Pub Date : 2025-09-20DOI: 10.1016/j.ajoint.2025.100172
God’sglory Isoken Braimoh, Faustina Idu, Clinton Ifeanyi Okechukwu
Purpose
To assess awareness, acceptance, and perceived barriers to tele-eye care among patients and eye care practitioners in Benin City, Nigeria.
Methods
A cross-sectional survey was conducted over three months among 332 patients attending clinics and 56 licensed eye care practitioners (optometrists and ophthalmologists). A structured questionnaire, adapted from prior studies, was administered via Google Forms. Practitioners received the survey through professional WhatsApp groups, while patients completed it during clinic visits. Data were analyzed using descriptive statistics and inferential tests (chi-square, t-tests, and logistic regression) to assess associations, with significance set at p < 0.05.
Results
Awareness of tele-eye care was modest among patients (47.6 %), and prior use was low (25.3 %), yet willingness to adopt mobile-based applications was high (88.6 %). Patients’ main concerns included reduced quality of care (81.3 %), limited personal interaction (53.0 %), and privacy risks (51.5 %). Most practitioners (93 %) were familiar with telemedicine, though only 32 % reported its use in their clinics. While 84 % believed it could expand access to care, concerns included diagnostic accuracy (67.9 %), restricted service applicability (73.2 %), and insufficient practitioner training (75 %).
Conclusion
Both patients and practitioners in Benin City expressed strong interest in tele-eye care, though actual use remains limited. Adoption is constrained by service limitations, privacy concerns, and inadequate training. Targeted practitioner education, improved digital infrastructure, and clear regulatory frameworks are needed to facilitate broader integration of tele-eye care into routine practice.
{"title":"Tele-eye care: Perspective and acceptance among patients and eye care practitioners in Benin City","authors":"God’sglory Isoken Braimoh, Faustina Idu, Clinton Ifeanyi Okechukwu","doi":"10.1016/j.ajoint.2025.100172","DOIUrl":"10.1016/j.ajoint.2025.100172","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess awareness, acceptance, and perceived barriers to tele-eye care among patients and eye care practitioners in Benin City, Nigeria.</div></div><div><h3>Methods</h3><div>A cross-sectional survey was conducted over three months among 332 patients attending clinics and 56 licensed eye care practitioners (optometrists and ophthalmologists). A structured questionnaire, adapted from prior studies, was administered via Google Forms. Practitioners received the survey through professional WhatsApp groups, while patients completed it during clinic visits. Data were analyzed using descriptive statistics and inferential tests (chi-square, <em>t</em>-tests, and logistic regression) to assess associations, with significance set at <em>p</em> < 0.05.</div></div><div><h3>Results</h3><div>Awareness of tele-eye care was modest among patients (47.6 %), and prior use was low (25.3 %), yet willingness to adopt mobile-based applications was high (88.6 %). Patients’ main concerns included reduced quality of care (81.3 %), limited personal interaction (53.0 %), and privacy risks (51.5 %). Most practitioners (93 %) were familiar with telemedicine, though only 32 % reported its use in their clinics. While 84 % believed it could expand access to care, concerns included diagnostic accuracy (67.9 %), restricted service applicability (73.2 %), and insufficient practitioner training (75 %).</div></div><div><h3>Conclusion</h3><div>Both patients and practitioners in Benin City expressed strong interest in tele-eye care, though actual use remains limited. Adoption is constrained by service limitations, privacy concerns, and inadequate training. Targeted practitioner education, improved digital infrastructure, and clear regulatory frameworks are needed to facilitate broader integration of tele-eye care into routine practice.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100172"},"PeriodicalIF":0.0,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-17DOI: 10.1016/j.ajoint.2025.100173
Emily Sun , Chen Dun , Susan K. Burden , Ambar Faridi , Laura K. Green , Andrea L. Kossler , Christina R. Prescott , Jamie B. Rosenberg , Erin M. Shriver , Grace Sun , Christina Y. Weng , Kimberly M. Winges , Maria A. Woodward , Fasika A. Woreta
Purpose
To examine gender differences in faculty rank and salary among ophthalmology subspecialists at U.S. medical schools.
Design
Retrospective cross-sectional
Methods
Gender and academic rank for faculty where state laws mandate public salary disclosure for university employees were collected from department websites. Annual salary was collected from GovSalaries.com. Differences in rank and salary, by gender, were analyzed using Student’s t-test.
Results
Salaries were available from 28/122 departments (23 %) from 17 states (538 ophthalmologists, 41.1 % women). A smaller proportion of women were full professors compared to men (25.8 % vs. 46.7 %). A larger proportion were assistant professors (47.1 % vs. 30.1 %) or associate professors (27.1 % vs. 22.7 %). Medical retina, neuro-ophthalmology, and comprehensive ophthalmology had the largest gender disparity among full professors between men and women (15.4 % vs. 61.5 %; 31.3 % vs. 69.0 %; 5.9 % vs. 42.1 % respectively).
Women had lower salaries compared to men across all subspecialties ($281,718 vs. $364,017, p < 0.0001), including assistant professors ($229,389 vs. $265,974, p = 0.03). There were no significant differences among associate ($280,704 vs. $324,434, p = 0.15) or full professors ($378,264 vs. $447,531, p = 0.08). Among assistant professors, women had lower salaries in comprehensive ophthalmology ($224,755 vs. $441,742 p < 0.0001), cornea ($181,284 vs. $276,121, p = 0.05), and medical retina ($204,057 vs. $393,616, p = 0.03). Overall, women earned significantly less after controlling for subspecialty, VA status, rank, and region ($278,751 vs. $308,629, p = 0.015), and earned significantly less in comprehensive ophthalmology ($230,837 vs. $355,782, p = 0.038) and cornea ($289,211 vs. $360,546, p = 0.018).
