Editor,—The key to successful age related macular degeneration (ARMD) screening is the efficient production of accurate classified images with minimum patient inconvenience.1 The technologies of digital image analysis and artificial neural networks (ANN) are not new and have been used in the past to provide a more objective basis for a range of medical applications.2-9They have, however, not been used for operational classification of maculopathies such as ARMD. Research has shown that ANN computer programs are capable of discriminating normal fundus from those with diabetic retinopathy, potentially reducing the numbers of images requiring expert examination by 70% or more.10

Digital fundus images from a Topcon Imagenet camera were modified by in-house computer imaging techniques (erdas Imagine Software) within a geographical information system (GIS) (Fig 1). The ANN used …