AJO International最新文献_第2页

Comparison of Iridex MP3 and P3 probes on long-term intraocular pressure control after MicroPulse Transscleral-Cyclophotocoagulation 微脉冲经巩膜环形光凝术后，Iridex MP3 和 P3 探针对长期眼压控制的影响比较

AJO International

Pub Date : 2024-10-16 DOI: 10.1016/j.ajoint.2024.100076

Baltaj Sandhur , Charles Zhang , Yousef Yousef , Sinan Ersan , Andrew Schwartz , Dmitriy Belous , Mohit Jethi , Sandra F Sieminski

Purpose

Micropulse transscleral cyclophotocoagulation (MP-TSCPC) is a glaucoma procedure that delivers energy to the ciliary body with minimal collateral-damage. We aim to assess the long-term effectiveness of MP-TSCPC using the original MP3 and revised P3 probe.

Methods and design

Baseline Retrospective cohort study was performed to obtain baseline characteristics, intraocular pressure (IOP), number of IOP-lowering medications, and best-corrected visual acuity (BCVA) were obtained from pre- and post-operative visits of patients treated with MP-TSCPC. Failure was defined as IOP>21 mmHg, reduced IOP<20% below baseline, or IOP<5 mmHg on 2 consecutive follow-up visits after post-operative month 1, reoperation for glaucoma, or loss of vision to no light perception.

Results

A total of 113 eyes were enrolled, 44 using the MP3 probe and 69 with the revised P3 probe. Survival analysis found a 75% failure rate in patients treated with the revised P3 probe by the final visit with a mean time to failure (MTTF) of 4.8 ± 0.7 months which was higher than the original probe at 66% failure rate with a MTTF of 6.1 ± 1.1 months (p = 0.04). All causes of failure were due to high IOP and 67% required repeat treatment with MP-TSCPC or incisional surgery. Prior to censure of data from failure, both probes had significant reduction in IOP compared to pre-operative IOP at all time points. No significant changes in BCVA were found. Both groups were associated with low rates of complications.

Conclusion

Both probes had a very low rate of visually significant complications when performed in a standardized method in accordance with surgical procedure and power settings recommended by Iridex; however, were associated with a high rate of single procedure failure due to uncontrolled IOP over the long term. The revised P3 probe was associated with a higher rate of failure. Patients experienced a reduction in IOP; however, a large proportion required additional treatment compared to the original MP3 probe.

目的微脉冲经巩膜环形光凝术（MP-TSCPC）是一种青光眼手术，可将能量输送到睫状体，同时将副损伤降到最低。方法和设计基线回顾性队列研究从接受 MP-TSCPC 治疗的患者的术前和术后访视中获取基线特征、眼压（IOP）、降眼压药物次数和最佳矫正视力（BCVA）。术后第 1 个月后连续 2 次随访时出现眼压下降 21 mmHg、眼压比基线下降 20% 或眼压下降 5 mmHg、因青光眼再次手术或视力下降至无光感，即为失败。生存分析发现，使用改进型 P3 探头治疗的患者在最后一次就诊时的失败率为 75%，平均失败时间（MTTF）为 4.8 ± 0.7 个月，高于原始探头的 66%，平均失败时间（MTTF）为 6.1 ± 1.1 个月（P = 0.04）。所有失败原因都是由于眼压过高，67%的患者需要再次接受 MP-TSCPC 或切开手术治疗。在对失败数据进行审查之前，两种探头在所有时间点的眼压都比术前显著降低。BCVA无明显变化。结论：如果按照 Iridex 建议的手术流程和功率设置以标准化方法进行操作，两种探针的视觉并发症发生率都很低；但是，由于眼压长期不受控制，两种探针的单次手术失败率都很高。改进后的 P3 探头的失败率更高。患者的眼压有所降低，但与最初的 MP3 探头相比，很大一部分患者需要额外的治疗。

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引用次数: 0

Early real-world experience with intravitreal Faricimab for neovascular AMD: FAN study 玻璃体内法瑞西单抗治疗新生血管性黄斑病变的早期实际经验：FAN 研究

AJO International

Pub Date : 2024-10-12 DOI: 10.1016/j.ajoint.2024.100074

Constance Weber , Pascal Schipper , Isabel Stasik , Leonie Weinhold , Louisa Bulirsch , Sarah Thiele , Frank Holz , Raffael Liegl

Purpose

This study presents real-world experiences and clinical outcomes of patients who switched to faricimab after prior treatment with other anti-vascular endothelial growth factor medication for patients with neovascular age-related macular degeneration (nAMD) in 2022.

