Comparison of 1-field, 2-fields, and 3-fields fundus photography for detection and grading of diabetic retinopathy.

AIM: To evaluate the sensitivity and specificity of 1-, 2-, and 3-fields, nonmydriatic (NM), 45° color photography compared with mydriatic ophthalmoscopy for detection of diabetic retinopathy (DR). METHODS: Masked, comparative case series was performed utilizing a group of 128 diabetic patients (256 eyes) with various stages of DR who underwent both 3-fields NM color photography and ophthalmologic examination. In a blinded manner, the same optometrist who read the original 3-fields images for a patient read the 1- and 2-fields photographs on separate dates later. RESULTS: The sensitivity and specificity of digital retinal photography compared with dilated ophthalmoscopy were, respectively: 88% and 76% for 1-field; 94% and 69% for 2-fields; and 100% and 79% for 3-fields. The proportion of agreement between fundus photography reading and exam DR diagnosis were 58% for 1-field, 58% for 2-fields, and 77% for 3-fields. Kappa and Cramer's V statistics for 1-, 2-, and 3-fields were 0.55 and 0.60, 0.52 and 0.57, and 0.72 and 0.74, respectively. Three-fields measurement of DR was most similar to the dilated ophthalmological exam overall and across all DR severity levels. CONCLUSIONS: Compared to 1- and 2-fields fundus photography, 3-fields is superior for detecting vision-threatening DR. One- and 2-fields have reasonable sensitivity for DR screening.

How frequently should asymptomatic patients be dilated? 20-year results / ¿Con qué frecuencia debería dilatarse a los pacientes asintomáticos? Resultados de 20 años

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Classification and Guidelines for Widefield Imaging: Recommendations from the International Widefield Imaging Study Group.

PURPOSE: To summarize the results of a consensus meeting aimed at defining terminology for widefield imaging across all retinal imaging methods and to provide recommendations for the nomenclature used to describe related images. DESIGN: An international panel with expertise in retinal imaging was assembled to define consensus terminology for widefield imaging and associated terminology. PARTICIPANTS: A panel of retina specialists with expertise in retinal imaging. METHODS: Before the consensus meeting, a set of 7 images acquired with a range of imaging methods and representing both healthy and diseased eyes was circulated to the expert panel for independent assignment of nomenclature for each example. The outputs were assembled and used as the starting point for discussions occurring at a subsequent roundtable meeting. The anatomic location, field of view, and perspective provided by each image example was reviewed. A process of open discussion and negotiation was undertaken until unanimous terminology for widefield imaging was achieved. MAIN OUTCOME MEASURES: Definitions of widefield imaging applicable to multiple imaging methods. RESULTS: Across a range of different imaging methods, the expert panel identified a lack of uniform terminology being used in recent literature to describe widefield images. The panel recommended the term widefield be limited to images depicting retinal anatomic features beyond the posterior pole, but posterior to the vortex vein ampulla, in all 4 quadrants. The term ultra widefield was recommended to describe images showing retinal anatomic features anterior to the vortex vein ampullae in all 4 quadrants. The definitions were recommended over other device-specific terminology. CONCLUSIONS: A consistent nomenclature for widefield imaging based on normal anatomic landmarks that is applicable to multiple retinal imaging methods has been proposed by the International Widefield Imaging Study Group. The panel recommends this standardized nomenclature for use in future publications.

Routine funduscopy in immune thrombocytopenic purpura-is it really necessary?

Immune thrombocytopenic purpura (ITP) is a common cause of symptomatic thrombocytopenia in children, most of whom present with cutaneous and mucosal bleeding. Complications, such as intracranial hemorrhage and occult hemorrhage from various sites, are rare, and retinal hemorrhage is exceptionally rare. Our institutional clinical practice guidelines for managing ITP in the pediatric emergency department (PED) include routine funduscopy. The aim of this retrospective case series is to provide evidence-based recommendations for a tertiary care PED work-up of ITP, with special emphasis on the guidelines for funduscopy. The medical records of all pediatric patients diagnosed with ITP over a 4-year period (2013-2016) who had a platelet count < 50,000/mm3 were retrieved and reviewed. Seventy-five patients with thrombocytopenia (platelet count < 50,000/mm3) were diagnosed as having ITP in the PED. Sixty-one (79%) of these patients underwent funduscopy and retinal hemorrhage was ruled out in all of them, indicating that retinal hemorrhage as a complication of ITP is very rare.Conclusion: Our data suggest that funduscopy should not be performed routinely on pediatric ITP patients, but rather be reserved for those who present with concurrent anemia or visual complaints. What is Known: • Many internal institutional protocols in Israel call for retinal hemorrhage bleeding surveillance in work up of ITP. Our study found no case of ITP with retinal bleeding. What is New: • Many internal institutional protocols in Israel call for retinal hemorrhage bleeding surveillance in work up of ITP. Our study found no case of ITP with retinal bleeding.

