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.
{"title":"Early real-world experience with intravitreal Faricimab for neovascular AMD: FAN study","authors":"Constance Weber , Pascal Schipper , Isabel Stasik , Leonie Weinhold , Louisa Bulirsch , Sarah Thiele , Frank Holz , Raffael Liegl","doi":"10.1016/j.ajoint.2024.100074","DOIUrl":"10.1016/j.ajoint.2024.100074","url":null,"abstract":"<div><h3>Purpose</h3><div>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.</div></div><div><h3>Design</h3><div>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.</div></div><div><h3>Methods</h3><div>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 (mm<sup>3</sup>) were evaluated after three (<em>n</em> = 71) and five (<em>n</em> = 57) faricimab injections with complete follow-up visits.</div></div><div><h3>Results</h3><div>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 (<em>p</em> = 0.33). Significant reductions were seen for FCP, CSRT and macular volume after the first five consecutive injections when compared to baseline (<em>p</em> < 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 mm<sup>3</sup> (1.83 – 4.90) to 2.31 mm<sup>3</sup> (1.80 – 3.19) at visit 5. Intraocular inflammation was observed in one eye showing anterior chamber cells that resolved with topical corticosteroid treatment.</div></div><div><h3>Conclusions</h3><div>The results of the FAN (<strong>FA</strong>ricimab for <strong>N</strong>eovascular AMD) study indicate that faricimab improves structural outcomes in patients with recalcitrant fluid due to nAMD with no major complications observed.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"1 4","pages":"Article 100074"},"PeriodicalIF":0.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142571349","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}
Pub Date : 2024-10-09DOI: 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.
{"title":"Evaluating adherence to AAO hydroxychloroquine screening guidelines","authors":"Jake Lesher, Andrew Zolot, Anjali S Hawkins","doi":"10.1016/j.ajoint.2024.100071","DOIUrl":"10.1016/j.ajoint.2024.100071","url":null,"abstract":"<div><h3>Purpose</h3><div>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.</div></div><div><h3>Design</h3><div>We employed a large, single-center retrospective case series study design.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"1 4","pages":"Article 100071"},"PeriodicalIF":0.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142700060","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}
Pub Date : 2024-10-06DOI: 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.
{"title":"Save sight keratoconus registry study: Transepithelial versus epithelium-off corneal crosslinking","authors":"Grace A. Borchert , Himal Kandel , Aanchal Gupta , Jern Yee Chen , Yves Kerdraon , Richard Mills , Stephanie L. Watson","doi":"10.1016/j.ajoint.2024.100073","DOIUrl":"10.1016/j.ajoint.2024.100073","url":null,"abstract":"<div><h3>Purpose</h3><div>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.</div></div><div><h3>Design</h3><div>An observational prospective study was conducted using real-world data from patients in the Save Sight Keratoconus Registry.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"1 4","pages":"Article 100073"},"PeriodicalIF":0.0,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142419823","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}
Pub Date : 2024-10-03DOI: 10.1016/j.ajoint.2024.100060
Omer Trivizki , Daniela Ferrara
{"title":"Editorial: Synergizing Clinician and AI for Enhanced Ophthalmology","authors":"Omer Trivizki , Daniela Ferrara","doi":"10.1016/j.ajoint.2024.100060","DOIUrl":"10.1016/j.ajoint.2024.100060","url":null,"abstract":"","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"1 3","pages":"Article 100060"},"PeriodicalIF":0.0,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142417217","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}
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.
{"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}
Pub Date : 2024-10-02DOI: 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.
{"title":"Avacopan rescue for Granulomatosis with Polyangiitis associated scleritis and panuveitis failing rituximab and cyclophosphamide","authors":"Elaine Hu , Sana Makhdumi , Kruti Dajee , Jennifer Cao","doi":"10.1016/j.ajoint.2024.100072","DOIUrl":"10.1016/j.ajoint.2024.100072","url":null,"abstract":"<div><h3>Purpose</h3><div>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.</div></div><div><h3>Design</h3><div>Case report</div></div><div><h3>Participants</h3><div>A patient with GPA-associated ocular disease failing rituximab and cyclophosphamide</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"1 4","pages":"Article 100072"},"PeriodicalIF":0.0,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535502","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}
Pub Date : 2024-09-30DOI: 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.