Conclusions
Significant gender differences in rank and salary exist in several subspecialties. Further research is needed to identify effective strategies for these disparities.
{"title":"Gender differences in faculty rank and salary among ophthalmology subspecialists at U.S. public medical schools","authors":"Emily Sun , Chen Dun , Susan K. Burden , Ambar Faridi , Laura K. Green , Andrea L. Kossler , Christina R. Prescott , Jamie B. Rosenberg , Erin M. Shriver , Grace Sun , Christina Y. Weng , Kimberly M. Winges , Maria A. Woodward , Fasika A. Woreta","doi":"10.1016/j.ajoint.2025.100173","DOIUrl":"10.1016/j.ajoint.2025.100173","url":null,"abstract":"<div><h3>Purpose</h3><div>To examine gender differences in faculty rank and salary among ophthalmology subspecialists at U.S. medical schools.</div></div><div><h3>Design</h3><div>Retrospective cross-sectional</div></div><div><h3>Methods</h3><div>Gender and academic rank for faculty where state laws mandate public salary disclosure for university employees were collected from department websites. Annual salary was collected from GovSalaries.com. Differences in rank and salary, by gender, were analyzed using Student’s <em>t</em>-test.</div></div><div><h3>Results</h3><div>Salaries were available from 28/122 departments (23 %) from 17 states (538 ophthalmologists, 41.1 % women). A smaller proportion of women were full professors compared to men (25.8 % vs. 46.7 %). A larger proportion were assistant professors (47.1 % vs. 30.1 %) or associate professors (27.1 % vs. 22.7 %). Medical retina, neuro-ophthalmology, and comprehensive ophthalmology had the largest gender disparity among full professors between men and women (15.4 % vs. 61.5 %; 31.3 % vs. 69.0 %; 5.9 % vs. 42.1 % respectively).</div><div>Women had lower salaries compared to men across all subspecialties ($281,718 vs. $364,017, <em>p</em> < 0.0001), including assistant professors ($229,389 vs. $265,974, <em>p</em> = 0.03). There were no significant differences among associate ($280,704 vs. $324,434, <em>p</em> = 0.15) or full professors ($378,264 vs. $447,531, <em>p</em> = 0.08). Among assistant professors, women had lower salaries in comprehensive ophthalmology ($224,755 vs. $441,742 <em>p</em> < 0.0001), cornea ($181,284 vs. $276,121, <em>p</em> = 0.05), and medical retina ($204,057 vs. $393,616, <em>p</em> = 0.03). Overall, women earned significantly less after controlling for subspecialty, VA status, rank, and region ($278,751 vs. $308,629, <em>p</em> = 0.015), and earned significantly less in comprehensive ophthalmology ($230,837 vs. $355,782, <em>p</em> = 0.038) and cornea ($289,211 vs. $360,546, <em>p</em> = 0.018).</div></div><div><h3>Conclusions</h3><div>Significant gender differences in rank and salary exist in several subspecialties. Further research is needed to identify effective strategies for these disparities.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100173"},"PeriodicalIF":0.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-10DOI: 10.1016/j.ajoint.2025.100171
Bethania López , Ellery López-Star , Van C. Lansingh , João M Furtado
Purpose
: To estimate the prevalence and causes of vision impairment and blindness among individuals aged ≥50 years in Querétaro, Mexico, and to assess progress in eye health indicators since a prior survey conducted in 2015.
Design
: Population-based cross-sectional study using the Rapid Assessment of Avoidable Blindness (RAAB) version 7 methodology.
Methods
: A total of 6574 individuals were selected via cluster sampling. Trained teams conducted visual acuity testing, lens examination, and ocular assessment using mobile data capture tools. Effective Cataract Surgical Coverage (eCSC) and Effective Refractive Error Coverage (eREC) were calculated. Results were compared with the 2015 RAAB study.
Results
: Of the eligible individuals, 5111 (77.8 %) completed the examination. The prevalence of blindness was 2.3 % (95 % CI: 1.7–3.0 %), and moderate-to-severe vision impairment was 11.4 % (95 % CI: 9.8–13.0 %). Cataract was the leading cause of blindness (49.2 %), while refractive error predominated among milder impairments. The eCSC at the <20/60 threshold was 26.6 % (95 % CI: 20.4–32.8 %), and eREC for distance vision was 37.6 % (95 % CI: 33.8–41.4 %). Compared to 2015, both prevalence of blindness and unmet need for cataract surgery increased. Barriers included cost, fear, and lack of awareness.
Conclusions
: Since 2015, the burden of avoidable blindness and vision impairment in Querétaro has grown. The findings underscore the need for expanded, higher-quality cataract and refractive services integrated into public health strategies to meet the WHO 2030 eye health targets.