Design

We evaluated all consecutive patients that received an intravitreal injection (IVI) with faricimab for nAMD and had complete follow-up visits after at least three IVI.

Methods

Functional and structural parameters including best-corrected visual acuity (BCVA, logMAR), foveal centre point (FCP, µm), central subfield retinal thickness (CSRT, µm) and macular volume (mm³) were evaluated after three (n = 71) and five (n = 57) faricimab injections with complete follow-up visits.

Results

We included 71 eyes of 63 patients. Mean BCVA at baseline was 0.49 logMAR (0 – 1.6) and did not change significantly after five faricimab injections (p = 0.33). Significant reductions were seen for FCP, CSRT and macular volume after the first five consecutive injections when compared to baseline (p < 0.0001 respectively). FCP was 388.35 µm (173–924 µm) at baseline and decreased to 279.16 µm (97 – 667) at visit 5. CSRT was 370.68 µm (202 – 1074) and decreased to 307.75 µm (168 – 590) at visit 5. Macular volume was reduced from 2.59 mm³ (1.83 – 4.90) to 2.31 mm³ (1.80 – 3.19) at visit 5. Intraocular inflammation was observed in one eye showing anterior chamber cells that resolved with topical corticosteroid treatment.

Conclusions

The results of the FAN (FAricimab for Neovascular AMD) study indicate that faricimab improves structural outcomes in patients with recalcitrant fluid due to nAMD with no major complications observed.

设计我们评估了所有接受过法尼单抗玻璃体内注射（IVI）治疗nAMD并在至少三次IVI后进行过完整随访的连续患者。方法评估了三次（n = 71）和五次（n = 57）法利单抗注射后的功能和结构参数，包括最佳矫正视力（BCVA，logMAR）、眼窝中心点（FCP，µm）、中央子场视网膜厚度（CSRT，µm）和黄斑体积（mm3），并进行了完整的随访。基线时的平均 BCVA 为 0.49 logMAR (0 - 1.6)，注射五次法尼单抗后无明显变化（p = 0.33）。连续注射五次后，FCP、CSRT 和黄斑体积与基线相比均有显著下降（分别为 p < 0.0001）。基线时的 FCP 为 388.35 微米（173-924 微米），在第 5 次注射时降至 279.16 微米（97-667）。CSRT 为 370.68 微米（202 - 1074），在第五次检查时降至 307.75 微米（168 - 590）。第 5 次检查时，黄斑体积从 2.59 立方毫米（1.83 - 4.90）降至 2.31 立方毫米（1.80 - 3.19）。结论 FAN（治疗新生血管性黄斑变性的法瑞西单抗）研究结果表明，法瑞西单抗可改善因 nAMD 引起的顽固性积液患者的结构性预后，且未观察到重大并发症。

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引用次数: 0

Evaluating adherence to AAO hydroxychloroquine screening guidelines 评估 AAO 羟氯喹筛查指南的遵守情况

AJO International

Pub Date : 2024-10-09 DOI: 10.1016/j.ajoint.2024.100071

Jake Lesher, Andrew Zolot, Anjali S Hawkins

Purpose

Hydroxychloroquine (HCQ) is commonly prescribed for autoimmune disorders but carries a risk of retinal damage, which increases over time. The American Academy of Ophthalmology (AAO) issued updated guidelines in 2016 to optimize screening for HCQ retinopathy, recommending dosing based on real body weight and specific visual field (VF) testing patterns. This study aimed to assess adherence to the AAO guidelines for HCQ retinopathy screening in a clinical setting and to identify deviations in the implementation of these guidelines.

Design

We employed a large, single-center retrospective case series study design.