{"title":"Ocular neuropathic pain in a real-world patient cohort with dry eye disease: A save sight dry eye registry study","authors":"Damien Tuan-Man Le , Himal Kandel , Ngozi C Chidi-Egboka , Gerd Geerling , Saaeha Rauz , Alberto Recchioni , Chris HL Lim , Stephanie L Watson","doi":"10.1016/j.ajoint.2024.100068","DOIUrl":"10.1016/j.ajoint.2024.100068","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare patient demographics, clinical signs, and questionnaire scores in dry eye disease (DED) patients with and without ocular neuropathic pain.</div></div><div><h3>Methods</h3><div>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*).</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"1 4","pages":"Article 100068"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142419821","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}
Pub Date : 2024-09-26DOI: 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.
{"title":"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","authors":"Mehmet Cem Sabaner , Arzu Seyhan Karatepe Hashas , Kemal Mert Mutibayraktaroglu , Zubeyir Yozgat , Oliver Niels Klefter , Yousif Subhi","doi":"10.1016/j.ajoint.2024.100070","DOIUrl":"10.1016/j.ajoint.2024.100070","url":null,"abstract":"<div><h3>Purpose</h3><div>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 (“<em>kunskapsprov för läkare</em>”) exams.</div></div><div><h3>Design</h3><div>Observational study.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 %) (<em>p</em> = <em>0.13</em>, and <em>p</em> = <em>0.04</em>, respectively). Moreover, ChatGPT-4o provided more correct answers in the neuro-ophthalmology section (<em>n</em> = 47) compared to Gemini 1.5 Pro across all three attempts in English (<em>p</em> <em><</em> <em>0.05</em>). There was no statistically significant difference either in the inter-AI comparison of other ophthalmology sections or in the inter-lingual comparison within AIs.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"1 4","pages":"Article 100070"},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142419820","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}
Pub Date : 2024-09-12DOI: 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.
{"title":"Ophthalmologic care for Indigenous Canadians","authors":"Mostafa Bondok , Brendan K. Tao , Christopher Hanson , Gurkaran Sarohia , Edsel Ing","doi":"10.1016/j.ajoint.2024.100067","DOIUrl":"10.1016/j.ajoint.2024.100067","url":null,"abstract":"<div><h3>Introduction</h3><p>Indigenous Canadians (IC) experience inequities in eye care. Identification of these inequities may inform the development of culturally appropriate interventions.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"1 4","pages":"Article 100067"},"PeriodicalIF":0.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2950253524000674/pdfft?md5=a5f67a4575ab233d57f60a0e8bc7b236&pid=1-s2.0-S2950253524000674-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142270720","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}
Pub Date : 2024-08-28DOI: 10.1016/j.ajoint.2024.100065
Stephanie Louise Watson , Ngozi Charity Chidi-Egboka , Pauline Khoo , Maria Cabrera-Aguas , Fiona Stapleton , Gerd Geerling , David Mingo , Saaeha Rauz , Alberto Recchioni , Francisco Arnalich-Montiel , Laura Elizabeth Downie , Vincent Daien , Fanny Babeau , Jennifer P Craig , Himal Kandel
Purpose
To describe a web-based, high-quality data collection tool able to track the clinical data of patients with dry eye disease (DED) in routine clinical practice.
Design
Retrospective analysis of core system web data from a prospectively designed, observational, routine clinical practice registry, the Save Sight Dry Eye Registry (SSDER).
Methods
Patients with DED, from 11-Nov-2020 to 04-Mar-2024 were analysed. Ocular Surface Disease Index (OSDI) and Ocular Comfort Index (OCI) questionnaires collected patient-reported DED symptoms, and the Patient Health Questionnaire-4 (PHQ-4) screened for anxiety and depression. Outcome data include index visit demography, DED symptoms and signs.
