Online images amplify gender bias.

Each year, people spend less time reading and more time viewing images1, which are proliferating online2-4. Images from platforms such as Google and Wikipedia are downloaded by millions every day2,5,6, and millions more are interacting through social media, such as Instagram and TikTok, that primarily consist of exchanging visual content. In parallel, news agencies and digital advertisers are increasingly capturing attention online through the use of images7,8, which people process more quickly, implicitly and memorably than text9-12. Here we show that the rise of images online significantly exacerbates gender bias, both in its statistical prevalence and its psychological impact. We examine the gender associations of 3,495 social categories (such as 'nurse' or 'banker') in more than one million images from Google, Wikipedia and Internet Movie Database (IMDb), and in billions of words from these platforms. We find that gender bias is consistently more prevalent in images than text for both female- and male-typed categories. We also show that the documented underrepresentation of women online13-18 is substantially worse in images than in text, public opinion and US census data. Finally, we conducted a nationally representative, preregistered experiment that shows that googling for images rather than textual descriptions of occupations amplifies gender bias in participants' beliefs. Addressing the societal effect of this large-scale shift towards visual communication will be essential for developing a fair and inclusive future for the internet.

Measurement of Body Surface Area for Psoriasis Using U-net Models.

During the evaluation of body surface area (BSA), precise measurement of psoriasis is crucial for assessing disease severity and modulating treatment strategies. Physicians usually evaluate patients subjectively through direct visual evaluation. However, judgment based on the naked eye is not reliable. This study is aimed at evaluating the use of machine learning methods, specifically U-net models, and developing an artificial neural network prediction model for automated psoriasis lesion segmentation and BSA measurement. The segmentation of psoriasis lesions using deep learning is adopted to measure the BSA of psoriasis so that the severity can be evaluated automatically in patients. An automated psoriasis lesion segmentation method based on the U-net architecture was used with a focus on high-resolution images and estimation of the BSA. The proposed method trained the model with the same patch size of 512 × 512 and predicted testing images with different patch sizes. We collected 255 high-resolution psoriasis images representing large anatomical sites, such as the trunk and extremities. The average residual of the ground truth image and the predicted image was approximately 0.033. The interclass correlation coefficient between the U-net and dermatologist's segmentations measured in the ratio of affected psoriasis over the body area in the test dataset was 0.966 (95% CI: 0.981-0.937), indicating strong agreement. Herein, the proposed U-net model achieved dermatologist-level performance in estimating the involved BSA for psoriasis.

Cataract Disease Detection by Using Transfer Learning-Based Intelligent Methods.

One of the most common visual disorders is cataracts, which people suffer from as they get older. The creation of a cloud on the lens of our eyes is known as a cataract. Blurred vision, faded colors, and difficulty seeing in strong light are the main symptoms of this condition. These symptoms frequently result in difficulty doing a variety of tasks. As a result, preliminary cataract detection and prevention may help to minimize the rate of blindness. This paper is aimed at classifying cataract disease using convolutional neural networks based on a publicly available image dataset. In this observation, four different convolutional neural network (CNN) meta-architectures, including InceptionV3, InceptionResnetV2, Xception, and DenseNet121, were applied by using the TensorFlow object detection framework. By using InceptionResnetV2, we were able to attain the avant-garde in cataract disease detection. This model predicted cataract disease with a training loss of 1.09%, a training accuracy of 99.54%, a validation loss of 6.22%, and a validation accuracy of 98.17% on the dataset. This model also has a sensitivity of 96.55% and a specificity of 100%. In addition, the model greatly minimizes training loss while boosting accuracy.

Representation of African American Patients in Social Media for Breast Reconstruction.