Use of a fundus photograph matching program in imparting proficiency in ophthalmoscopy.

OBJECTIVE: To determine whether practice using an online fundus photograph program results in a long-term increase in proficiency with direct ophthalmoscopy skills in medical students. DESIGN: This study was a prospective medical education trial. Students were enrolled to participate in a voluntary Objective Structured Clinical Examination (OSCE) using 5 patients with ocular findings. Students who matched a minimum of 6 discs 16 months before the study were assigned to the intervention group and were compared with students who did not participate in the exercise. PARTICIPANTS: Forty-six second-year medical students at Queen's University: 15 in the intervention group and 31 in the control group. METHODS: Students were evaluated using the Queen's University Ophthalmoscopy OSCE Checklist (QUOOC). Students were asked to calculate the cup-to-disc ratio, comment on disc margins, and whether there was any macular pathology. Students participated in a summative OSCE as part of the curriculum in which all students attempted to match fundus photographs. RESULTS: Students in the intervention group performed significantly better on the QUOOC, with a mean score of 78.3% (± 4.2), compared with the control, who had a mean score of 69.4% (± 4.2) (p = 0.005). The intervention group was significantly more accurate at matching optic nerve photographs, with 100% (15/15) of the students correctly identifying the correct optic nerve on first attempt compared with 53.3% (16/30) in the control group (p = 0.0014). CONCLUSIONS: The use of an online peer fundus photograph program leads to a long-term increase in examination technique, proficiency in ophthalmoscopy, and accuracy at matching optic nerve photographs.

Video Diversion Improves Success Rate of Fundoscopic Examination in Children: A Prospective Randomized Controlled Trial.

BACKGROUND: Fundoscopy is an important component of the neurological examination as it can detect pathologies such as high intracranial pressure. However, the examination can be challenging in young children. This study evaluated whether playing a video during eye examination improves the success, duration, and ease of pediatric fundoscopy. MATERIALS AND METHODS: This was a prospective, multipractitioner, multiclinic, randomized controlled trial. Patients aged one to four years were recruited in the emergency department, neurology clinic, spinal cord clinic, and general pediatric clinic. Eye examination was randomized to video or non-video-assisted fundoscopy. Successful examinations were defined as visualizing the fundus within 60 seconds. Time to visualize optic disc was recorded and difficulty of examination was assessed using a 10-point Likert scale. RESULTS: We recruited 101 subjects with a mean age of 2.8 years. Overall, there was a 20% absolute improvement in the success rate of visualizing the optic disc in the video versus non-video group (P < 0.001, 95%CI: 7.8% to 31%). Time to visualize optic disc was also improved (Δ5.3 seconds, P < 0.01, 95%CI: 1.4 to 9.1 seconds). Practitioners and caregivers noticed a 33% (P < 0.01, 95%CI: 21% to 44%) and 42% (P < 0.01, 95%CI: 30% to 56%) relative improvement in the ease of examination with video, respectively. CONCLUSIONS: The use of videos improved the ease, duration, and, most importantly, the success of fundoscopy in younger children. This simple, inexpensive adjunct has great potential to improve the ease and efficacy of this aspect of the neurological examination and allow fundoscopic examination to be effectively performed earlier in the age-appropriate vision screening protocols.

Reliability of Cyclotorsion measurements using Scanning Laser Ophthalmoscopy imaging in healthy subjects: the CySLO study.