Results
Fifteen clinicians (ophthalmologists and optometrists) from nine practices across Australia, France, Germany, Nepal, Spain and the United Kingdom contributed data, comprising index visits of 958 eyes from 479 patients (mean±SD age 56±17 years; 78.7% female). Up to 89.9% of the patients had either evaporative or mixed DED based on clinician's judgement. Mean OSDI symptom score at index visit was 35.7 ± 19.4 (n = 366), and the mean sores for frequency and intensity of discomfort with the OCI was 31.9 ± 6.1 and 31.4 ± 6.8 (n = 202) respectively. Forty-one percent of patients had mild to severe symptoms of anxiety and depression. Median tear breakup time and tear meniscus height were 5 (IQR 2–8) seconds and 0.3 (IQR 0.2–0.4) mm, respectively. Ocular surface staining was graded as none (37.6%), minimal (31.7%), mild (19.8%), moderate (8.8%) and severe (2.1%).
Conclusion
The SSDER facilitated the collection of data from patients with DED from real-world clinical practice. Presenting patients had moderate DED, which was mostly evaporative in nature. Symptoms of anxiety and depression were reported by more than one-third of the cohort.
{"title":"Efficient capture of dry eye data from the real world: The Save Sight Dry Eye Registry","authors":"Stephanie Louise Watson , Ngozi Charity Chidi-Egboka , Pauline Khoo , Maria Cabrera-Aguas , Fiona Stapleton , Gerd Geerling , David Mingo , Saaeha Rauz , Alberto Recchioni , Francisco Arnalich-Montiel , Laura Elizabeth Downie , Vincent Daien , Fanny Babeau , Jennifer P Craig , Himal Kandel","doi":"10.1016/j.ajoint.2024.100065","DOIUrl":"10.1016/j.ajoint.2024.100065","url":null,"abstract":"<div><h3>Purpose</h3><p>To describe a web-based, high-quality data collection tool able to track the clinical data of patients with dry eye disease (DED) in routine clinical practice.</p></div><div><h3>Design</h3><p>Retrospective analysis of core system web data from a prospectively designed, observational, routine clinical practice registry, the Save Sight Dry Eye Registry (SSDER).</p></div><div><h3>Methods</h3><p>Patients with DED, from 11-Nov-2020 to 04-Mar-2024 were analysed. Ocular Surface Disease Index (OSDI) and Ocular Comfort Index (OCI) questionnaires collected patient-reported DED symptoms, and the Patient Health Questionnaire-4 (PHQ-4) screened for anxiety and depression. Outcome data include index visit demography, DED symptoms and signs.</p></div><div><h3>Results</h3><p>Fifteen clinicians (ophthalmologists and optometrists) from nine practices across Australia, France, Germany, Nepal, Spain and the United Kingdom contributed data, comprising index visits of 958 eyes from 479 patients (mean±SD age 56±17 years; 78.7% female). Up to 89.9% of the patients had either evaporative or mixed DED based on clinician's judgement. Mean OSDI symptom score at index visit was 35.7 ± 19.4 (<em>n</em> = 366), and the mean sores for frequency and intensity of discomfort with the OCI was 31.9 ± 6.1 and 31.4 ± 6.8 (<em>n</em> = 202) respectively. Forty-one percent of patients had mild to severe symptoms of anxiety and depression. Median tear breakup time and tear meniscus height were 5 (IQR 2–8) seconds and 0.3 (IQR 0.2–0.4) mm, respectively. Ocular surface staining was graded as none (37.6%), minimal (31.7%), mild (19.8%), moderate (8.8%) and severe (2.1%).</p></div><div><h3>Conclusion</h3><p>The SSDER facilitated the collection of data from patients with DED from real-world clinical practice. Presenting patients had moderate DED, which was mostly evaporative in nature. Symptoms of anxiety and depression were reported by more than one-third of the cohort.</p></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"1 3","pages":"Article 100065"},"PeriodicalIF":0.0,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2950253524000650/pdfft?md5=62c015da5162b169a9054e2b74b27702&pid=1-s2.0-S2950253524000650-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142087853","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}
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