Methods

We conducted a retrospective analysis of 391 patients treated with HCQ at a single academic center from 2017 to 2019. The study focused on the appropriateness of screening tests, specifically optical coherence tomography (OCT) and VF testing, based on the duration of HCQ therapy.

Results

Our analysis showed that over-testing with OCT and VF was prevalent among patients on HCQ for five years or less, occurring in 56% and 48% of encounters, respectively. Conversely, there were missed screenings in patients on HCQ for more than five years, with 12% and 16% of encounters lacking OCT and VF testing, respectively. Notably, adherence to VF testing guidelines for Asian patients was poorly implemented, with the recommended wide pattern VF testing conducted in only two of nine cases. Additionally, there were significant instances where HCQ dosages exceeded recommended levels without subsequent adjustments, despite ophthalmologists' recommendations.

Conclusions

The study highlights a critical need for improved guideline adherence to prevent unnecessary testing costs and undetected retinopathy in long-term HCQ users. It underscores the importance of using real body weight for dosing decisions and enhancing collaboration between ophthalmologists and rheumatologists to manage the delicate balance between disease control and the risk of retinopathy. Further multi-center studies are warranted to evaluate adherence variations and develop strategies for guideline implementation.

目的羟氯喹（HCQ）是治疗自身免疫性疾病的常用处方药，但它具有视网膜损伤的风险，而且这种风险会随着时间的推移而增加。美国眼科学会（AAO）于2016年发布了优化HCQ视网膜病变筛查的最新指南，建议根据实际体重和特定的视野（VF）测试模式进行用药。本研究旨在评估临床环境中AAO关于HCQ视网膜病变筛查指南的遵守情况，并找出这些指南实施过程中的偏差。设计我们采用了大型单中心回顾性病例系列研究设计。方法我们对2017年至2019年在一个学术中心接受HCQ治疗的391名患者进行了回顾性分析。结果我们的分析表明，在使用 HCQ 5 年或更短时间的患者中，过度检测 OCT 和 VF 的情况很普遍，分别发生在 56% 和 48% 的病例中。相反，使用 HCQ 超过五年的患者中存在漏检现象，分别有 12% 和 16% 的就诊者未进行 OCT 和 VF 检测。值得注意的是，亚裔患者对VF检测指南的遵守情况很差，9例患者中只有2例进行了推荐的广泛模式VF检测。此外，尽管眼科医生提出了建议，但HCQ用量超过建议水平而未进行后续调整的情况也屡见不鲜。结论该研究强调了改善指南遵守情况的迫切需要，以防止长期使用HCQ的患者出现不必要的检测费用和未被发现的视网膜病变。该研究强调了使用真实体重来决定用药剂量以及加强眼科医生和风湿病医生之间的合作以管理疾病控制和视网膜病变风险之间微妙平衡的重要性。有必要进一步开展多中心研究，以评估依从性的变化并制定指南实施策略。

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引用次数: 0

Save sight keratoconus registry study: Transepithelial versus epithelium-off corneal crosslinking 拯救视力角膜病登记研究：经上皮角膜交联与离体上皮角膜交联

AJO International

Pub Date : 2024-10-06 DOI: 10.1016/j.ajoint.2024.100073

Grace A. Borchert , Himal Kandel , Aanchal Gupta , Jern Yee Chen , Yves Kerdraon , Richard Mills , Stephanie L. Watson

Purpose

Corneal collagen crosslinking (CXL) is the primary treatment for progressive keratoconus and can be performed with the epithelium on or off. Evidence is needed to guide clinicians and patients on whether they should have transepithelial or epithelium-off CXL. The aim of this study was to determine the safety and efficacy of transepithelial and epithelium-off CXL.

Design

An observational prospective study was conducted using real-world data from patients in the Save Sight Keratoconus Registry.

Methods

Patients with no previous intervention before CXL were included. The primary outcomes were adverse events, change in Kmax, habitual visual acuity and minimum corneal thickness from baseline to 12 months follow up. Mixed effects regression models evaluated changes in outcomes adjusted for age, sex, eye laterality, practices, and baseline outcomes.