BACKGROUND/AIMS: To evaluate inter-rater and intra-rater reliability of objective cyclotorsion measurements obtained in healthy subjects using the Heidelberg Spectralis spectral domain-optical coherence tomography (SD-OCT) device. METHODS: In this prospective methodological study, 32 healthy subjects (14 men, 18 women; aged 21-64 years) were enrolled, 31 right eyes were examined and their foveo-papillary angles (FPAs) were measured. The retinal nerve fibre layer (RNFL) programme by Heidelberg Spectralis (Heidelberg Engineering, Heidelberg, Germany) was used to measure cyclotorsion based on the in-built algorithm for the measurement of the FPA on the scanning laser ophthalmoscopy (SLO) image. Repeated scans of the fixating and non-fixating right eye without and with eye tracker each were obtained by three different examiners. RESULTS: The mean FPA measured overall by all three examiners was 6.6°±2.8°. The inter-rater reliability of the measured FPAs using the linear mixed effects model is estimated as rhointer=0.8803. The intra-rater reliability is estimated as rhointra=0.9589. CONCLUSIONS: Repeatability of objective cyclotorsion measurements within and between observers using the Heidelberg Spectralis OCT is very high. SD-OCT/SLO imaging is a reliable imaging technique to measure and study cyclotorsion. CLINICAL TRIAL NUMBER: NCT02631369, Results.

Characterization of Artifacts Associated With Multicolor Confocal Scanning Laser Ophthalmoscopy.

BACKGROUND AND OBJECTIVE: To characterize the appearance of three types of artifacts observed on multicolor confocal scanning laser ophthalmoscopy (cSLO). PATIENTS AND METHODS: Retrospective review of 159 eyes of 96 consecutive patients from the Duke Eye Center who underwent multicolor cSLO with spectral-domain optical coherence tomography (SD-OCT). Infrared (IR), green, blue, and multicolor reflectance images were evaluated for artifacts with corresponding SD-OCT scans available for reference. RESULTS: Multicolor cSLO artifacts were detected in 23.3% (37 of 159) of eyes and comprised three main patterns: spot, wisp, and net. Only three instances of these artifacts were detected on IR reflectance versus 34, 37, and 35 instances on green, blue, and multicolor reflectance, respectively. Artifacts were observed in 0% of eyes with clear lenses, 27.7% of eyes with cataracts, and in 20.8% of eyes with posterior chamber intraocular lenses. CONCLUSION: Awareness of spot, wisp, and net artifacts when interpreting multicolor cSLO images may facilitate the identification of true retinal pathology. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:810-815.].

White Dots as a Novel Marker of Diabetic Retinopathy Severity in Ultrawide Field Imaging.

PURPOSE: To characterize white dots in diabetic retinopathy (DR) and their association with disease severity using ultra-wide-field scanning laser ophthalmoscopy. METHODS: We randomly selected 125 eyes of 77 patients (25 eyes from individual categories of the international classification of DR severity) for which ultrawide field photographs were obtained. We characterized white dots, which were delineated by higher signal levels on green but not red laser images, and evaluated the relationship between the number of white dots and the international severity scale of DR. RESULTS: Most white dots were located in nonperfused areas, and the number of total white dots was significantly correlated to that of dots in nonperfused areas. White dots corresponded to microaneurysms around the boundary between nonperfused areas and perfused areas or unknown lesions in nonperfused areas. Eyes with DR had significantly more white dots than those with no apparent retinopathy. The numbers of white dots in moderate nonproliferative diabetic retinopathy (NPDR) or more severe grades were significantly higher than in mild NPDR. The area under the receiver operating characteristics curve (AROC) analyses demonstrated that the number of white dots had the significance in the diagnosis of DR (0.908-0.986) and moderate NPDR or more severe grades (0.888-0.974). CONCLUSIONS: These data suggest the clinical relevance of white dots seen on ultrawide field images in the diagnosis of the severity of DR.

Clinical Competency of 1-Year Trained Vision Technicians in Andhra Pradesh, India.

PURPOSE: To assess clinical competency of 1-year trained vision technicians (VTs) in detecting and referring causes of visual impairment in India. METHODS: Eye examination results and management plans for 328 patients examined by 24 VTs in 24 vision centers of LV Prasad Eye Institute in Andhra Pradesh were compared with those of a standard optometrist who examined the same patients. Eye examinations included retinoscopy and subjective refraction, slit lamp examination, applanation tonometry and undilated direct ophthalmoscopy. Data were analyzed for level of concordance in retinoscopy, spectacle prescription, disease detection and referral. RESULTS: VTs demonstrated moderate to good levels of agreement in refraction, disease detection and referral. Sensitivity and specificity for ocular pathology identification were 77.4% (95% confidence interval, CI, 69.4-84.2%) and 86.6% (95% CI 81.1-91.1%), respectively. The highest sensitivity was demonstrated in detecting significant cataract (91.5%) and refractive error (83.0%). VT spectacle prescriptions were accurate 76% of the time for mean spherical equivalent and 65% of the time for astigmatism. VT sensitivity in detecting posterior segment abnormalities was low (18.5%) resulting in failure to detect retinal conditions such as diabetic retinopathy and maculopathy. Despite lack of recognition of the specific pathology, referral decisions were correct in 78.4% of cases. CONCLUSION: VTs in India competently detect and manage or refer the two most common causes of visual impairment; uncorrected refractive error and cataract. Over two-thirds of patients received accurate and appropriate services from VTs, suggesting that they are a useful and competent cadre for rural and remote eye care.

