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Editors Selection IGR 11-3
Telemedicine and e-Health
Comment by Linda Zangwill on:
24394 Tele-transmission of stereoscopic images of the optic nerve head in glaucoma via internet, Bergua A; Mardin CY; Horn FK, Telemedicine Journal and E-Health: the Official Journal of the American Telemedicine Association, 2009; 15: 439-444
Documentation and assessment of optic disc and retinal nerve fiber layer damage is one of the most important yet challenging aspects of glaucoma management. Although clinicians are increasingly using imaging instruments for evaluation of the optic nerve head, the development of inexpensive methods to exchange and view stereoscopic photographs of the optic disc for glaucoma management and research purposes remains important. Bergua et al. (1121) qualitatively de - scribe an inexpensive system to visualize stereoscopic photographs of the optic nerve head, and transmit them over the internet. Specifically, two experienced observers together graded on a three-point scale the visibility of 11 optic nerve head features of stereoscopic photographs of 18 glaucoma eyes. They compared three different viewing methods, time-multiplexing LCDshutter glasses, red-cyan goggles and monoscopically. From this very limited case series, the authors observed 'excellent stereoscopic representation of the optic nerve head' using either shutter glasses or red-cyan goggles, but pigmentation of parapapillary atrophy and focal hemorrhages was seen more precisely with shutter glasses. This very preliminary report does not include a statistical comparison of viewing methods nor does it evaluate the inter-observer or intra-observer reproducibility of the graders assessment using the three viewing systems. Therefore this publication can at best serve as a proof of concept of the methods evaluated. As the authors suggest, future studies should evaluate more accurately the quality of the visualization and ease of use of the various stereoscopic viewing methods compared to film based photographs. In addition, the feasibility and diagnostic value of the stereoscopic photograph viewing systems should be compared to other imaging techniques.