BACKGROUND: Social media use by plastic surgeons may contribute to the overall increase in breast reconstruction in the United States. However, recent data show a concerning decrease in breast reconstruction in African American women. The purpose of this study was to analyze the inclusion of African American women in social media posts for breast reconstruction, with the premise that this may be a possible contributing factor to decreasing rates of breast reconstruction in this population. METHODS: Data from several social media platforms were obtained manually on December 1, 2019. Each image was analyzed using the Fitzpatrick scale as a guide. RESULTS: A total of 2580 photographs were included that met the authors' criteria. Only 172 photographs (6.7 percent) were nonwhite. This study surveyed 543 surgeons, 5 percent of whom were nonwhite. The analysis of the results from the random sample of the top plastic surgery social media influencers showed that only 22 (5 percent) of the photographs uploaded were nonwhite patients. Furthermore, 30 percent of surgeons did not have any photographs of nonwhite patients uploaded. CONCLUSIONS: Numerous factors can contribute to the disparity between the growing trend of white patients seeking reconstructive surgery compared to the decreasing trend of African American patients, one of which may be the disparity in their representation in social media, particularly among common platforms and social media influencers. This study highlights the evolving factors that may impair African American breast cancer patients' access to safe, effective breast reconstruction, which must be identified and resolved.

Les défis de la gestion du diabète chez les personnes itinérantes : étude qualitative avec la méthode photovoix.

CONTEXTE: La recherche sur les défis de la prise en charge du diabète chez les personnes itinérantes qui en sont atteintes n'a pas tendance à prendre en considération le point de vue des personnes touchées. Nous avons utilisé une approche de recherche participative avec la communauté pour explorer ces défis. MÉTHODES: Nous avons recruté des cochercheurs ayant une connaissance expérientielle de l'itinérance et du diabète. Les chercheurs principaux leur ont offert une formation en recherche et ont préparé le terrain avec eux pour ce projet. Les cochercheurs ont collectivement choisi d'utiliser la méthode photovoix pour illustrer la difficulté de bien s'alimenter quand on est en situation d'itinérance et explorer en quoi cet écueil affecte plus largement la gestion du diabète. Après une formation en photographie et en éthique, les cochercheurs ont pris des photos en lien avec les objectifs du projet et rédigé des récits connexes au moyen de techniques de rédaction inspirée par des photos. Les chercheurs principaux ont analysé les photos et les récits, et ils en ont dégagé des thèmes qui se sont précisés lors de discussions de groupe. RÉSULTATS: Les 8 cochercheurs étaient atteints de diabète de type 2 (diagnostiqué de 18 mois à 23 ans auparavant) et avaient vécu en situation d'itinérance pendant des périodes allant de 8 mois à 12 ans. Nous avons dégagé 4 thèmes à partir de 17 photos et récits produits. L'itinérance affecte grandement la santé émotionnelle et mentale des personnes, ce qui nuit à leur capacité de bien gérer leur diabète. Les aliments servis dans les refuges sont rarement nutritifs ou appétissants. L'obtention d'une forme de logement peut faciliter la prise en charge du diabète en créant un environnement stable qui favorise l'autonomie, mais les coûts et le manque de connaissances sont des obstacles à la préparation de repas sains. L'itinérance complique aussi l'accès aux professionnels de la prise en charge du diabète et aux médicaments d'ordonnance. INTERPRÉTATION: Les images et les récits associés permettent de dresser un tableau frappant, complet et fidèle des défis auxquels sont confrontées les personnes en situation d'itinérance qui essaient de gérer leur diabète. Comprendre ces défis est la première étape qui permettra aux intervenants et aux décideurs de répondre aux besoins de cette population.