Optic nerve head and fibre layer imaging for diagnosing glaucoma.

BACKGROUND: The diagnosis of glaucoma is traditionally based on the finding of optic nerve head (ONH) damage assessed subjectively by ophthalmoscopy or photography or by corresponding damage to the visual field assessed by automated perimetry, or both. Diagnostic assessments are usually required when ophthalmologists or primary eye care professionals find elevated intraocular pressure (IOP) or a suspect appearance of the ONH. Imaging tests such as confocal scanning laser ophthalmoscopy (HRT), optical coherence tomography (OCT) and scanning laser polarimetry (SLP, as used by the GDx instrument), provide an objective measure of the structural changes of retinal nerve fibre layer (RNFL) thickness and ONH parameters occurring in glaucoma. OBJECTIVES: To determine the diagnostic accuracy of HRT, OCT and GDx for diagnosing manifest glaucoma by detecting ONH and RNFL damage. SEARCH METHODS: We searched several databases for this review. The most recent searches were on 19 February 2015. SELECTION CRITERIA: We included prospective and retrospective cohort studies and case-control studies that evaluated the accuracy of OCT, HRT or the GDx for diagnosing glaucoma. We excluded population-based screening studies, since we planned to consider studies on self-referred people or participants in whom a risk factor for glaucoma had already been identified in primary care, such as elevated IOP or a family history of glaucoma. We only considered recent commercial versions of the tests: spectral domain OCT, HRT III and GDx VCC or ECC. DATA COLLECTION AND ANALYSIS: We adopted standard Cochrane methods. We fitted a hierarchical summary ROC (HSROC) model using the METADAS macro in SAS software. After studies were selected, we decided to use 2 x 2 data at 0.95 specificity or closer in meta-analyses, since this was the most commonly-reported level. MAIN RESULTS: We included 106 studies in this review, which analysed 16,260 eyes (8353 cases, 7907 controls) in total. Forty studies (5574 participants) assessed GDx, 18 studies (3550 participants) HRT, and 63 (9390 participants) OCT, with 12 of these studies comparing two or three tests. Regarding study quality, a case-control design in 103 studies raised concerns as it can overestimate accuracy and reduce the applicability of the results to daily practice. Twenty-four studies were sponsored by the manufacturer, and in 15 the potential conflict of interest was unclear.Comparisons made within each test were more reliable than those between tests, as they were mostly based on direct comparisons within each study.The Nerve Fibre Indicator yielded the highest accuracy (estimate, 95% confidence interval (CI)) among GDx parameters (sensitivity: 0.67, 0.55 to 0.77; specificity: 0.94, 0.92 to 0.95). For HRT measures, the Vertical Cup/Disc (C/D) ratio (sensitivity: 0.72, 0.60 to 0.68; specificity: 0.94, 0.92 to 0.95) was no different from other parameters. With OCT, the accuracy of average RNFL retinal thickness was similar to the inferior sector (0.72, 0.65 to 0.77; specificity: 0.93, 0.92 to 0.95) and, in different studies, to the vertical C/D ratio.Comparing the parameters with the highest diagnostic odds ratio (DOR) for each device in a single HSROC model, the performance of GDx, HRT and OCT was remarkably similar. At a sensitivity of 0.70 and a high specificity close to 0.95 as in most of these studies, in 1000 people referred by primary eye care, of whom 200 have manifest glaucoma, such as in those who have already undergone some functional or anatomic testing by optometrists, the best measures of GDx, HRT and OCT would miss about 60 cases out of the 200 patients with glaucoma, and would incorrectly refer 50 out of 800 patients without glaucoma. If prevalence were 5%, e.g. such as in people referred only because of family history of glaucoma, the corresponding figures would be 15 patients missed out of 50 with manifest glaucoma, avoiding referral of about 890 out of 950 non-glaucomatous people.Heterogeneity investigations found that sensitivity estimate was higher for studies with more severe glaucoma, expressed as worse average mean deviation (MD): 0.79 (0.74 to 0.83) for MD < -6 db versus 0.64 (0.60 to 0.69) for MD ≥ -6 db, at a similar summary specificity (0.93, 95% CI 0.92 to 0.94 and, respectively, 0.94; 95% CI 0.93 to 0.95; P < 0.0001 for the difference in relative DOR). AUTHORS' CONCLUSIONS: The accuracy of imaging tests for detecting manifest glaucoma was variable across studies, but overall similar for different devices. Accuracy may have been overestimated due to the case-control design, which is a serious limitation of the current evidence base.We recommend that further diagnostic accuracy studies are carried out on patients selected consecutively at a defined step of the clinical pathway, providing a description of risk factors leading to referral and bearing in mind the consequences of false positives and false negatives in the setting in which the diagnostic question is made. Future research should report accuracy for each threshold of these continuous measures, or publish raw data.

