Sir,

We read with great interest the work of DAL Maberley et al1 on the ‘Evaluation of photographic screening for neovascular age-related macular degeneration’. The authors were looking at the utility of colour fundus photographs for identifying subjects with potentially treatable neovascular AMD. While the methods, analysis and conclusions of the study seem both convincing and sound, the following is a suggestion, although meager, we feel could be of value to the authors.

DAL Maberley et al used Kodak-chrome colour slides for both stereoscopic and nonstereo images. Although important in both documentation and diagnosis, the 35 mm colour fundus photos are slowly loosing their allure in retinal imaging. Colour slides are being replaced by the technologically more advanced digital fundus photography. This imaging tool used to give a less detailed picture in the past when compared to 35 mm, however, with the recently available 6.0 megapixel cameras, resolution of the photos has been comparable if not superior to traditional cameras. Even reference reading centres, such as the University of Wisconsin Reading Centre is gradually switching to high-resolution digital photography, replacing the gold standard 35 mm slides. Advantages in digital photography comprise better manipulation of the fundus image, including magnification and colour filtering, and easier electronic storage/e-mailing. Finally, despite an initial higher cost, the digital camera's on going financial burden is by far less than film. We suggest to our authors embarking on digital photography (stereo and nonstereo) for projects to detect retinal pathology. This was proven both valuable and effective in ample studies.2, 3, 4 Also, by using the different image manipulation tools, the authors then might achieve an even higher sensitivity and specificity than the one reported.