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Objective: To evaluate macular and peripapillary retinal nerve fiber layer (RNFL) thickness in amblyopic eyes compared to the fellow eye., Design: Cross-sectional study., Participants: 30 patients (60 eyes) older than 18 years of age with amblyopia., Methods: Inclusion criteria included individuals older than 18 years, amblyopia, and best-corrected visual acuity (BCVA) ≤ 20/40. A complete medical history was taken and an eye examination carried out. Optical coherence tomography (OCT) was carried out on both eyes of all patients. Exclusion criteria included intraocular pressure (IOP) >23 mm Hg and eye pathology that may affect OCT measurements. The primary outcome measures were foveal thickness and average peripapillary RNFL thickness, which were compared using a paired t test. Quadrants in peripapillary scans and concentric rings in macular scans were analyzed., Results: The average age was 56 years (range = 33-82 years). Visual acuity ranged from 20/40 to 20/4000 (mean = 20/275). The average peripapillary RNFL thickness was 90.6 μm (SD = 9.6 μm) in the amblyopic eye and 90.1 μm (SD = 12.1 μm) in the fellow eye (p = 0.64). The average macular thickness in amblyopic eyes was 260.1 μm (SD = 32.0 μm), and 254.7 μm (SD = 32.5 μm) in fellow eyes (p = 0.10). No statistical difference existed between peripapillary quadrants or macular concentric rings. These differences were smaller when the strabismic amblyopes were isolated., Conclusions: There does not seem to be a difference in peripapillary RNFL or macular thickness between the amblyopic eye and fellow eye., (Crown Copyright © 2011. Published by Elsevier Inc. All rights reserved.)

Purpose: To ascertain the interobserver agreement among various specialists when analyzing images of the optic nerve head taken with the RetCam 120 (Clarity Medical Systems, Inc., Pleasanton, CA) for assessing the progression of optic disk cupping in pediatric glaucoma., Methods: Five observers compared pairs of RetCam 120 two-dimensional photographs from 64 eyes to identify whether or not changes in the optic disk had occurred. Observers included a pediatric glaucoma specialist, pediatric neurophthalmologist, strabismologist, pediatric ophthalmic imaging specialist, and pediatric ophthalmology fellow. Each was masked to the patient identity and clinical course. For each patient, the observers reviewed the photographs taken prior to therapy and at a minimum of 6 months following initiation of therapy. Interobserver variability was calculated and analysis conducted to identify influential variables., Results: Poor agreement was noted between the observers. No significant association was obtained between agreement level and variables affecting photographic quality: variability of contrast and illumination, exposure and magnification, image clarity, presence of fluorescein on the cornea, and pixelation of the image with poor resolution. Raters noted problems with these image variables in 75.6% of the observations. The Kappa statistic obtained was kappa = 0.29 with overall proportion of agreement of p = 0.69, suggesting a fair agreement but not a moderate agreement., Conclusions: Comparison of RetCam 120 pediatric optic nerve head photographs, when performed subjectively by observers with different perspectives, and in isolation from clinical information, may not be a reliable indicator of cupping change. In addition, variations in image contrast, luminance, color, and pixelation pose significant challenges to agreement between observers. Comparison of RetCam 120 images should not be considered the sole criterion for monitoring pediatric glaucoma.