Automated alternation flicker for the detection of optic disc haemorrhages

Zeba A. Syed, Nathan M. Radcliffe, Carlos Gustavo De Moraes, Scott D. Smith, Jeffrey M. Liebmann, Robert Ritch

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Purpose: 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). Conclusion: 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.

Original languageEnglish
Pages (from-to)645-650
Number of pages6
JournalActa Ophthalmologica
Issue number7
StatePublished - Nov 2012
Externally publishedYes


  • automated alternation flicker
  • disc haemorrhages
  • glaucoma
  • progressive optic neuropathy


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