Validación, reproducibilidad y confiabilidad del registro dietético fotográfico para la valoración de la ingesta alimentaria / Validation, reproducibility, and reliability of food photographic record for food intake assessment

Introducción: registrar la ingesta alimentaria permite valorar la dieta y facilita el proceso de autoevaluación, autocontrol y motivación al cambio del comportamiento alimentario. Las nuevas tecnologías y el uso de los teléfonos móviles permiten otra forma de registrar la ingesta. Objetivo: validar y valorar el registro dietético fotográfico (RDF) como instrumento de utilidad en la práctica profesional. Metodología: participaron 40 licenciados en Nutrición. En una primera etapa, se analizaron y correlacionaron las variables alimentarias obtenidas a través de los instrumentos RDF frente a un cuestionario de frecuencia de consumo alimentario (CFCA) y un recordatorio de 24 horas (R24hs). En una segunda etapa se aplicó nuevamente el RDF y se valoró su estabilidad temporal en los registros obtenidos (RDF 1 y RDF 2). Se aplicaron el test de Wilcoxon y el test de correlación de Spearman. Resultados: se encontró una asociación positiva moderada y estadísticamente significativa para el VET y las grasas totales entre el RDF y el R24hs (r = 0,68, p = 0,0008 y r = 0,52, p = 0,01, respectivamente). Además, se observó una asociación positiva de intensidad moderada y estadísticamente significativa para el VET, las proteínas y las grasas entre el RDF 1 y el RDF 2 (r = 0,61, p = 0,0004; r = 0,60, p = 0,0005; r = 0,64, p = 0,0002, respectivamente). Conclusión: el RDF es un método válido en la práctica profesional para la estimación de la ingesta alimentaria, en mayor consonancia con los datos obtenidos con el R24hs, y presenta estabilidad temporal para los registros de VET, proteínas y grasas. Además, colabora en la adquisición de hábitos alimentarios positivos como son las ingestas más conscientes, entre otros beneficios. (AU)

Introduction: food intake records are a useful resource for diet assessment, as well as for self-evaluation, self-control, and self-motivation to change an eating behavior. New technologies based on mobile phones permit a different way of recording food intake. Objective: to validate and assess food photographic record (FPR) as a useful instrument in professional practice for assessing food intake. Methodology: forty nutrition professionals participated. In a first stage, food variables obtained through FPR were analyzed and correlated with data from the frequency of food consumption questionnaire (FFQ) and a 24-hour recall (24HR). In a second stage, FPR was applied again to evaluate temporal stability (FPR 1 versus FPR 2). Wilcoxon's test and Spearman's correlation test were applied. Results: a moderate and significant positive association was found for total caloric intake (TCI) and total fat between FPR and 24HR (r = 0.68, p = 0.0008, and r = 0.52, p = 0.01, respectively). In addition, a positive and moderate association was found for TCI, proteins and fats between FPR 1 and FPR 2 (r = 0.61, p = 0.0004; r = 0.60, p = 0.0005; r = 0.64, p = 0.0002, respectively). Conclusion: FPR is a valid method for professional practice to estimate dietary intake, with greater consistency with 24HR data than FFQ, and presents temporal stability for TCI, protein and fat recordings. In addition, FPR may facilitate the adoption of positive eating habits such as more conscious intakes, among other benefits. (AU)

Identifying gaps in the photographic record of the vascular plant flora of the Americas.

Field photographs of plant species are crucial for research and conservation, but the lack of a centralized database makes them difficult to locate. We surveyed 25 online databases of field photographs and found that they harboured only about 53% of the approximately 125,000 vascular plant species of the Americas. These results reflect the urgent need for a centralized database that can both integrate and complete the photographic record of the world's flora.

Deep-learning models for the detection and incidence prediction of chronic kidney disease and type 2 diabetes from retinal fundus images.

Regular screening for the early detection of common chronic diseases might benefit from the use of deep-learning approaches, particularly in resource-poor or remote settings. Here we show that deep-learning models can be used to identify chronic kidney disease and type 2 diabetes solely from fundus images or in combination with clinical metadata (age, sex, height, weight, body-mass index and blood pressure) with areas under the receiver operating characteristic curve of 0.85-0.93. The models were trained and validated with a total of 115,344 retinal fundus photographs from 57,672 patients and can also be used to predict estimated glomerulal filtration rates and blood-glucose levels, with mean absolute errors of 11.1-13.4 ml min-1 per 1.73 m2 and 0.65-1.1 mmol l-1, and to stratify patients according to disease-progression risk. We evaluated the generalizability of the models for the identification of chronic kidney disease and type 2 diabetes with population-based external validation cohorts and via a prospective study with fundus images captured with smartphones, and assessed the feasibility of predicting disease progression in a longitudinal cohort.