{"title":"Blindness and vision impairment in Querétaro, Mexico: A comparison of RAAB surveys conducted in 2015 and 2024","authors":"Bethania López , Ellery López-Star , Van C. Lansingh , João M Furtado","doi":"10.1016/j.ajoint.2025.100171","DOIUrl":"10.1016/j.ajoint.2025.100171","url":null,"abstract":"<div><h3>Purpose</h3><div><strong>:</strong> To estimate the prevalence and causes of vision impairment and blindness among individuals aged ≥50 years in Querétaro, Mexico, and to assess progress in eye health indicators since a prior survey conducted in 2015.</div></div><div><h3>Design</h3><div><strong>:</strong> Population-based cross-sectional study using the Rapid Assessment of Avoidable Blindness (RAAB) version 7 methodology.</div></div><div><h3>Methods</h3><div><strong>:</strong> A total of 6574 individuals were selected via cluster sampling. Trained teams conducted visual acuity testing, lens examination, and ocular assessment using mobile data capture tools. Effective Cataract Surgical Coverage (eCSC) and Effective Refractive Error Coverage (eREC) were calculated. Results were compared with the 2015 RAAB study.</div></div><div><h3>Results</h3><div><strong>:</strong> Of the eligible individuals, 5111 (77.8 %) completed the examination. The prevalence of blindness was 2.3 % (95 % CI: 1.7–3.0 %), and moderate-to-severe vision impairment was 11.4 % (95 % CI: 9.8–13.0 %). Cataract was the leading cause of blindness (49.2 %), while refractive error predominated among milder impairments. The eCSC at the <20/60 threshold was 26.6 % (95 % CI: 20.4–32.8 %), and eREC for distance vision was 37.6 % (95 % CI: 33.8–41.4 %). Compared to 2015, both prevalence of blindness and unmet need for cataract surgery increased. Barriers included cost, fear, and lack of awareness.</div></div><div><h3>Conclusions</h3><div><strong>:</strong> Since 2015, the burden of avoidable blindness and vision impairment in Querétaro has grown. The findings underscore the need for expanded, higher-quality cataract and refractive services integrated into public health strategies to meet the WHO 2030 eye health targets.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100171"},"PeriodicalIF":0.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-10DOI: 10.1016/j.ajoint.2025.100170
Mohammed Suhail Najm Al-Salam , Ahmed shakir Ali Al-Wassiti , Muthanna Basheer Yasir , Mohammed Tareq Mutar
Purpose
Uveitic macular edema is a serious complication of uveitis which if not properly managed can cause visual impairment. The study aimed to assess the response of uvetic macular edema to suprachoroidal triamcinolone injections for sub-Tenon triamcinolone acetonide resistant patients. The response was measured by changes in central macular thickness (CMT) and visual acuity (VA), with measurements taken before treatment, one and three months after treatment.
Design
Prospective Single Arm Clinical Study
Methods
The study included 9 patients with non-infectious uveitis treated with systemic steroids and immunosuppressant therapy. These patients had uveitic macular edema that persisted despite adequate control of intra-ocular inflammation and showed no response to posterior sub-tenon steroids injections. Suprachoroidal triamcinolone acetonide injection was considered for those patients; 4 mg was injected into the suprachoroidal space.
Results
The study involved 44.4 % males; the mean age was 35 years. The underlying etiologies included Vogt–Koyanagi–Harada (VKH) syndrome in three patients (33.3 %), pars planitis in four patients (44.5 %), and Behcet disease in two (22.2 %).
The mean central macular thickness CMT decreased from 556 µm to 270 µm, and LogMAR visual acuity improved from 0.876 to 0.470 over three months. Over three months, 8 patients showed a 40 % reduction in CMT, with >60 % decline in 3 patients. In terms of VA, 6 patients gained 2 lines and 2 patients gained 4 lines.
Conclusion
Suprachoroidal triamcinolone demonstrated a significant improvement in visual acuity and a reduction in CMT at one and three months in patients with non-infectious uveitis.
{"title":"Suprachoroidal triamcinolone in macular edema for patients with non-infectious uveitis resistant to subtenon triamcinolone","authors":"Mohammed Suhail Najm Al-Salam , Ahmed shakir Ali Al-Wassiti , Muthanna Basheer Yasir , Mohammed Tareq Mutar","doi":"10.1016/j.ajoint.2025.100170","DOIUrl":"10.1016/j.ajoint.2025.100170","url":null,"abstract":"<div><h3>Purpose</h3><div>Uveitic macular edema is a serious complication of uveitis which if not properly managed can cause visual impairment. The study aimed to assess the response of uvetic macular edema to suprachoroidal triamcinolone injections for sub-Tenon triamcinolone acetonide resistant patients. The response was measured by changes in central macular thickness (CMT) and visual acuity (VA), with measurements taken before treatment, one and three months after treatment.</div></div><div><h3>Design</h3><div>Prospective Single Arm Clinical Study</div></div><div><h3>Methods</h3><div>The study included 9 patients with non-infectious uveitis treated with systemic steroids and immunosuppressant therapy. These patients had uveitic macular edema that persisted despite adequate control of intra-ocular inflammation and showed no response to posterior sub-tenon steroids injections. Suprachoroidal triamcinolone acetonide injection was considered for those patients; 4 mg was injected into the suprachoroidal space.</div></div><div><h3>Results</h3><div>The study involved 44.4 % males; the mean age was 35 years. The underlying etiologies included Vogt–Koyanagi–Harada (VKH) syndrome in three patients (33.3 %), pars planitis in four patients (44.5 %), and Behcet disease in two (22.2 %).</div><div>The mean central macular thickness CMT decreased from 556 µm to 270 µm, and LogMAR visual acuity improved from 0.876 to 0.470 over three months. Over three months, 8 patients showed a 40 % reduction in CMT, with >60 % decline in 3 patients. In terms of VA, 6 patients gained 2 lines and 2 patients gained 4 lines.</div></div><div><h3>Conclusion</h3><div>Suprachoroidal triamcinolone demonstrated a significant improvement in visual acuity and a reduction in CMT at one and three months in patients with non-infectious uveitis.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100170"},"PeriodicalIF":0.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.ajoint.2025.100168
Hashem Abu Serhan , Hamad A. Alkorbi , Elhassan Mahmoud , Muhammad Zain Kaleem , Omar Abousaad , Mohamed Nasser Elshabrawi , Ibrahim M. Alrawi , Abdulrahman Nasir Al Khatib , Ahmed E. Habib , Ayman G. Elnahry
Purpose
Postoperative endophthalmitis is a rare but serious complication following cataract surgery, often leading to severe vision loss and increased healthcare burden. This systematic review and meta-analysis aimed to evaluate the effectiveness of intracameral antibiotic prophylaxis in reducing the risk of postoperative endophthalmitis.
