Pub Date : 2024-09-19DOI: 10.1007/s00417-024-06624-5
Yangzhou Zhang, Huiling Yang, Jipu Pu, Yan Guo
Background
Intraocular pressure (IOP) reduction is the approach that is commonly accepted for the control of open-angle glaucoma (OAG). Medical therapy is typically the first-line of treatment. Laser trabeculoplasty (LT) is an alternative therapy; however, whether pharmaco-therapeutic options can be replaced by LT as the first-line is still debatable.
Methods
studies conducted till July 2023 that compared the efficacy of medications and LT for OAG were retrieved from databases such as Embase, PubMed, Cochrane Library, and Web of Science. We completed data extraction for outcomes of interest. The quality of eligible studies was evaluated and random-effects (RE) model was applied for analysis.
Results
A total of eighteen trials with 2024 patients were included in the analysis. Overall, there was no statistically significant difference between therapies including laser trabeculoplasty (LT) and drug therapy in terms of successful IOP control (RR:1.30, 95%CI: 0.96, 1.78, P = 0.09, I2 = 96%), and reducing intraocular pressure (IOP) (MD:0.15; 95%CI:-0.55,0.85; P = 0.67, I2 = 62%). A significant reduction in drug therapy need in comparison to the group that received medicine (MD:-1.07; 95%CI;-1.21,-0.93), P < 0.001, with a low heterogeneity level (I2 = 16%). Adverse ocular events were more common in the argon laser group (RR:11.71, 95%CI: 9.93, 23.1; P < 0.001).
Conclusion
Both LT and topical drug therapy exhibit comparable rates of success and efficacy in reducing intraocular pressure in patients with open-angle glaucoma. Selective LT is considered a safe treatment option with a reduced occurrence of adverse effects on the eyes while eliminating the possible adherence concerns associated with topical medicine and it can be considered a viable initial option for first OAG treatment.
Key Messages
What is known
Drug therapy is typically the 1st line of treatment for open-angle glaucoma. Although drugs have been shown to effectively reduce intraocular pressure (IOP), they are associated with a range of ocular and systemic negative effects which contributes to suboptimal adherence to medications.
Laser trabeculoplasty (LT) is an alternative therapy; however, whether pharmaco-therapeutic options can be replaced by LT as the first-line is still debatable.
What is new
In terms of IOP reduction and IOP success rate, LT therapy was comparable in efficacy to drug therapy according to our findings.
The safety profile of selective LT was found to be preferable compared to Argon LT.
背景降低眼压（IOP）是公认的控制开角型青光眼（OAG）的方法。药物治疗通常是一线治疗方法。方法从Embase、PubMed、Cochrane Library和Web of Science等数据库中检索了截至2023年7月进行的比较药物和LT治疗OAG疗效的研究。我们完成了相关结果的数据提取。我们对符合条件的研究进行了质量评估，并采用随机效应（RE）模型进行分析。总体而言，在成功控制眼压（RR:1.30, 95%CI: 0.96, 1.78, P = 0.09, I2 = 96%）和降低眼压（MD:0.15; 95%CI:-0.55,0.85; P = 0.67, I2 = 62%）方面，激光小梁成形术（LT）等疗法与药物疗法之间没有统计学意义上的显著差异。与接受药物治疗组相比，药物治疗需求明显减少（MD:-1.07; 95%CI;-1.21,-0.93），P < 0.001，异质性水平较低（I2 = 16%）。结论LT和局部药物治疗在降低开角型青光眼患者眼压方面的成功率和疗效相当。选择性低温冷冻疗法被认为是一种安全的治疗方案，对眼睛的不良影响较小，同时消除了与局部用药相关的可能的依从性问题，可被视为首次治疗开角型青光眼的可行的初始方案。激光小梁成形术（LT）是一种替代疗法；然而，LT作为一线疗法能否取代药物疗法仍有待商榷。新发现根据我们的研究结果，在降低眼压和眼压成功率方面，LT疗法的疗效与药物疗法相当。
{"title":"Safety and efficacy of laser trabeculoplasty compared to drug therapy for the management of open-angle glaucoma: systematic review and meta-analysis study","authors":"Yangzhou Zhang, Huiling Yang, Jipu Pu, Yan Guo","doi":"10.1007/s00417-024-06624-5","DOIUrl":"https://doi.org/10.1007/s00417-024-06624-5","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Intraocular pressure (IOP) reduction is the approach that is commonly accepted for the control of open-angle glaucoma (OAG). Medical therapy is typically the first-line of treatment. Laser trabeculoplasty (LT) is an alternative therapy; however, whether pharmaco-therapeutic options can be replaced by LT as the first-line is still debatable.