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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.

Grape seed extract (GSE) is a potent antioxidant. We examined the effect of GSE on oxidative stress-induced cell death in a transformed retinal ganglion cell line, RGC-5.Staurosporine-differentiated RGC-5 (ssdRGC-5) cells obtained by treating RGC-5 cells with 1 µM staurosporine were incubated with GSE for 2 h and then exposed to buthionine sulfoximine plus glutamate (B/G) for 24 h. Cell death was detected using the LIVE/DEAD viability assay and the type of cell death was evaluated using fluorescein isothiocyanate-conjugated Annexin-V/propidium iodide staining. To investigate the mechanism underlying cell death, we determined the caspase-3 activity and level of reactive oxygen species (ROS) formation.Treatment of ssdRGC-5 cells with B/G increased intracellular ROS and induced apoptosis (not necrosis) with increasing caspase-3 activity. GSE rescued the ssdRGC-5 cells from oxidative stress-induced cell death by inhibiting both intracellular ROS production and caspase-3 activation.GSE had a neuroprotective effect against oxidative stress-induced apoptotic death in ssdRGC-5 cells.