There have been times over the past few months when I've felt that 'Year 3 of TAT' is so called because some of the images are so poor, they look like they were taken by a class of 7-year-olds. I'm still convinced that one or two were captured by candlelight with the patient's glasses still on, using a pinhole camera knocked up from an old occluder and a box of tropicamide.

I know we're meant to be saving sight, but at times I've been more worried about the vision of the photographer who felt they were acceptable images. We live in an age of digital photography, where the only cost of a bad photo is a few seconds of the operative's time, so surely we should be wiping those smudges off the lens, removing the dust from the microchip, and then bumping up the flash and having another go.

Of course, the whole point of Test and Training is to perform an EQA function, and it's definitely succeeding there. I've identified a few outliers myself, just from looking at the photos. Now we just need to find out which programmes they work for, and teach them how to use a camera.

Personally I think each Test & Training image should be coded to identify the photographer, and come with a scorecard, allowing us all to rate them on a scale of one to ten. Thus every image set would not only give an insight into the skill of the grader, but also provide quality assurance for the photographers. Screeners whose photos receive consistently low marks could be flagged up for more training, in the same way that graders are.

If anything, this is an even more vital aspect of EQA. It's all very well checking that your graders are up to the job, but if the images they're presented with are sub-standard, no amount of grading skill is going to compensate for that, and disease will undoubtedly be missed. The photos are the foundation on which the whole screening process is based, and if programmes make do with poor quality images, that house of cards will soon come crashing down around us.

On the plus side, of course, grading the occasional dodgy photo does give us a bit of practice with the more unusual and challenging images we all face from time to time. So have a go at this one...

Retina Display
Suffice it to say, there's a lot going on there. Fragments of the temporal arcade are still visible, particularly the superior artery, but the optic disc appears to have faded into the background, possibly as a result of papilloedema. The macula is ill-defined, with some haemorrhaging at the fovea, and some lighter patches which could be AMD, hard exudates or clumps of drusen. Overall, the picture looks so ischaemic that virtually the entire retinal blood supply has been shut down, with obvious implications for vision.

It's clearly not a well eye. In fact it's not an eye at all. It's actually a photo of the sun. But I think I'd go for R1M1 and a routine referral.