AJO International最新文献

{"title":"Effectiveness of intracameral antibiotics in reducing postoperative endophthalmitis risk after cataract surgery: A meta-analysis","authors":"Hashem Abu Serhan ,&nbsp;Hamad A. Alkorbi ,&nbsp;Elhassan Mahmoud ,&nbsp;Muhammad Zain Kaleem ,&nbsp;Omar Abousaad ,&nbsp;Mohamed Nasser Elshabrawi ,&nbsp;Ibrahim M. Alrawi ,&nbsp;Abdulrahman Nasir Al Khatib ,&nbsp;Ahmed E. Habib ,&nbsp;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}

{"title":"Development of a deep learning model to classify choroidal melanoma risk factors based on color fundus photographs","authors":"Huzaifa Suri ,&nbsp;P. Connor Lentz ,&nbsp;David A. Leske ,&nbsp;Mostafa Mousavi ,&nbsp;Haley S. D’Souza ,&nbsp;Muhammad B. Qureshi ,&nbsp;Raymond Iezzi ,&nbsp;Yogatheesan Varatharajah ,&nbsp;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 &gt; 5 mm, tumor thickness &gt; 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}

{"title":"Bridging gaps in ophthalmology education through large language models","authors":"Shahrzad Gholami ,&nbsp;Beth Wilson ,&nbsp;Sarah Page ,&nbsp;Daniel B. Mummert ,&nbsp;Joseph Carr ,&nbsp;Robert R. McNabb ,&nbsp;Rahul Dodhia ,&nbsp;Juan M. Lavista Ferres ,&nbsp;William B. Weeks ,&nbsp;Dale E. Fajardo ,&nbsp;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> &lt; 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}

{"title":"The value of plasma calprotectin as an inflammatory marker in giant cell arteritis","authors":"Michael Stormly Hansen ,&nbsp;Lene Terslev ,&nbsp;Uffe Møller Døhn ,&nbsp;Viktoria Fana ,&nbsp;Mads Radmer Jensen ,&nbsp;Anne Katrine Wiencke ,&nbsp;Steffen Heegaard ,&nbsp;Oliver Niels Klefter ,&nbsp;Yousif Subhi ,&nbsp;Jane Maestri Brittain ,&nbsp;Niklas Rye Jørgensen ,&nbsp;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> &lt; 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}

{"title":"Three-year outcomes of a multidisciplinary ocular genetics clinic: Diagnostic yield and workflow insights from an Australian tertiary center","authors":"Sujan A. Surendran ,&nbsp;Sena A. Gocuk ,&nbsp;Aamira J. Huq ,&nbsp;Alex W. Hewitt ,&nbsp;Thomas G. Campbell ,&nbsp;Doron G. Hickey ,&nbsp;Lisa Kearns ,&nbsp;Joshua Schulz ,&nbsp;Thomas L. Edwards ,&nbsp;Jonathan B. Ruddle ,&nbsp;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}

{"title":"Gender-based differences in career paths, parenthood and perspectives on professional barriers among Asian ophthalmologists","authors":"Claire L Peterson ,&nbsp;Brian S.Y. Yeo ,&nbsp;Shelley Yin-Hsi Chang ,&nbsp;Rachel S Chong ,&nbsp;Marcus Ang ,&nbsp;Anna CS Tan ,&nbsp;Tina Wong ,&nbsp;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&lt;0.001) and career progression (W64% vs M39%, p&lt;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&lt;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&lt;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}