Results

There were 46 eyes (37 patients) and 1203 eyes (976 patients) included treated with transepithelial and epithelium-off CXL, respectively. At 12 months follow up, the habitual visual acuity, pinhole visual acuity, Kmax, K2 and minimum corneal thickness were not significantly different between epithelium-off and transepithelial CXL. There were fewer adverse events recorded in transepithelial compared to epithelium-off CXL.

Conclusion

Epithelium-off and transepithelial CXL were similarly effective, measured by visual acuity and corneal curvature, to stabilise and prevent progression between baseline and 12 months follow-up in keratoconus. Transepithelial CXL had fewer adverse events compared to epithelium-off CXL.

目的角膜胶原交联（CXL）是渐进性角膜炎的主要治疗方法，可以在上皮层打开或关闭的情况下进行。临床医生和患者应该接受经上皮还是离上皮的 CXL 治疗，这需要证据来指导。本研究旨在确定经上皮和离上皮CXL的安全性和有效性。方法纳入在CXL之前未接受过干预的患者。主要结果是不良事件、Kmax、习惯性视力和最小角膜厚度从基线到 12 个月随访期间的变化。混合效应回归模型评估了经年龄、性别、眼球偏侧、做法和基线结果调整后的结果变化。结果分别有 46 只眼睛（37 名患者）和 1203 只眼睛（976 名患者）接受了经上皮细胞和上皮细胞脱落 CXL 治疗。在 12 个月的随访中，上皮脱落式 CXL 和经上皮式 CXL 的习惯视力、针孔视力、最大 Kmax、K2 和最小角膜厚度均无显著差异。结论从视力和角膜曲率的角度看，上皮脱落和经上皮CXL对稳定和防止角膜病变在基线和12个月随访期间的进展具有相似的效果。与上皮脱落CXL相比，经上皮CXL的不良反应更少。

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引用次数: 0

Editorial: Synergizing Clinician and AI for Enhanced Ophthalmology 社论：协同临床医生和人工智能，提高眼科医疗水平

AJO International

Pub Date : 2024-10-03 DOI: 10.1016/j.ajoint.2024.100060

Omer Trivizki , Daniela Ferrara

引用次数: 0

Comparative analysis of modulation transfer function in various intraocular lenses under normal, decentration, and tilt conditions 正常、分散和倾斜条件下各种眼内透镜调制传递函数的比较分析

AJO International

Pub Date : 2024-10-02 DOI: 10.1016/j.ajoint.2024.100069

Andi Masdipa , Yuji Matsuda , Sachiko Kaidzu , Masaki Tanito

Purpose

This study aims to compare the modulation transfer function (MTF) of different intraocular lenses (IOLs) under normal, decentration, and tilt conditions to evaluate their optical performance.

Design

Experimental setting.

Methods

A total of 12 IOL models (+20 D diopter, n = 3 each) were measured for MTF using the OptiSpheric IOL system with a 3 mm aperture diameter at a water temperature of 35 °C. Measurements were made with a spatial frequency of 0 - 200 lp/mm at the normal, decentration of 0.5 mm, and tilt of 5° positions.

Results

The MTF values were significantly different between normal and decentration conditions for XY1A (monofocal, toric) (P = 0.03), Tecnis ZCB00V (P = 0.0009), and NS-60YG (P = 0.004). Differences were significant between normal and tilt conditions for MP70 (P = 0.009), XY1 (P = 0.0005), and Clareon (P = 0.049), and were significant between decentration and tilt conditions only for LentisComfort (bifocal) (P = 0.01). With normal condition, MTF of Eyhance DIB00V (extended depth of focus) showed significant differences with 11 other IOLs (P < 0.0001), while LentisComfort exhibited differences with 10 other IOLs (P < 0.0001) except for XY1A (P = 0.0002). Similarly, with decentration condition, Eyhance DIB00V differed significantly from 11 other IOLs (P < 0.0001). With tilt condition, Eyhance DIB00V showed significant differences with 10 other IOLs (P < 0.0001) except for LentisComfort, which itself differed significantly from 10 other IOLs (P < 0.0001).

Conclusions

In the experimental settings, while specialized IOLs can address specific visual issues, monofocal IOLs remain superior in terms of overall contrast transfer quality and resolution even in the implanted IOL position is not ideal. These results provide a basis for recommending the use of monofocal IOLs in cases where the anterior chamber depth and lens position are prone to instability, such as in eyes with weakened zonules or following glaucoma filtering surgery.