Design
A systematic review and meta-analysis.
Methods
A comprehensive literature search was conducted across PubMed, Cochrane Library, Scopus, and EMBASE up to September 18, 2024. Studies were included if they compared intracameral antibiotic prophylaxis with no prophylaxis in patients undergoing cataract surgery. The primary outcome was the odds of developing postoperative endophthalmitis. Random-effects and quality-effects models were used for meta-analysis, with heterogeneity assessed via the I² statistic. Subgroup analyses were conducted based on antibiotic type, study design, and geographic region.
Results
A total of 25 studies involving 5665,621 participants were included. The pooled odds ratio (OR) for the risk of endophthalmitis with intracameral antibiotics was 0.31 (95 % CI: 0.15–0.61), indicating a 69 % reduction in risk compared to no prophylaxis. Subgroup analysis revealed significant differences in efficacy based on antibiotic type, with moxifloxacin (OR: 0.24, 95 % CI: 0.20–0.29) and vancomycin (OR: 0.11, 95 % CI: 0.04–0.30) showing the greatest protective effects. Sensitivity analyses confirmed the robustness of results, though publication bias was suggested by funnel and Doi plots asymmetry.
Conclusions
Intracameral antibiotic prophylaxis significantly reduces the risk of postoperative endophthalmitis following cataract surgery, with moxifloxacin and vancomycin showing the strongest protective effects. Given the variability in efficacy across antibiotic types, further randomized controlled trials are needed to optimize prophylactic strategies. These findings support broader adoption of intracameral antibiotics to enhance patient safety and reduce the global burden of post-cataract endophthalmitis.
{"title":"Effectiveness of intracameral antibiotics in reducing postoperative endophthalmitis risk after cataract surgery: A meta-analysis","authors":"Hashem Abu Serhan , Hamad A. Alkorbi , Elhassan Mahmoud , Muhammad Zain Kaleem , Omar Abousaad , Mohamed Nasser Elshabrawi , Ibrahim M. Alrawi , Abdulrahman Nasir Al Khatib , Ahmed E. Habib , Ayman G. Elnahry","doi":"10.1016/j.ajoint.2025.100168","DOIUrl":"10.1016/j.ajoint.2025.100168","url":null,"abstract":"<div><h3>Purpose</h3><div>Postoperative endophthalmitis is a rare but serious complication following cataract surgery, often leading to severe vision loss and increased healthcare burden. This systematic review and meta-analysis aimed to evaluate the effectiveness of intracameral antibiotic prophylaxis in reducing the risk of postoperative endophthalmitis.</div></div><div><h3>Design</h3><div>A systematic review and meta-analysis.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted across PubMed, Cochrane Library, Scopus, and EMBASE up to September 18, 2024. Studies were included if they compared intracameral antibiotic prophylaxis with no prophylaxis in patients undergoing cataract surgery. The primary outcome was the odds of developing postoperative endophthalmitis. Random-effects and quality-effects models were used for meta-analysis, with heterogeneity assessed via the I² statistic. Subgroup analyses were conducted based on antibiotic type, study design, and geographic region.</div></div><div><h3>Results</h3><div>A total of 25 studies involving 5665,621 participants were included. The pooled odds ratio (OR) for the risk of endophthalmitis with intracameral antibiotics was 0.31 (95 % CI: 0.15–0.61), indicating a 69 % reduction in risk compared to no prophylaxis. Subgroup analysis revealed significant differences in efficacy based on antibiotic type, with moxifloxacin (OR: 0.24, 95 % CI: 0.20–0.29) and vancomycin (OR: 0.11, 95 % CI: 0.04–0.30) showing the greatest protective effects. Sensitivity analyses confirmed the robustness of results, though publication bias was suggested by funnel and Doi plots asymmetry.</div></div><div><h3>Conclusions</h3><div>Intracameral antibiotic prophylaxis significantly reduces the risk of postoperative endophthalmitis following cataract surgery, with moxifloxacin and vancomycin showing the strongest protective effects. Given the variability in efficacy across antibiotic types, further randomized controlled trials are needed to optimize prophylactic strategies. These findings support broader adoption of intracameral antibiotics to enhance patient safety and reduce the global burden of post-cataract endophthalmitis.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100168"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145010699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-31DOI: 10.1016/j.ajoint.2025.100167
Huzaifa Suri , P. Connor Lentz , David A. Leske , Mostafa Mousavi , Haley S. D’Souza , Muhammad B. Qureshi , Raymond Iezzi , Yogatheesan Varatharajah , Lauren A. Dalvin
Choroidal melanoma is the most common malignant primary intraocular tumor and can develop either de novo or from a preexisting choroidal nevus, a benign pigmented lesion. Key risk factors for the transformation of choroidal nevus into melanoma include tumor diameter > 5 mm, tumor thickness > 2 mm, orange pigment, subretinal fluid, and low internal reflectivity on ultrasound. However, the assessment of many of these risk factors requires multimodal imaging equipment and skilled subspecialists, only available at tertiary referral centers. In this study, we developed and validated a deep learning approach to identifying these risk factors based solely on fundus images of choroidal nevi. Results indicate acceptable to excellent predictive performance for detection of all five risk factors. These findings suggest that deep learning models may be valuable tools for identifying high-risk choroidal nevi, particularly in resource-limited settings.