Photographic Reading Center of the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT): Methods and Baseline Results.

PURPOSE: To describe the methods used by the Photographic Reading Center (PRC) of the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT) and to report baseline assessments of papilledema severity in participants. METHODS: Stereoscopic digital images centered on the optic disc and the macula were collected using certified personnel and photographic equipment. Certification of the camera system included standardization and calibration using a model eye. Lay readers assessed disc photos of all eyes using the Frisén grade and performed quantitative measurements of papilledema. Frisén grades by PRC were compared with site investigator clinical grades. Spearman rank correlations were used to quantify associations among disc features and selected clinical variables. RESULTS: Frisén grades according to the PRC and site investigator's grades, matched exactly in 48% of the study eyes and 42% of the fellow eyes and within one grade in 94% of the study eyes and 92% of the fellow eyes. Frisén grade was strongly correlated (r > 0.65, P < 0.0001) with quantitative measures of disc area. Cerebrospinal fluid pressure was weakly associated with Frisén grade and disc area determinations (r ≤ 0.31). Neither Frisén grade nor any fundus feature was associated with perimetric mean deviation. CONCLUSIONS: In a prospective clinical trial, lay readers agreed reasonably well with physicians in assessing Frisén grade. Standardization of camera systems enhanced consistency of photographic quality across study sites. Images were affected more by sensors with poor dynamic range than by poor resolution. Frisén grade is highly correlated with quantitative assessment of disc area. (ClinicalTrials.gov number, NCT01003639.).

Validity of direct ophthalmoscopy skill evaluation with ocular fundus examination simulators.

OBJECTIVE: We examined how direct ophthalmoscopy (DO) skills can be evaluated in a clinical setting using a simulator, and determined the appropriate assessment criteria for the DO skills in practical tests such as the Objective Structured Clinical Examination (OSCE). DESIGN: Cross-sectional study. PARTICIPANTS: Medical students, residents, and attending physicians (73 total participants). METHODS: We selected the following 3 factors that may indicate the ability to perform nonmydriatic direct funduscopy: (i) experience: total number of cases examined (without mydriasis); (ii) frequency: number of cases examined during the previous month; and (iii) range: viewable fundus field range. We used a fundus simulator with 3-level adjustable pupil sizes (2, 3.5, and 5 mm) and created original test slides for use in the simulator. We counted the number of correct answers of each participant for each pupil size using the simulator and test slides. RESULTS: There were significant differences in the median number of correct answers for pupil diameters of 2 (p = 0.008) and 3.5 mm (p = 0.007) among groups divided according to the total number of cases examined (without mydriasis). There were no significant differences among groups divided according to the viewable fundus field range (2 mm: p = 0.103, 3.5 mm: p = 0.083, 5 mm: p = 0.347). CONCLUSIONS: The results suggest a possible relation between the surrogate indicators "experience" and "range" and DO skills using a fundus simulator. The surrogate indicator experience showed a strong relation to DO skills using a fundus simulator.

Imaging of the optic disk in caring for patients with glaucoma: ophthalmoscopy and photography remain the gold standard.

Optic disk imaging is integral to the diagnosis and treatment of patients with glaucoma. We discuss the various forms of imaging the optic nerve, including ophthalmoscopy, photography, and newer imaging modalities, including optical coherence tomography (OCT), confocal scanning laser ophthalmoscopy (HRT), and scanning laser polarimetry (GDx), specifically highlighting their benefits and disadvantages. We argue that ophthalmoscopy and photography remain the gold standard of imaging due to portability, ease of interpretation, and the presence of a large database of images for comparison.