目的本研究旨在比较不同眼内人工晶体（IOL）在正常、分散和倾斜条件下的调制传递函数（MTF），以评估其光学性能。方法使用 OptiSpheric IOL 系统在 35 °C 水温下测量 12 个 IOL 模型（+20 D 屈光度，每个模型 n = 3）的 MTF，该系统的孔径为 3 mm。结果 XY1A（单焦散光）（P = 0.03）、Tecnis ZCB00V（P = 0.0009）和 NS-60YG（P = 0.004）的 MTF 值在正常和散光条件下有显著差异。MP70 (P = 0.009)、XY1 (P = 0.0005) 和 Clareon (P = 0.049) 在正常和倾斜条件下差异显著，而 LentisComfort（双焦点）仅在分散和倾斜条件下差异显著 (P = 0.01)。在正常条件下，Eyhance DIB00V（扩展焦距）的 MTF 与其他 11 种人工晶体有显著差异（P = 0.0001），而 LentisComfort 与其他 10 种人工晶体有差异（P = 0.0001），只有 XY1A 除外（P = 0.0002）。同样，在分散条件下，Eyhance DIB00V 与其他 11 种人工晶体存在显著差异（P < 0.0001）。在倾斜条件下，Eyhance DIB00V 与其他 10 种人工晶体有显著差异（P < 0.0001），但 LentisComfort 除外，它与其他 10 种人工晶体有显著差异（P < 0.0001）。这些结果为推荐在前房深度和人工晶体位置容易不稳定的情况下使用单焦点人工晶体提供了依据，例如在眼球结构弱化或青光眼滤过手术后。

{"title":"Comparative analysis of modulation transfer function in various intraocular lenses under normal, decentration, and tilt conditions","authors":"Andi Masdipa , Yuji Matsuda , Sachiko Kaidzu , Masaki Tanito","doi":"10.1016/j.ajoint.2024.100069","DOIUrl":"10.1016/j.ajoint.2024.100069","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aims to compare the modulation transfer function (MTF) of different intraocular lenses (IOLs) under normal, decentration, and tilt conditions to evaluate their optical performance.</div></div><div><h3>Design</h3><div>Experimental setting.</div></div><div><h3>Methods</h3><div>A total of 12 IOL models (+20 D diopter, <em>n</em> = 3 each) were measured for MTF using the OptiSpheric IOL system with a 3 mm aperture diameter at a water temperature of 35 °C. Measurements were made with a spatial frequency of 0 - 200 lp/mm at the normal, decentration of 0.5 mm, and tilt of 5° positions.</div></div><div><h3>Results</h3><div>The MTF values were significantly different between normal and decentration conditions for XY1A (monofocal, toric) (<em>P</em> = 0.03), Tecnis ZCB00V (<em>P</em> = 0.0009), and NS-60YG (<em>P</em> = 0.004). Differences were significant between normal and tilt conditions for MP70 (<em>P</em> = 0.009), XY1 (<em>P</em> = 0.0005), and Clareon (<em>P</em> = 0.049), and were significant between decentration and tilt conditions only for LentisComfort (bifocal) (<em>P</em> = 0.01). With normal condition, MTF of Eyhance DIB00V (extended depth of focus) showed significant differences with 11 other IOLs (<em>P</em> < 0.0001), while LentisComfort exhibited differences with 10 other IOLs (<em>P</em> < 0.0001) except for XY1A (<em>P</em> = 0.0002). Similarly, with decentration condition, Eyhance DIB00V differed significantly from 11 other IOLs (<em>P</em> < 0.0001). With tilt condition, Eyhance DIB00V showed significant differences with 10 other IOLs (<em>P</em> < 0.0001) except for LentisComfort, which itself differed significantly from 10 other IOLs (<em>P</em> < 0.0001).</div></div><div><h3>Conclusions</h3><div>In the experimental settings, while specialized IOLs can address specific visual issues, monofocal IOLs remain superior in terms of overall contrast transfer quality and resolution even in the implanted IOL position is not ideal. These results provide a basis for recommending the use of monofocal IOLs in cases where the anterior chamber depth and lens position are prone to instability, such as in eyes with weakened zonules or following glaucoma filtering surgery.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"1 4","pages":"Article 100069"},"PeriodicalIF":0.0,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142419822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Avacopan rescue for Granulomatosis with Polyangiitis associated scleritis and panuveitis failing rituximab and cyclophosphamide 阿伐潘挽救了利妥昔单抗和环磷酰胺治疗失败的肉芽肿伴多血管炎相关性巩膜炎和泛葡萄膜炎患者的生命