{"title":"Development of a deep learning model to classify choroidal melanoma risk factors based on color fundus photographs","authors":"Huzaifa Suri , P. Connor Lentz , David A. Leske , Mostafa Mousavi , Haley S. D’Souza , Muhammad B. Qureshi , Raymond Iezzi , Yogatheesan Varatharajah , Lauren A. Dalvin","doi":"10.1016/j.ajoint.2025.100167","DOIUrl":"10.1016/j.ajoint.2025.100167","url":null,"abstract":"<div><div>Choroidal melanoma is the most common malignant primary intraocular tumor and can develop either de novo or from a preexisting choroidal nevus, a benign pigmented lesion. Key risk factors for the transformation of choroidal nevus into melanoma include tumor diameter > 5 mm, tumor thickness > 2 mm, orange pigment, subretinal fluid, and low internal reflectivity on ultrasound. However, the assessment of many of these risk factors requires multimodal imaging equipment and skilled subspecialists, only available at tertiary referral centers. In this study, we developed and validated a deep learning approach to identifying these risk factors based solely on fundus images of choroidal nevi. Results indicate acceptable to excellent predictive performance for detection of all five risk factors. These findings suggest that deep learning models may be valuable tools for identifying high-risk choroidal nevi, particularly in resource-limited settings.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100167"},"PeriodicalIF":0.0,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145010779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-23DOI: 10.1016/j.ajoint.2025.100166
Shahrzad Gholami , Beth Wilson , Sarah Page , Daniel B. Mummert , Joseph Carr , Robert R. McNabb , Rahul Dodhia , Juan M. Lavista Ferres , William B. Weeks , Dale E. Fajardo , Karine D. Bojikian
Purpose
To assess the performance of general-domain large language models (LLMs), particularly OpenAI’s Generative Pre-trained Transformer (GPT) models, within the American Academy of Ophthalmology (AAO) Self-Assessment Program, which is based on AAO’s Basic and Clinical Science Course.
Methods
We input 3357 questions into GPT-4o, GPT-4-Turbo, o1 and o3-mini via Microsoft’s Azure OpenAI Service using zero-shot and chain-of-thought (CoT) prompting. Questions with images were analyzed using the multimodal version of GPT-4o and GPT-4.1. The performance of the LLMs was compared to 1371 unique residents who had previously participated in the program. Additionally, we compared the performance on 1399 questions, including information on 3 question types: recall, interpretation, and decision-making or clinical management. Average accuracy rates were used to evaluate performance and compare statistical significance across categories.
Results
o1 (CoT) was the most accurate model (95% confidence interval [CI]: 90.3%–92.1%) with performance ranging from 95.17% (general medicine) to 86.9% (cornea) and 91.1% accuracy on a synthesized sample test. It also outperformed residents in recall-type, interpretation-type, and decision-making or clinical management questions (95.7%, 85.3%, and 90.8%, respectively, P < 0.001). Third-year residents were more accurate than first-year or second-year residents (78.2%, 68.3%, 74.9%, respectively). On multimodal inputs, adding images improved the model’s accuracy but all models still underperformed compared to residents.
Conclusions
The accuracy of the LLMs models continues to improve, with o1 (CoT) showing the highest overall performance. Multimodal inputs can enhance model accuracy, but current models still need improvement. LLMs shows great potential in democratizing access to high-quality medical knowledge.
{"title":"Bridging gaps in ophthalmology education through large language models","authors":"Shahrzad Gholami , Beth Wilson , Sarah Page , Daniel B. Mummert , Joseph Carr , Robert R. McNabb , Rahul Dodhia , Juan M. Lavista Ferres , William B. Weeks , Dale E. Fajardo , Karine D. Bojikian","doi":"10.1016/j.ajoint.2025.100166","DOIUrl":"10.1016/j.ajoint.2025.100166","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess the performance of general-domain large language models (LLMs), particularly OpenAI’s Generative Pre-trained Transformer (GPT) models, within the American Academy of Ophthalmology (AAO) Self-Assessment Program, which is based on AAO’s Basic and Clinical Science Course.</div></div><div><h3>Methods</h3><div>We input 3357 questions into GPT-4o, GPT-4-Turbo, o1 and o3-mini via Microsoft’s Azure OpenAI Service using zero-shot and chain-of-thought (CoT) prompting. Questions with images were analyzed using the multimodal version of GPT-4o and GPT-4.1. The performance of the LLMs was compared to 1371 unique residents who had previously participated in the program. Additionally, we compared the performance on 1399 questions, including information on 3 question types: recall, interpretation, and decision-making or clinical management. Average accuracy rates were used to evaluate performance and compare statistical significance across categories.</div></div><div><h3>Results</h3><div>o1 (CoT) was the most accurate model (95% confidence interval [CI]: 90.3%–92.1%) with performance ranging from 95.17% (general medicine) to 86.9% (cornea) and 91.1% accuracy on a synthesized sample test. It also outperformed residents in recall-type, interpretation-type, and decision-making or clinical management questions (95.7%, 85.3%, and 90.8%, respectively, <em>P</em> < 0.001). Third-year residents were more accurate than first-year or second-year residents (78.2%, 68.3%, 74.9%, respectively). On multimodal inputs, adding images improved the model’s accuracy but all models still underperformed compared to residents.</div></div><div><h3>Conclusions</h3><div>The accuracy of the LLMs models continues to improve, with o1 (CoT) showing the highest overall performance. Multimodal inputs can enhance model accuracy, but current models still need improvement. LLMs shows great potential in democratizing access to high-quality medical knowledge.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100166"},"PeriodicalIF":0.0,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144917789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Blood tests used in workup for giant cell arteritis (GCA) have shortcomings such as lack of disease specificity. We evaluated if plasma calprotectin at first clinical presentation could predict the final clinical diagnosis of GCA as evaluated at follow-up after six months.
