disc (C/D) ratio, state of the optic rim, presence of peripapillary atrophy and appearance of the retinal nerve fiber layer, blood vessels, and lamina cribrosa. The film-based and image-based diagnoses (glaucoma yes/no) were compared as well. RESULTS:: Despite high level of agreement across graders using the same method for the horizontal and vertical C/D ratio, (intraclass correlations 0.80 to 0.83), the agreement across graders was much lower for the other parameters using the same method. Similarly the agreement between the findings of the same grader using either method was high for horizontal and vertical C/D ratio, but low for the other parameters. The latter differences were reflected in the disagreement regarding the final diagnosis: The diagnoses differed by technique for each grader in 18% to 46% of eyes, resulting in 38.5% of eyes diagnosed with glaucoma by film photography that "lost" their diagnosis on the digital images, whereas 18.7% of eyes diagnosed as nonglaucomatous by film photography were considered to have glaucoma on the digital images. CONCLUSIONS:: Although there is consistency between 35-mm film stereoscopy and digital stereoscopy in determining the cup/disc (C/D) ratio, in all other parameters large differences exist, leading to differences in diagnosis. Differences in capturing images between digital and film photography may lead to loss of information and misdiagnosis. Further studies are needed to determine the reliability of the new digital techniques.

Original languageEnglish
Pages (from-to)238-242
Number of pages5
JournalJournal of Glaucoma
Issue number3
StatePublished - Mar 2013


  • Glaucoma
  • Optic nerve head
  • Stereoscopic 35-mm color slide photographs
  • Stereoscopic digital images


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