AJO International

Pub Date : 2024-10-02 DOI: 10.1016/j.ajoint.2024.100072

Elaine Hu , Sana Makhdumi , Kruti Dajee , Jennifer Cao

Purpose

To report the use of avacopan to achieve sustained steroid-free remission in a patient with ocular inflammation secondary to Granulomatosis with Polyangiitis (GPA) failing rituximab and cyclophosphamide.

Design

Case report

Participants

A patient with GPA-associated ocular disease failing rituximab and cyclophosphamide

Results

A 45-year-old man with a diagnosis of GPA developed nodular scleritis in the right eye. He was initially treated with steroids and rituximab with resolution of his scleritis. However, his scleritis recurred and progressed with development of panuveitis, which failed treatment with repeat rituximab dosing. All findings resolved two months after the addition of Avacopan.

Conclusion

This case report documents the second successful use of avacopan to induce steroid-free remission in a GPA patient who failed standard treatment with corticosteroids and rituximab.

目的报告一名继发于多发性肉芽肿性炎症（GPA）的眼部炎症患者在使用阿伐潘后，因无类固醇而获得持续缓解的情况。他最初接受了类固醇和利妥昔单抗治疗，巩膜炎有所缓解。然而，他的巩膜炎复发并发展为泛葡萄膜炎，再次使用利妥昔单抗治疗无效。本病例报告记录了在皮质类固醇和利妥昔单抗标准治疗失败的 GPA 患者中第二次成功使用阿伐潘诱导无类固醇缓解的病例。

引用次数: 0

Ocular neuropathic pain in a real-world patient cohort with dry eye disease: A save sight dry eye registry study 真实世界干眼症患者队列中的眼部神经性疼痛：救盲干眼症登记研究

AJO International

Pub Date : 2024-09-30 DOI: 10.1016/j.ajoint.2024.100068

Damien Tuan-Man Le , Himal Kandel , Ngozi C Chidi-Egboka , Gerd Geerling , Saaeha Rauz , Alberto Recchioni , Chris HL Lim , Stephanie L Watson

Purpose

To compare patient demographics, clinical signs, and questionnaire scores in dry eye disease (DED) patients with and without ocular neuropathic pain.

Methods

A cross-sectional cohort study was performed using the Save Sight Dry Eye Registry (SSDER). Patients were divided into two groups based on a clinician diagnosis of ocular neuropathic pain and Tear Film and Ocular Surface Society Dry Eye Workshop II definitions. Patient demographics, Ocular Surface Disease Index (OSDI) and Ocular Comfort Index (OCI) scores, and DED signs were compared along with Patient Health Questionnaire-4 (PHQ-4) scores, average screen time and treatment compliance. Statistical analyses included descriptive statistics, Mann-Whitney U test, Chi-squared test of independence, and Fisher's exact test. P-values were Bonferroni corrected (p*).

Results

Data from 298 patients with DED symptoms and signs (26 with ocular neuropathic pain) were analysed. There was no statistical difference in patient demographics (p*>0.0063). Patients with ocular neuropathic pain had worse final, domain, and pain-related question scores for the OSDI (p*<0.0031) and OCI (p*<0.0039) and had higher scores for anxiety and depression for the PHQ-4 (p*<0.0083). Patients with ocular neuropathic pain had a lower rate and severity of meibomian gland dysfunction (p*<0.0063).

Conclusion

Real-world data from the SSDER demonstrated patient demographics and clinical signs poorly differentiated patients with ocular neuropathic pain within a DED cohort. Patients with ocular neuropathic pain reported significantly worse OSDI and OCI scores, indicating greater symptom severity. While this highlighted symptom differences, further research is required to determine whether OSDI and OCI scores can assist in identifying ocular neuropathic pain in DED.