[Validation, reproducibility, and reliability of food photographic record for food intake assessment]. / Validación, reproducibilidad y confiabIlidad del registro dietético fotográfico para la valoración de la ingesta alimentaria.

INTRODUCTION: Introduction: food intake records are a useful resource for diet assessment, as well as for self-evaluation, self-control, and self-motivation to change an eating behavior. New technologies based on mobile phones permit a different way of recording food intake. Objective: to validate and assess food photographic record (FPR) as a useful instrument in professional practice for assessing food intake. Methodology: forty nutrition professionals participated. In a first stage, food variables obtained through FPR were analyzed and correlated with data from the frequency of food consumption questionnaire (FFQ) and a 24-hour recall (24HR). In a second stage, FPR was applied again to evaluate temporal stability (FPR 1 versus FPR 2). Wilcoxon's test and Spearman's correlation test were applied. Results: a moderate and significant positive association was found for total caloric intake (TCI) and total fat between FPR and 24HR (r = 0.68, p = 0.0008, and r = 0.52, p = 0.01, respectively). In addition, a positive and moderate association was found for TCI, proteins and fats between FPR 1 and FPR 2 (r = 0.61, p = 0.0004; r = 0.60, p = 0.0005; r = 0.64, p = 0.0002, respectively). Conclusion: FPR is a valid method for professional practice to estimate dietary intake, with greater consistency with 24HR data than FFQ, and presents temporal stability for TCI, protein and fat recordings. In addition, FPR may facilitate the adoption of positive eating habits such as more conscious intakes, among other benefits.

INTRODUCCIÓN: Introducción: registrar la ingesta alimentaria permite valorar la dieta y facilita el proceso de autoevaluación, autocontrol y motivación al cambio del comportamiento alimentario. Las nuevas tecnologías y el uso de los teléfonos móviles permiten otra forma de registrar la ingesta. Objetivo: validar y valorar el registro dietético fotográfico (RDF) como instrumento de utilidad en la práctica profesional. Metodología: participaron 40 licenciados en Nutrición. En una primera etapa, se analizaron y correlacionaron las variables alimentarias obtenidas a través de los instrumentos RDF frente a un cuestionario de frecuencia de consumo alimentario (CFCA) y un recordatorio de 24 horas (R24hs). En una segunda etapa se aplicó nuevamente el RDF y se valoró su estabilidad temporal en los registros obtenidos (RDF 1 y RDF 2). Se aplicaron el test de Wilcoxon y el test de correlación de Spearman. Resultados: se encontró una asociación positiva moderada y estadísticamente significativa para el VET y las grasas totales entre el RDF y el R24hs (r = 0,68, p = 0,0008 y r = 0,52, p = 0,01, respectivamente). Además, se observó una asociación positiva de intensidad moderada y estadísticamente significativa para el VET, las proteínas y las grasas entre el RDF 1 y el RDF 2 (r = 0,61, p = 0,0004; r = 0,60, p = 0,0005; r = 0,64, p = 0,0002, respectivamente). Conclusión: el RDF es un método válido en la práctica profesional para la estimación de la ingesta alimentaria, en mayor consonancia con los datos obtenidos con el R24hs, y presenta estabilidad temporal para los registros de VET, proteínas y grasas. Además, colabora en la adquisición de hábitos alimentarios positivos como son las ingestas más conscientes, entre otros beneficios.

Evaluating the speed camera sites selection criteria in the UK.