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>studies conducted till July 2023 that compared the efficacy of medications and LT for OAG were retrieved from databases such as Embase, PubMed, Cochrane Library, and Web of Science. We completed data extraction for outcomes of interest. The quality of eligible studies was evaluated and random-effects (RE) model was applied for analysis.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>A total of eighteen trials with 2024 patients were included in the analysis. Overall, there was no statistically significant difference between therapies including laser trabeculoplasty (LT) and drug therapy in terms of successful IOP control (RR:1.30, 95%CI: 0.96, 1.78, <i>P</i> = 0.09, I<sup>2</sup> = 96%), and reducing intraocular pressure (IOP) (MD:0.15; 95%CI:-0.55,0.85; <i>P</i> = 0.67, I<sup>2</sup> = 62%). A significant reduction in drug therapy need in comparison to the group that received medicine (MD:-1.07; 95%CI;-1.21,-0.93), <i>P</i> < 0.001, with a low heterogeneity level (I<sup>2</sup> = 16%). Adverse ocular events were more common in the argon laser group (RR:11.71, 95%CI: 9.93, 23.1; <i>P</i> < 0.001).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Both LT and topical drug therapy exhibit comparable rates of success and efficacy in reducing intraocular pressure in patients with open-angle glaucoma. Selective LT is considered a safe treatment option with a reduced occurrence of adverse effects on the eyes while eliminating the possible adherence concerns associated with topical medicine and it can be considered a viable initial option for first OAG treatment.</p><h3 data-test=\"abstract-sub-heading\">Key Messages</h3><p><i>What is known</i></p><ul>\u0000<li>\u0000<p>Drug therapy is typically the 1st line of treatment for open-angle glaucoma. Although drugs have been shown to effectively reduce intraocular pressure (IOP), they are associated with a range of ocular and systemic negative effects which contributes to suboptimal adherence to medications.</p>\u0000</li>\u0000<li>\u0000<p>Laser trabeculoplasty (LT) is an alternative therapy; however, whether pharmaco-therapeutic options can be replaced by LT as the first-line is still debatable.</p>\u0000</li>\u0000</ul><p><i>What is new</i></p><ul>\u0000<li>\u0000<p>In terms of IOP reduction and IOP success rate, LT therapy was comparable in efficacy to drug therapy according to our findings.</p>\u0000</li>\u0000<li>\u0000<p>The safety profile of selective LT was found to be preferable compared to Argon LT.</p>\u0000</li>\u0000</ul>","PeriodicalId":12748,"journal":{"name":"Graefe's Archive for Clinical and Experimental Ophthalmology","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-19DOI: 10.1007/s00417-024-06644-1
Mukharram M. Bikbov, Gyulli M. Kazakbaeva, Ellina M. Iakupova, Albina A. Fakhretdinova, Timur R. Gilmanshin, Songhomitra Panda-Jonas, Jost B. Jonas
<h3 data-test="abstract-sub-heading">Purpose</h3><p>To assess the prevalence of age-related macular degeneration (AMD) and reticular pseudodrusen (RPD) in very old individuals.</p><h3 data-test="abstract-sub-heading">Methods</h3><p>The population-based Ural Very Old Study consisted of 1526 (81.1%) out of 1882 eligible individuals aged 85 + years. All individuals living in the study regions and having an age of 85 + years were eligible for the study. The presence of AMD and RPDs was assessed on color fundus photographs, red-free fundus images, and optical coherence tomographic images.</p><h3 data-test="abstract-sub-heading">Results</h3><p>The study included 932 (61.1% of 1526) individuals (age:88.6 ± 2.7 years) with available fundus images. Prevalence of any, early, intermediate and late AMD was 439/932 (47.1%; 95%CI:44.0,50.0), 126/932 (13.5%; 95% CI:11.0,16.0), 185/932 (19.8%; 95% CI:17.3,22.3) and 128/932 (13.7%; 95% CI:11.7,15.7), respectively. Neovascular AMD was present in 63 eyes (6.8%;95%CI:5.3,8.3) and geographic atrophy in 65 eyes (7.0%;95%CI:5.0,9.0). Higher prevalence of any AMD and late AMD was significantly correlated with urban region of habitation (OR:3.34; 