目的比较有眼部神经痛和无眼部神经痛的干眼症（DED）患者的人口统计学特征、临床体征和问卷评分。根据临床医生对眼部神经性疼痛的诊断以及泪膜和眼表学会干眼研讨会 II 的定义，将患者分为两组。比较了患者的人口统计学特征、眼表疾病指数（OSDI）和眼舒适指数（OCI）评分、干眼症体征以及患者健康问卷-4（PHQ-4）评分、平均筛查时间和治疗依从性。统计分析包括描述性统计、曼-惠特尼 U 检验、独立性卡方检验和费雪精确检验。结果分析了 298 名有 DED 症状和体征的患者（26 名有眼神经痛）的数据。患者的人口统计学特征无统计学差异（p*>0.0063）。眼神经痛患者在 OSDI（P*<0.0031）和 OCI（P*<0.0039）中的最终得分、领域得分和疼痛相关问题得分较低，在 PHQ-4 中的焦虑和抑郁得分较高（P*<0.0083）。来自 SSDER 的真实世界数据显示，在 DED 队列中，患者人口统计学和临床体征很难区分眼神经痛患者。眼神经痛患者的 OSDI 和 OCI 评分明显更差，表明症状严重程度更高。虽然这突出了症状差异，但仍需进一步研究，以确定 OSDI 和 OCI 评分是否有助于识别 DED 中的眼神经痛。

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引用次数: 0

The performance of artificial intelligence-based large language models on ophthalmology-related questions in Swedish proficiency test for medicine: ChatGPT-4 omni vs Gemini 1.5 Pro 基于人工智能的大型语言模型在瑞典语医学水平测试中眼科相关问题上的表现：ChatGPT-4 omni vs Gemini 1.5 Pro

AJO International

Pub Date : 2024-09-26 DOI: 10.1016/j.ajoint.2024.100070

Mehmet Cem Sabaner , Arzu Seyhan Karatepe Hashas , Kemal Mert Mutibayraktaroglu , Zubeyir Yozgat , Oliver Niels Klefter , Yousif Subhi

Purpose

To compare the interpretation and response context of two commonly used artificial intelligence (AI)-based large language model (LLM) platforms to ophthalmology-related multiple choice questions (MCQs) in the Swedish proficiency test for medicine (“kunskapsprov för läkare”) exams.

Design

Observational study.

Methods

The questions of a total of 29 exams held between 2016 and 2024 were reviewed. All ophthalmology-related questions were included in this study, and categorized into ophthalmology sections. Questions were asked to ChatGPT-4o and Gemini 1.5 Pro AI-based LLM chatbots in Swedish and English with specific commands. Secondly, all MCQs were asked again without feedback. As the final step, feedback was given for questions that were still answered incorrectly, and all questions were subsequently re-asked.

Results

A total of 134 ophthalmology-related questions out of 4876 MCQs were evaluated via both AI-based LLMs. The MCQ count in the 29 exams was 4.62 ± 2.21 (range: 0–8). After the final step, ChatGPT-4o achieved higher accuracy in Swedish (94 %) and English (95.5 %) compared to Gemini 1.5 Pro (both at 88.1 %) (p = 0.13, and p = 0.04, respectively). Moreover, ChatGPT-4o provided more correct answers in the neuro-ophthalmology section (n = 47) compared to Gemini 1.5 Pro across all three attempts in English (p < 0.05). There was no statistically significant difference either in the inter-AI comparison of other ophthalmology sections or in the inter-lingual comparison within AIs.

Conclusion

Both AI-based LLMs, and especially ChatGPT-4o, appear to perform well in ophthalmology-related MCQs. AI-based LLMs can contribute to ophthalmological medical education not only by selecting correct answers to MCQs but also by providing explanations.