Design
Prospective cohort study.
Methods
Blood was drawn at presentation in consecutive patients suspected of GCA. Plasma calprotectin was measured using the Gentian GCAL® Calprotectin Reagent Kit. The final diagnosis of GCA was given at six-month follow-up.
Results
Of 110 patients reviewed, 103 were eligible for data analysis, and 76 had plasma calprotectin analysis available. Of these 76, 44 (58 %) had a final diagnosis of GCA, 31 (41 %) had no GCA, and one case (1 %) was inconclusive. Plasma median calprotectin concentration was significantly higher in those with GCA than in those without (p < 0.001). Comparing the upper reference limit of the Gentian GCAL® (≥0.970 mg/L) with the final clinical diagnosis, plasma calprotectin performed with sensitivity 67 % (95 %CI: 50–81 %) and specificity 75 % (95 %CI: 55–89 %). The area under the receiver operating characteristics curve (AUC) was 0.71 (95 %CI: 0.58–0.84). Accuracy was 70 % (95 %CI 58–81 %). Using an optimal ROC cut-off limit of 0.635 mg/L, test statistics reached sensitivity 87 % (95 %CI: 73–96 %), specificity 61 % (95 %CI: 41–79 %), AUC 0.74 (95 %CI: 0.61–0.87), and accuracy 76 % (95 %CI: 64–86 %).
Conclusions
Plasma calprotectin was elevated in cases where GCA was subsequently confirmed. The value of plasma calprotectin as an inflammatory marker in cases with suspected GCA warrants further studies.
{"title":"The value of plasma calprotectin as an inflammatory marker in giant cell arteritis","authors":"Michael Stormly Hansen , Lene Terslev , Uffe Møller Døhn , Viktoria Fana , Mads Radmer Jensen , Anne Katrine Wiencke , Steffen Heegaard , Oliver Niels Klefter , Yousif Subhi , Jane Maestri Brittain , Niklas Rye Jørgensen , Steffen Hamann","doi":"10.1016/j.ajoint.2025.100165","DOIUrl":"10.1016/j.ajoint.2025.100165","url":null,"abstract":"<div><h3>Purpose</h3><div>Blood tests used in workup for giant cell arteritis (GCA) have shortcomings such as lack of disease specificity. We evaluated if plasma calprotectin at first clinical presentation could predict the final clinical diagnosis of GCA as evaluated at follow-up after six months.</div></div><div><h3>Design</h3><div>Prospective cohort study.</div></div><div><h3>Methods</h3><div>Blood was drawn at presentation in consecutive patients suspected of GCA. Plasma calprotectin was measured using the Gentian GCAL® Calprotectin Reagent Kit. The final diagnosis of GCA was given at six-month follow-up.</div></div><div><h3>Results</h3><div>Of 110 patients reviewed, 103 were eligible for data analysis, and 76 had plasma calprotectin analysis available. Of these 76, 44 (58 %) had a final diagnosis of GCA, 31 (41 %) had no GCA, and one case (1 %) was inconclusive. Plasma median calprotectin concentration was significantly higher in those with GCA than in those without (<em>p</em> < 0.001). Comparing the upper reference limit of the Gentian GCAL® (≥0.970 mg/L) with the final clinical diagnosis, plasma calprotectin performed with sensitivity 67 % (95 %CI: 50–81 %) and specificity 75 % (95 %CI: 55–89 %). The area under the receiver operating characteristics curve (AUC) was 0.71 (95 %CI: 0.58–0.84). Accuracy was 70 % (95 %CI 58–81 %). Using an optimal ROC cut-off limit of 0.635 mg/L, test statistics reached sensitivity 87 % (95 %CI: 73–96 %), specificity 61 % (95 %CI: 41–79 %), AUC 0.74 (95 %CI: 0.61–0.87), and accuracy 76 % (95 %CI: 64–86 %).</div></div><div><h3>Conclusions</h3><div>Plasma calprotectin was elevated in cases where GCA was subsequently confirmed. The value of plasma calprotectin as an inflammatory marker in cases with suspected GCA warrants further studies.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100165"},"PeriodicalIF":0.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-12DOI: 10.1016/j.ajoint.2025.100163
Sujan A. Surendran , Sena A. Gocuk , Aamira J. Huq , Alex W. Hewitt , Thomas G. Campbell , Doron G. Hickey , Lisa Kearns , Joshua Schulz , Thomas L. Edwards , Jonathan B. Ruddle , Lauren N. Ayton
Background
Genetic diagnosis of inherited retinal diseases (IRDs) is challenging due to significant disease heterogeneity and the many potential gene loci. The Royal Victorian Eye and Ear Hospital Ocular Genetics Clinic (OGC) was established in 2018 to streamline IRD diagnosis in Victoria, Australia. This study audited the activities of the OGC during its first three years of operation, focusing on clinical and genetic diagnoses, and identifying areas for improvement in clinic workflow. The aim was to highlight how an integrated multidisciplinary care model – combining ophthalmology, clinical genetics, and genetic counselling – can address gaps in diagnostic access, care coordination and variant interpretation.
