Enhancement of retinal images: pros and problems

Evaluation of retinal images is essential to modern ophthalmic care. With the advent of image processing equipment, digital recording and processing of retinal images is starting to replace the standard film based fundus photography. The ability to enhance images is cited as one of the major benefits of this expensive technology. This paper critically reviews the practices employed in the image enhancement literature. It is argued that the papers published to date have not presented convincing evidence regarding the diagnostic value of retinal image enhancement. The more elaborate studies in radiology suggest, at best, modest diagnostic improvement with enhancement. The special difficulties associated with the demonstration of an improved diagnosis in ophthalmic imaging are discussed in terms of the diagnostic task and the selection of study populations.