{"title":"Prevalence, coverage and effective coverage of refractive error in all age groups in Theni District, India","authors":"Ganesh-Babu Balu Subburaman ,&nbsp;Sachin Gupta ,&nbsp;Ashok Vardhan S ,&nbsp;Dipankar Datta ,&nbsp;Balagiri Sundar ,&nbsp;Thulasiraj Ravilla","doi":"10.1016/j.ajoint.2025.100162","DOIUrl":"10.1016/j.ajoint.2025.100162","url":null,"abstract":"<div><h3>Purpose</h3><div>To estimate prevalence of distance and near vision refractive errors (RE) across all age groups in Theni district, Tamil Nadu, India, using the World Health Organization’s (WHO) visual acuity threshold. To report refractive error coverage for distance and near vision (REC_D and REC_N) and effective REC (eREC_D and eREC_N), and to examine association with socio-demographic variables.</div></div><div><h3>Design</h3><div>Population-based cross-sectional study</div></div><div><h3>Methods</h3><div>In 2017–2018 we recruited 24,327 participants through random cluster sampling. Basic eye examinations were performed for those below 40 years, while those ≥40 years, along with referrals from those &lt;40 underwent full eye examinations, resulting in 16,963 participants.</div></div><div><h3>Results</h3><div>The prevalence of distance RE was 12%, increasing with age and tripling among those &gt;60 years. Females had a higher prevalence (<em>p</em> &lt; 0.001). Overall, REC_D was 35.5% but declined with age, dropping to 26% in the 61–70 age group. Coverage was higher among urban populations, better educated individuals, pre-school-age children, and students. eREC_D was 33.4%, with a small relative quality gap of 5.9%.</div><div>The prevalence of near vision RE was 30%, increasing with age but declining beyond 50 years. Females and rural populations had higher prevalence (<em>p</em> &lt; 0.001). Overall, REC_N was alarmingly low at 15.9%, improving to 24% in those &gt;70 years, with higher coverage in males and urban populations (<em>p</em> &lt; 0.001). eREC_N was 9.6%, with a quality gap of 39.8%.</div></div><div><h3>Conclusion</h3><div>Prevalence rates, REC and eREC, can serve as the basis for planning and tracking progress toward WHO’s global target of a 40 percentage-point increase in eREC in Theni District.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 3","pages":"Article 100162"},"PeriodicalIF":0.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144809745","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}

{"title":"Understanding barriers to spectacle wear compliance among schoolchildren in Calabar Nigeria: A qualitative study","authors":"Anne Effiom Ebri ,&nbsp;Pirindha Govender ,&nbsp;Kovin Naidoo ,&nbsp;Frank Albert ,&nbsp;Kajal Shah ,&nbsp;Ving Fai Chan","doi":"10.1016/j.ajoint.2025.100160","DOIUrl":"10.1016/j.ajoint.2025.100160","url":null,"abstract":"<div><h3>Purpose</h3><div>Despite the availability of free spectacles, many schoolchildren in Africa do not wear them regularly. This study explores the factors affecting compliance with spectacle wear among schoolchildren in Nigeria, aiming to inform targeted eye health education strategies and future interventions.</div></div><div><h3>Design</h3><div>A qualitative study using Focus group discussion with 42 participants including 34 schoolchildren.</div></div><div><h3>Methods</h3><div>Participants for the focus group discussions (FGD) were selected from a cluster-randomized controlled trial that assessed spectacle compliance between September 2017 and June 2018. Out of 4241 schoolchildren aged 10 to 18 recruited for the study, 308 received spectacles. In early February 2018, during the third month of the trial, 40 students were purposively identified and invited to participate in the FGD. A total of 34 students were interviewed in four groups across four schools. Additionally, a fifth group of selected adults was interviewed in a hall. The interviews took place in mid-February 2018 and each session lasted between 45 and 85 min<strong>.</strong></div></div><div><h3>Results</h3><div>The findings reveal a mix of sociocultural misconceptions, stigma, environmental factors and self-perception issues influence children's decision to wear spectacles. According to the Health Belief Model, low perceived risk, high barriers to use, and limited cues to action hinder consistent wear. While improved vision and academic performance motivate some children, these benefits are outweighed by peer pressure and a lack of support.</div></div><div><h3>Conclusion</h3><div>Enhancing self-efficacy through child-centred approaches, such as frame choice and improving frame aesthetics, promoting peer acceptance through targeted. School and community-based eye health initiatives should improve compliance.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 3","pages":"Article 100160"},"PeriodicalIF":0.0,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144779567","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}