Methods
Retrospective chart review of suspected or confirmed IRD patients assessed in the OGC between December 2018 to December 2021. Genetic testing approach was determined by the OGC and tailored to each patient’s clinical presentation, in conjunction with sequencing and panel options available through funded laboratories. Demographic data, clinical information and timing between key steps within the clinical workflow were systematically recorded.
Results
Five hundred and thirty-nine patients were seen in the first three years of operation. Of the total, 249 patients (46.2 %) underwent diagnostic genetic testing, the mean age of the IRD group being 36.2 years and 51.8 % male, 219 patients (40.6 %) had an IRD phenotype. Panretinal pigmentary retinopathies were the most common phenotype (63.9 %), followed by macular retinopathies (26.9 %), stationary retinopathies (5.5 %), and hereditary vitreoretinopathies (5.5 %). Diagnostic yield of the tested cohort was 71.2 %. Comparison between 2019 and 2020-2021 revealed an overall improvement in mean time from referral to disclosure of results of 647 to 467 days (p=0.001).
Conclusion
The OGC provides patients with an accessible, holistic care model for diagnosing inherited retinal diseases. The distribution of phenotypes and diagnostic yield of genetic tests were consistent with published literature. It provides a good framework for global healthcare systems implementing an ocular genomic service, especially where subspeciality ophthalmologists and genetics services are a limited resource. Although in its early stages, there are opportunities to improve clinic workflow, and a compelling case for increased resources to support timely diagnosis, especially as emerging therapies for IRDs become available.
{"title":"Three-year outcomes of a multidisciplinary ocular genetics clinic: Diagnostic yield and workflow insights from an Australian tertiary center","authors":"Sujan A. Surendran , Sena A. Gocuk , Aamira J. Huq , Alex W. Hewitt , Thomas G. Campbell , Doron G. Hickey , Lisa Kearns , Joshua Schulz , Thomas L. Edwards , Jonathan B. Ruddle , Lauren N. Ayton","doi":"10.1016/j.ajoint.2025.100163","DOIUrl":"10.1016/j.ajoint.2025.100163","url":null,"abstract":"<div><h3>Background</h3><div>Genetic diagnosis of inherited retinal diseases (IRDs) is challenging due to significant disease heterogeneity and the many potential gene loci. The Royal Victorian Eye and Ear Hospital Ocular Genetics Clinic (OGC) was established in 2018 to streamline IRD diagnosis in Victoria, Australia. This study audited the activities of the OGC during its first three years of operation, focusing on clinical and genetic diagnoses, and identifying areas for improvement in clinic workflow. The aim was to highlight how an integrated multidisciplinary care model – combining ophthalmology, clinical genetics, and genetic counselling – can address gaps in diagnostic access, care coordination and variant interpretation.</div></div><div><h3>Methods</h3><div>Retrospective chart review of suspected or confirmed IRD patients assessed in the OGC between December 2018 to December 2021. Genetic testing approach was determined by the OGC and tailored to each patient’s clinical presentation, in conjunction with sequencing and panel options available through funded laboratories. Demographic data, clinical information and timing between key steps within the clinical workflow were systematically recorded.</div></div><div><h3>Results</h3><div>Five hundred and thirty-nine patients were seen in the first three years of operation. Of the total, 249 patients (46.2 %) underwent diagnostic genetic testing, the mean age of the IRD group being 36.2 years and 51.8 % male, 219 patients (40.6 %) had an IRD phenotype. Panretinal pigmentary retinopathies were the most common phenotype (63.9 %), followed by macular retinopathies (26.9 %), stationary retinopathies (5.5 %), and hereditary vitreoretinopathies (5.5 %). Diagnostic yield of the tested cohort was 71.2 %. Comparison between 2019 and 2020-2021 revealed an overall improvement in mean time from referral to disclosure of results of 647 to 467 days (p=0.001).</div></div><div><h3>Conclusion</h3><div>The OGC provides patients with an accessible, holistic care model for diagnosing inherited retinal diseases. The distribution of phenotypes and diagnostic yield of genetic tests were consistent with published literature. It provides a good framework for global healthcare systems implementing an ocular genomic service, especially where subspeciality ophthalmologists and genetics services are a limited resource. Although in its early stages, there are opportunities to improve clinic workflow, and a compelling case for increased resources to support timely diagnosis, especially as emerging therapies for IRDs become available.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 3","pages":"Article 100163"},"PeriodicalIF":0.0,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144879107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-09DOI: 10.1016/j.ajoint.2025.100161
Claire L Peterson , Brian S.Y. Yeo , Shelley Yin-Hsi Chang , Rachel S Chong , Marcus Ang , Anna CS Tan , Tina Wong , Andrew S.H. Tsai
Background
Gender equality in Asia remains under-researched, especially within medical fields. This study explored gender-related differences among ophthalmologists in Asia.