目的比较两种常用的基于人工智能（AI）的大型语言模型（LLM）平台对瑞典医学水平考试（"kunskapsprov för läkare"）中眼科相关选择题（MCQ）的解释和回答情况。所有与眼科相关的问题都被纳入本研究，并归入眼科部分。通过特定命令向基于人工智能的瑞典语和英语 LLM 聊天机器人 ChatGPT-4o 和 Gemini 1.5 Pro 提问。其次，在没有反馈的情况下再次提问所有 MCQ。结果在 4876 道 MCQ 中，共有 134 道与眼科相关的问题通过两个人工智能 LLM 进行了评估。29 次考试的 MCQ 数量为 4.62 ± 2.21（范围：0-8）。在最后一步之后，与 Gemini 1.5 Pro（均为 88.1%）相比，ChatGPT-4o 的瑞典语（94%）和英语（95.5%）准确率更高（分别为 p = 0.13 和 p = 0.04）。此外，与 Gemini 1.5 Pro 相比，ChatGPT-4o 在神经眼科部分（n = 47）的三次英语尝试中提供了更多正确答案（p < 0.05）。结论基于人工智能的 LLM，尤其是 ChatGPT-4o，似乎在眼科相关的 MCQ 中表现出色。基于人工智能的 LLM 不仅能为 MCQ 选择正确答案，还能提供解释，从而为眼科医学教育做出贡献。

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引用次数: 0

Ophthalmologic care for Indigenous Canadians 为加拿大土著居民提供眼科护理

AJO International

Pub Date : 2024-09-12 DOI: 10.1016/j.ajoint.2024.100067

Mostafa Bondok , Brendan K. Tao , Christopher Hanson , Gurkaran Sarohia , Edsel Ing

Introduction

Indigenous Canadians (IC) experience inequities in eye care. Identification of these inequities may inform the development of culturally appropriate interventions.

Methods

For this review, a literature search of Ovid Medline, Ovid Embase, CINAHL – EBSCO and Scopus from inception to January 24, 2024 was conducted. Studies were screened by two independent reviewers, and conflicts were resolved through discussion with a third reviewer.

Results

IC have a greater burden but lower likelihood of being screened for diabetic retinopathy (DR). Barriers to DR care include poor access and racism; enablers include supportive interactions, culturally sensitive programming, and the inclusion of Indigenous staff. IC have less access to cataract surgery and post-operative follow-up due to geographic, economic, and cultural factors. Inuit people have the highest global rates of angle-closure glaucoma. Tele-glaucoma may reduce the time to treatment for open-angle glaucoma. Compared to non-IC, uveitis in IC occurs at a younger age, is more often bilateral and granulomatous with pan-uveal involvement, in part because Vogt Koyanagi Harada is more common in IC. Uncorrected refractive errors, conjunctival papilloma, epiblepharon, and spheroidal keratopathy may disproportionally affect IC.

Conclusions

Barriers to ophthalmic care for IC persist in both rural and urban settings. Health care should be culturally appropriate, integrated with primary care and incorporate tele-ophthalmology if needed. Holistic care at Indigenous-led centres is ideal.

导言加拿大原住民（IC）在眼科护理方面遭受着不公平待遇。本综述对 Ovid Medline、Ovid Embase、CINAHL - EBSCO 和 Scopus 从开始到 2024 年 1 月 24 日的文献进行了检索。由两名独立审稿人对研究进行筛选，并通过与第三名审稿人讨论解决冲突问题。研究结果女性的负担更重，但接受糖尿病视网膜病变（DR）筛查的可能性较低。糖尿病视网膜病变护理的障碍包括难以获得和种族主义；促进因素包括支持性互动、文化敏感性计划以及土著员工的参与。受地理、经济和文化因素的影响，印第安人接受白内障手术和术后随访的机会较少。因纽特人是全球闭角型青光眼发病率最高的人群。远程青光眼可缩短开角型青光眼的治疗时间。与非伊努伊特人相比，伊努伊特人的葡萄膜炎发生年龄较小，多为双侧性和肉芽肿性，泛葡萄膜受累，部分原因是 Vogt Koyanagi Harada 在伊努伊特人中更为常见。未矫正的屈光不正、结膜乳头状瘤、上睑下垂和球形角膜病可能会对 IC 造成不成比例的影响。医疗保健应与文化相适应，与初级保健相结合，并在必要时纳入远程眼科。在土著人主导的中心提供整体护理是理想的选择。

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