INTRODUCTION: Speed cameras have been implemented to improve road safety over recent decades in the UK. Although the safety impacts of the speed camera have been estimated thoroughly, the criteria for selecting camera sites have rarely been studied. This paper evaluates the current speed camera sites selection criteria in the UK based on safety performance. METHOD: A total of 332 speed cameras and 2,513 control sites with road traffic accident data are observed from 2002 to 2010. Propensity score matching method and empirical Bayes method are employed and compared to estimate the safety effects of speed cameras under different scenarios. RESULTS: First, the main characteristics of speed cameras meeting and not meeting the selection criteria are identified. The results indicate that the proximity to school zones and residential neighborhoods, as well as population density, are the main considerations when selecting speed camera sites. Then the official criteria used for selecting camera sites are evaluated, including site length (a stretch of road that has a fixed speed camera or has had one in the past), previous accident history, and risk value (a numerical scale of the risk level). The results suggest that a site length of 500 m should be used to achieve the optimum safety effects of speed cameras. Furthermore, speed cameras are most effective in reducing crashes when the requirement of minimum number of historical killed and seriously injured collisions (KSIs) is met. In terms of the risk value, it is found that the speed cameras can obtain optimal effectiveness with a risk value greater than or equal to 30, rather than the recommended risk value of 22.

Does body appreciation or satisfaction buffer against idealised functionality-focused images of models?

Research suggests that greater levels of body appreciation and body satisfaction may protect women from negative outcomes when viewing media images of the thin-ideal. In this study, we compared the effectiveness of body appreciation and body satisfaction in ameliorating negative effects from viewing images of the traditional thin-ideal and the newer functional-ideal (i.e., models presented in active stances with a focus on the function of their body). A sample of 122 women (Mage = 24.43 years) from a regional university and the general community was recruited to complete an online study. Participants were randomly allocated to view images of models presented in either an active or posed stance, or images of scenery. Participants completed pre- and post-test measures of appearance and functionality satisfaction, as well as trait measures of body appreciation and satisfaction. Results showed that women had poorer outcomes after viewing the active but not the posed or scenery images. Neither body appreciation nor body satisfaction moderated effects. Active, functional images may be particularly insidious and further research is needed to identify effective protective strategies.

Monitoring photographic proof of cecal intubation: A closed-loop audit of best practice colonoscopy.

Gold standard colonoscopy in the UK demands a 90% cecal intubation (CI) rate. Endoscopists must provide photographic evidence of CI, which can include images of the terminal ileum, appendix orifice, anastomosis or ileocecal valve. Whilst photographic proof of intubation should be obtained for all complete colonoscopies, this is not routinely audited. Three hundred and ninety-six complete colonoscopies were analyzed, 200 in an initial audit, and 196 in a second audit. Photos taken during colonoscopy were reviewed for evidence of successful CI, as well as whether these photographs had been marked as "proof of intubation" (POI). Results were shared at departmental governance meetings in order to assess any improvement in practice. Initial audit revealed 70% of colonoscopies had provided sufficient proof of CI but only 50% provided photographs that were described as such. Twenty percent of colonoscopies provided sufficient images, but these were not identified as POI. Thirty percent of all colonoscopies provided insufficient proof of CI. Upon repeat audit, 71% of colonoscopies met best practice standards, with the remaining 29% showing insufficient evidence of CI. In the modern era of digital technology, lack of photographic evidence should be seen as unacceptable and may raise important clinical and medicolegal concerns. We recommend that audits such as this become standard practice to ensure best practice.

The Utility of Routine Fundus Photography Screening for Posterior Segment Disease: A Stepped-wedge, Cluster-randomized Trial in South India.