{"title":"The Brazilian experience on screening, visual assessment, and prescription of glasses in childhood: A perspective of global interest","authors":"ACSB Carneiro ,&nbsp;JM Furtado ,&nbsp;AL Silva ,&nbsp;ALF Darcie ,&nbsp;AC Ribeiro ,&nbsp;LM Hopker ,&nbsp;C Nakanami ,&nbsp;SP Donahue ,&nbsp;JD Rossetto","doi":"10.1016/j.ajoint.2025.100158","DOIUrl":"10.1016/j.ajoint.2025.100158","url":null,"abstract":"<div><h3>Purpose</h3><div>This perspective presents evidence-based guidelines developed by a representative expert group from Brazil. The guidelines aim to enhance pediatric eye care through structured screening protocols, comprehensive eye examinations, and effective eyeglass prescriptions tailored to local contexts.</div></div><div><h3>Methods</h3><div>The guidelines were developed through a narrative literature review and expert consensus among Brazilian Society of Pediatric Ophthalmology members, utilizing a comprehensive search strategy on PubMed from September 2022 to July 2024.</div></div><div><h3>Results</h3><div>Key recommendations include performing the red reflex test (RRT) before neonatal discharge and repeating it at least three times per year during the first three years of life. Additional recommendations include initiating photoscreening at one year of age and conducting visual acuity screening between ages 3 and 5—prioritizing age 5 for amblyopia detection—and again at ages 10–11. Follow-up screenings are advised at critical developmental stages. To expand access, trained non-ophthalmology professionals should participate in screening efforts within existing healthcare frameworks. Scaling secondary and tertiary care and aligning the program with other governmental initiatives are essential for sustainability and impact. Additionally, structuring the health program to align with other government initiatives will help ensure its sustainability and long-term impact.</div></div><div><h3>Conclusion</h3><div>These guidelines provide a solid foundation for effective pediatric eye health programs, contributing to broader public health and sustainable development goals.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 3","pages":"Article 100158"},"PeriodicalIF":0.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144757146","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}

{"title":"Pilot study of ASSORT (AI-based Symptom Stratification in Ophthalmology for Rapid Triage): a triage tool for ophthalmic emergencies","authors":"Claudio Xompero,&nbsp;Lorenzo Rossi,&nbsp;Francesca Amoroso,&nbsp;Antonio Bechara Ghobril,&nbsp;Diana Elena Ionita,&nbsp;Eric H. Souied,&nbsp;Carl-Joe Mehanna","doi":"10.1016/j.ajoint.2025.100159","DOIUrl":"10.1016/j.ajoint.2025.100159","url":null,"abstract":"<div><h3>Introduction</h3><div>ASSORT (AI-based Symptom Stratification in Ophthalmology for Rapid Triage) is a GPT-4-based triage tool designed to assess ophthalmic emergencies using a three-tier color-coded system. This study compares ASSORT to the Rescue triage method, using the ophthalmologist’s final assessment as the reference standard.</div></div><div><h3>Materials and methods</h3><div>A prospective study was conducted at the Créteil University Hospital from April to June 2024. Each patient underwent triage using ASSORT, followed by the Rescue triage method. Both tools used the same color-coding system to stratify severity: yellow for emergency cases, green for urgent cases, and white for non-urgent cases. An examining ophthalmologist in their final year of residency performed the final assessment. Concordance between the ophthalmologist and each of the tools was analyzed using Cohen’s kappa coefficient, alongside precision and recall metrics.</div></div><div><h3>Results</h3><div>Fifty-one patients were included. Case severities were distributed as follows: 22/51 white, 27/51 green, and 2/51 yellow, with conjunctivitis (17.5 %) and corneal abrasions (12.5 %) being the two most common presentations. ASSORT demonstrated moderate agreement with the ophthalmologist (κ = 0.54), whereas Rescue showed stronger concordance (κ = 0.85). ASSORT tended to overestimate urgency, assigning more yellow codes than the ophthalmologist. McNemar’s test confirmed significant misclassification by ASSORT (<em>p</em> = 0.0156), while Rescue showed no significant deviation (<em>p</em> = 0.5).</div></div><div><h3>Conclusion</h3><div>While the small sample size limits generalizability, ASSORT shows potential for AI-driven ophthalmic triage but currently overestimates severity compared to the ophthalmologist. Further refinements such as reinforcement learning and multimodal input, as well as large-scale validation are needed to improve accuracy and reduce unnecessary emergency classifications before clinical implementation.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 3","pages":"Article 100159"},"PeriodicalIF":0.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144724726","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}