Design
Observational, cross-sectional survey study.
Methods
An anonymous online survey was distributed across 21 Asian regions via the Young Ophthalmologist network (June–July 2024), examining career paths, leadership, research, parenthood and gender-related workplace experiences.
Results
A total of 242 cisgendered ophthalmologists from 20 regions responded; 163(67%) identified as women. Although most institutions had gender-balanced workforces, gender disparities persisted. Men were more likely than women to pursue surgically-oriented subspecialties such as surgical retina and cornea (M83% VS W52%, p=0.02). Women reported a greater impact on parenthood on subspecialty choice (W54% vs M28%, p<0.001) and career progression (W64% vs M39%, p<0.001). Women were also more likely to work part-time due to family commitments.
While overall leadership, academic positions and research output were similar, head of department roles in particular were predominantly held by men (62%), with women perceiving they had less opportunities in leadership (W61% vs M90%, p<0.001) and research (W80%, M93%, p=0.01) compared to their male counterparts, and reporting a need to champion women in these areas. Women also experienced more gender discrimination and sexual harassment from their patients, colleagues, and bosses of the opposite sex compared to men(p<0.05).
Conclusion
Women contribute significantly to ophthalmology in Asia but gender-related disparities remain for subspecialty choice, perceived leadership and research opportunities, parenthood, discrimination and harassment. Addressing these through mentorship, education, flexible career support, advocacy and institutional reform is essential to achieving gender equity in all areas of ophthalmology.
亚洲的性别平等问题仍未得到充分研究，尤其是在医疗领域。本研究探讨了亚洲眼科医生的性别差异。设计观察性、横断面调查研究。方法通过青年眼科医生网络（Young ophthalologist network）在亚洲21个地区进行了一项匿名在线调查（2024年6月至7月），调查了职业道路、领导力、研究、为人父母和与性别相关的工作经历。结果共有来自20个地区的242名非性别眼科医生参与调查；163人（67%）为女性。虽然大多数机构的工作人员性别平衡，但性别差异仍然存在。男性比女性更有可能追求外科导向的亚专科，如外科视网膜和角膜（M83% VS W52%, p=0.02）。女性报告称，生育对亚专业选择（W54%对M28%， p<0.001）和职业发展（W64%对M39%， p<0.001）的影响更大。由于家庭责任，女性也更有可能从事兼职工作。虽然整体领导、学术职位和研究成果相似，但部门主管的角色主要由男性担任（62%），女性认为与男性同行相比，她们在领导（W61% vs M90%, p<0.001）和研究（W80%, M93%, p=0.01）方面的机会较少，并报告需要在这些领域支持女性。与男性相比，女性也经历了更多来自异性患者、同事和老板的性别歧视和性骚扰（p<0.05）。结论亚洲地区女性对眼科的贡献显著，但在亚专科选择、领导和研究机会感知、生育、歧视和骚扰等方面仍存在性别差异。通过指导、教育、灵活的职业支持、宣传和机构改革来解决这些问题，对于在眼科所有领域实现性别平等至关重要。
{"title":"Gender-based differences in career paths, parenthood and perspectives on professional barriers among Asian ophthalmologists","authors":"Claire L Peterson , Brian S.Y. Yeo , Shelley Yin-Hsi Chang , Rachel S Chong , Marcus Ang , Anna CS Tan , Tina Wong , Andrew S.H. Tsai","doi":"10.1016/j.ajoint.2025.100161","DOIUrl":"10.1016/j.ajoint.2025.100161","url":null,"abstract":"<div><h3>Background</h3><div>Gender equality in Asia remains under-researched, especially within medical fields. This study explored gender-related differences among ophthalmologists in Asia.</div></div><div><h3>Design</h3><div>Observational, cross-sectional survey study.</div></div><div><h3>Methods</h3><div>An anonymous online survey was distributed across 21 Asian regions via the Young Ophthalmologist network (June–July 2024), examining career paths, leadership, research, parenthood and gender-related workplace experiences.</div></div><div><h3>Results</h3><div>A total of 242 cisgendered ophthalmologists from 20 regions responded; 163(67%) identified as women. Although most institutions had gender-balanced workforces, gender disparities persisted. Men were more likely than women to pursue surgically-oriented subspecialties such as surgical retina and cornea (M83% VS W52%, p=0.02). Women reported a greater impact on parenthood on subspecialty choice (W54% vs M28%, p<0.001) and career progression (W64% vs M39%, p<0.001). Women were also more likely to work part-time due to family commitments.</div><div>While overall leadership, academic positions and research output were similar, head of department roles in particular were predominantly held by men (62%), with women perceiving they had less opportunities in leadership (W61% vs M90%, p<0.001) and research (W80%, M93%, p=0.01) compared to their male counterparts, and reporting a need to champion women in these areas. Women also experienced more gender discrimination and sexual harassment from their patients, colleagues, and bosses of the opposite sex compared to men(p<0.05).</div></div><div><h3>Conclusion</h3><div>Women contribute significantly to ophthalmology in Asia but gender-related disparities remain for subspecialty choice, perceived leadership and research opportunities, parenthood, discrimination and harassment. Addressing these through mentorship, education, flexible career support, advocacy and institutional reform is essential to achieving gender equity in all areas of ophthalmology.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 3","pages":"Article 100161"},"PeriodicalIF":0.0,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144861343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号