PURPOSE: To assess whether routine fundus photography (RFP) to screen for posterior segment disease at community eye clinics (vision centers [VCs]) in India increases referral to centralized ophthalmolic care. DESIGN: Stepped-wedge, cluster-randomized trial. PARTICIPANTS: Patients aged 40 to 75 years and those aged 20 to 40 years with a known history of hypertension or diabetes mellitus presenting to 4 technician-run VCs associated with the Aravind Eye Care System in India. METHODS: VCs (clusters) were randomized to standard care or RFP across five 2-week study periods (steps). Patients in each cluster received standard care initially. At the start of each subsequent step, a randomly chosen cluster crossed over to providing RFP to eligible patients. All clusters took part in RFP during the last step. Standard care involved technician eye exams, optional fundus photography, and teleconsultation with an ophthalmologist. RFP involved eye exams, dilation and 40-degree fundus photography, and teleconsultation with an ophthalmologist. MAIN OUTCOME MEASURES: Standard care and RFP clusters were compared by the proportion of patients referred for in-person evaluation by an ophthalmologist because of fundus photography findings and urgency of referral (urgently in ≤ 2 weeks vs. nonurgently in > 2 weeks). Generalized linear mixed models adjusting for cluster and step were used to estimate the odds of referral due to fundus photography findings compared with standard care. RESULTS: A total of 1447 patients were enrolled across the VCs, including 737 in the standard care group and 710 in the RFP group. Compared with standard care, the RFP group had a higher proportion of referrals due to fundus photography findings (11.3% vs. 4.4%), nonurgent referrals due to fundus photography (9.3% vs. 3.3%), and urgent referrals due to fundus photography (1.8% vs. 1.1%). The RFP intervention was associated with a 2-fold increased odds of being referred because of photography findings compared with standard care (odds ratio, 2.07; 95% confidence interval, 0.98-4.40; P = 0.058). CONCLUSIONS: Adding RFP to community eye clinics was associated with an increased odds of referral compared with standard care. This increase in referral was mostly due to nonurgent posterior segment disease.

A causal analysis of time-varying speed camera safety effects based on the propensity score method.

INTRODUCTION: Speed limit enforcement cameras provide an effective approach to reduce vehicle speeds and the number of road accidents. However, it is still unclear whether the safety effects of speed cameras show durability over long periods of time. This paper analyses how the effects of speed cameras on road accidents change over time. A total number of 771 camera sites and 4787 potential control sites are observed for a period of 18 years (1999-2016) across England. METHOD: Covariates such as road class, crash history, speed limit, and annual average daily traffic (AADT) are included in the data set. A difference in difference (DID) based propensity score matching (PSM) method is employed to select proper control sites and estimate the treatment effects. The safety effects of speed cameras are then evaluated from a long-term perspective. The post-treatment period is divided into four equal-length periods: early, medium 1 and 2, and late. RESULTS AND CONCLUSIONS: The results show that speed cameras have significantly reduced the number of road accidents near the camera sites. However, the effects vary across different time periods. The safety effects of speed cameras experienced a sharp decrease during the medium periods after an initial period of highly reduced accidents (medium 1: -53.1%, medium 2: -40.7%) and recovered slightly during the late period. In addition, to evaluate the criteria for selecting camera sites in the UK, we further investigated whether speed cameras at high risk sites have better safety performance. The results show that while safety effects at high risk camera sites also decreased during the medium periods, the reduction was smaller (medium 1: -20.8%, medium 2: -2.1%). Practical Applications: Appropriate road traffic regulations and management, as well as proper camera sites selection criterion, are important to maintain the effectiveness of speed cameras.

Development and Validation Clinician and Patient Reported Photonumeric Scales to Assess Buttocks Cellulite Severity.

BACKGROUND: The Clinician Reported Photonumeric Cellulite Severity Scale (CR-PCSS) and Patient Reported PCSS (PR-PCSS) are newly developed tools for assessing cellulite severity. OBJECTIVE: To report on the reliability, validity, and ability to detect a change in cellulite severity on the buttocks of adult women with the CR-PCSS and PR-PCSS. MATERIALS AND METHODS: Content validity of both scales was established through concept elicitation and cognitive interviews. Test-retest reliability was evaluated, and intra-rater (both scales) and inter-rater (CR-PCSS only) reliability were estimated using intraclass correlation coefficients (ICCs) for agreement and consistency. Ability to detect a change was determined using the Subject-Global Aesthetic Improvement Scale (GAIS) or Investigator-GAIS as anchors. RESULTS: For the CR-PCSS (n = 6) at baseline and Day 2, the mean interrater ICCs were ≥0.70 and mean intrarater ICCs (95% confidence interval [CI]) were ≥0.81 (0.72-0.90) for both buttocks. For the PR-PCSS (n = 99) at baseline and Day 14, the mean test-retest reliability ICCs (95% CI) were ≥0.86 (0.79-0.91) for both buttocks. A clinically meaningful change was 1.0 point on the PR-PCSS and 1.0 on the CR-PCSS. CONCLUSION: The CR-PCSS and PR-PCSS reliably assess cellulite severity of the buttocks and can detect a clinically meaningful change after treatment for cellulite.