How frequently should asymptomatic patients be dilated?

PURPOSE: To determine if routine dilated fundus examination (DFE) should be performed sooner than at 10-year intervals in asymptomatic patients. METHODS: Records for all patients consecutively evaluated in a one-year time frame were systematically reviewed. Of those patients who received initial DFE and were living 10 years later, records for sequential DFE were again evaluated to determine presence of clinically-significant, peripheral retinal findings. Databases were also searched in order to determine the number of patients during the same 10-year time period who developed vision or life-threatening peripheral retinal findings. The two groups were cross-matched to determine effectiveness of routine DFE. RESULTS: Only 10 of 592 patients were deemed to have "clinically-significant" peripheral retinal findings--none of whom developed untoward outcomes. Of the 29 new retinal detachments and four intraocular tumors discovered during ten years of clinical follow-up, nearly 90% were symptomatic at the time of discovery. Three detachments and one tumor were detected as incidental findings in asymptomatic patients. No further treatment was recommended for the three detachments and the patient with the tumor survives, although with profound loss of vision in the involved eye. CONCLUSIONS: In the absence of symptoms, routine DFE seems to have a very low yield for discovery of serious ocular events and appears to be ineffective in altering the course of incidental findings. Routine DFE is not indicated for older, asymptomatic patients--even at decade intervals. The findings of this study should be prospectively confirmed in population-based studies.

The KIDROP model of combining strategies for providing retinopathy of prematurity screening in underserved areas in India using wide-field imaging, tele-medicine, non-physician graders and smart phone reporting.

AIM: To report the Karnataka Internet Assisted Diagnosis of Retinopathy of Prematurity (KIDROP) program for retinopathy of prematurity (ROP) screening in underserved rural areas using an indigenously developed tele-ROP model. MATERIALS AND METHODS: KIDROP currently provides ROP screening and treatment services in three zones and 81 neonatal units in Karnataka, India. Technicians were trained to use a portable Retcam Shuttle (Clarity, USA) and validated against ROP experts performing indirect ophthalmoscopy. An indigenously developed 20-point score (STAT score) graded their ability (Level I to III) to image and decide follow-up based on a three-way algorithm. Images were also uploaded on a secure tele-ROP platform and accessed and reported by remote experts on their smart phones (iPhone, Apple). RESULTS: 6339 imaging sessions of 1601 infants were analyzed. A level III technician agreed with 94.3% of all expert decisions. The sensitivity, specificity, positive predictive value and negative predictive value for treatment grade disease were 95.7, 93.2, 81.5 and 98.6 respectively. The kappa for technicians to decide discharge of babies was 0.94 (P < 0.001). Only 0.4% of infants needing treatment were missed.The kappa agreement of experts reporting on the iPhone vs. Retcam for treatment requiring and mild ROP were 0.96 and 0.94 (P < 0.001) respectively. CONCLUSIONS: This is the first and largest real-world program to employ accredited non-physicians to grade and report ROP. The KIDROP tele-ROP model demonstrates that ROP services can be delivered to the outreach despite lack of specialists and may be useful in other middle-income countries with similar demographics.

Diagnostic ability of a new method for measuring haemoglobin levels in the optic nerve head in multiple sclerosis patients.

AIMS: To evaluate a new method for measuring haemoglobin (Hb) levels and quantifying the colour changes in the optic nerve head of multiple sclerosis (MS) patients to detect axonal loss and consequently optic disc atrophy. MATERIAL AND METHODS: 40 MS patients and 40 age and sex-matched healthy subjects were included in this prospective cross-sectional study and underwent a full ophthalmological examination, including three photographs of the optic disc. The Laguna ONhE ('optic nerve hemoglobin'; Insoft SL, Tenerife, Spain) software was used to obtain the Hb analysis in each of the 24 sectors and average Hb of optic disc photographs acquired. Reproducibility of measurements provided by Laguna ONhE program was analysed. RESULTS: MS patients showed significant reduction of optic disc Hb percentages in average Hb (58.99% in MS, 65.39% in healthy subjects; p<0.001) and in almost all analysed sectors with the largest differences in temporal sectors. Laguna ONhE program showed good reproducibility measuring Hb percentages in MS patients and healthy subjects. CONCLUSIONS: Measurements of optic disc Hb levels obtained with Laguna ONhE software had good ability detecting optic atrophy and axonal loss in MS patients. This method had good reliability and is easy to implement in routine clinical practice.