PhotoId-Whale: Blue whale dorsal fin classification for mobile devices.

Photo-identification (photo-id) is a method used in field studies by biologists to monitor animals according to their density, movement patterns and behavior, with the aim of predicting and preventing ecological risks. However, these methods can introduce subjectivity when manually classifying an individual animal, creating uncertainty or inaccuracy in the data as a result of the human criteria involved. One of the main objectives in photo-id is to implement an automated mechanism that is free of biases, portable, and easy to use. The main aim of this work is to develop an autonomous and portable photo-id system through the optimization of image classification algorithms that have high statistical dependence, with the goal of classifying dorsal fin images of the blue whale through offline information processing on a mobile platform. The new proposed methodology is based on the Scale Invariant Feature Transform (SIFT) that, in conjunction with statistical discriminators such as the variance and the standard deviation, fits the extracted data and selects the closest pixels that comprise the edges of the dorsal fin of the blue whale. In this way, we ensure the elimination of the most common external factors that could affect the quality of the image, thus avoiding the elimination of relevant sections of the dorsal fin. The photo-id method presented in this work has been developed using blue whale images collected off the coast of Baja California Sur. The results shown have qualitatively and quantitatively validated the method in terms of its sensitivity, specificity and accuracy on the Jetson Tegra TK1 mobile platform. The solution optimizes classic SIFT, balancing the results obtained with the computational cost, provides a more economical form of processing and obtains a portable system that could be beneficial for field studies through mobile platforms, making it available to scientists, government and the general public.

Optical coherence tomography and color fundus photography in the screening of age-related macular degeneration: A comparative, population-based study.

PURPOSE: To analyze the individual value and the contribution of color fundus photography (CFP) and optical coherence tomography (OCT) in the screening of age-related macular degeneration (AMD) of an unselected population. METHODS: CFP and OCT images of 15957 eyes of 8069 subjects older than 55 years, obtained during a population-based screening for AMD using a single diagnostic non-mydriatic imaging device, were analyzed by a blinded examiner. The two techniques were preliminary evaluated considering the dichotomous parameter "gradable/ungradable", then gradable images were classified. CFP were graded according to the standardized classification of AMD lesions. OCT images were also categorized considering the presence of signs of early/intermediate AMD, late AMD, or other retinal diseases. Another blinded operator re-graded 1978 randomly selected images (for both CFP and OCT), to assess test reproducibility. RESULTS: Of the 15957 eyes, 8356 CFP (52.4%) and 15594 (97.7%) OCT scans were gradable. Moreover, most of the eyes with ungradable CFP (7339, 96.6%) were gradable at OCT. AMD signs were revealed in 7.4% of gradable CFP and in 10.4% of gradable OCT images. Moreover, at OCT, AMD signs were found in 1110 (6.9%) eyes whose CFP were ungradable or without AMD (847 and 263 eyes, respectively). The inter-operator agreement was good for the gradable versus ungradable parameter, and optimal for the AMD grading parameter of CFP. The agreement was optimal for all OCT parameters. CONCLUSIONS: OCT provided gradable images in almost all examined eyes, compared to limited CFP efficiency. Moreover, OCT images allowed to detect more AMD eyes compared to gradable photos. OCT imaging appears to significantly improve the power of AMD screening in a general, unselected population, compared to CFP alone.