95% CI:2.37,4.71; <i>P</i> < 0.001), and with older age (OR:1.12; 95% CI:1.04,1.19; <i>P</i> = 0.001), female sex (OR:1.63; 95%CI:1.02,2.60; <i>P</i> = 0.04), and urban region of habitation (OR:2.89; 95% CI:1.59,5.26; <i>P</i> < 0.001), respectively. RPDs (assessed in 889 (58.3%) study participants) were present in 220/889 participants (24.7%; 95%CI:21.7,27.7). Higher RPD prevalence was associated (multivariable analysis) with higher serum concentration of the rheumatoid factor (OR:1.15; 95% CI:1.04,1.28; <i>P</i> = 0.008), shorter axial length (OR:0.84;95%CI:0.71,0.00;<i>P</i> = 0.04), and higher degree of nuclear cataract (OR:1.06; 95% CI:1.01,1.12; <i>P</i> = 0.02). AMD was the main cause for vision impairment in 230 (24.7%) participants, for moderate-to-severe vision impairment in 75 (8.0%; 95% CI: 6.4, 10.0) individuals, and for blindness in 15 (1.6%; 95%CI: 0.8, 2.5) persons respectively.</p><h3 data-test="abstract-sub-heading">Conclusions</h3><p>In this ethnically mixed, very old population, AMD prevalence (any AMD:47.1%;late AMD:13.7%) was statistically independent of most systemic and ocular parameters. Higher RPD prevalence correlated with shorter axial length.</p><h3 data-test="abstract-sub-heading">Key messages</h3><p><i>What is known</i></p><ul> <li> <p>The prevalence of age-related macular degeneration (AMD) has been explored in many studies and societies. Information is missing about its prevalence and associations in very old individuals. The same holds true for reticular pseudodrusen of the macula.</p> </li> </ul><p><i>What is new</i></p><ul> <li> <p>In an ethnically mixed, very old population in Bashkortostan / Russia, the prevalence of AMD (any AMD: 47.1%; late AMD:13.7%) was statistically independent of most systemic and ocular parameters.</p> </li> <li
{"title":"Prevalence of age-related macular degeneration and retinal pseudodrusen in an elderly population. The ural very old study","authors":"Mukharram M. Bikbov, Gyulli M. Kazakbaeva, Ellina M. Iakupova, Albina A. Fakhretdinova, Timur R. Gilmanshin, Songhomitra Panda-Jonas, Jost B. Jonas","doi":"10.1007/s00417-024-06644-1","DOIUrl":"https://doi.org/10.1007/s00417-024-06644-1","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>To assess the prevalence of age-related macular degeneration (AMD) and reticular pseudodrusen (RPD) in very old individuals.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>The population-based Ural Very Old Study consisted of 1526 (81.1%) out of 1882 eligible individuals aged 85 + years. All individuals living in the study regions and having an age of 85 + years were eligible for the study. The presence of AMD and RPDs was assessed on color fundus photographs, red-free fundus images, and optical coherence tomographic images.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The study included 932 (61.1% of 1526) individuals (age:88.6 ± 2.7 years) with available fundus images. Prevalence of any, early, intermediate and late AMD was 439/932 (47.1%; 95%CI:44.0,50.0), 126/932 (13.5%; 95% CI:11.0,16.0), 185/932 (19.8%; 95% CI:17.3,22.3) and 128/932 (13.7%; 95% CI:11.7,15.7), respectively. Neovascular AMD was present in 63 eyes (6.8%;95%CI:5.3,8.3) and geographic atrophy in 65 eyes (7.0%;95%CI:5.0,9.0). Higher prevalence of any AMD and late AMD was significantly correlated with urban region of habitation (OR:3.34; 95% CI:2.37,4.71; <i>P</i> < 0.001), and with older age (OR:1.12; 95% CI:1.04,1.19; <i>P</i> = 0.001), female sex (OR:1.63; 95%CI:1.02,2.60; <i>P</i> = 0.04), and urban region of habitation (OR:2.89; 95% CI:1.59,5.26; <i>P</i> < 0.001), respectively. RPDs (assessed in 889 (58.3%) study participants) were present in 220/889 participants (24.7%; 95%CI:21.7,27.7). Higher RPD prevalence was associated (multivariable analysis) with higher serum concentration of the rheumatoid factor (OR:1.15; 95% CI:1.04,1.28; <i>P</i> = 0.008), shorter axial length (OR:0.84;95%CI:0.71,0.00;<i>P</i> = 0.04), and higher degree of nuclear cataract (OR:1.06; 95% CI:1.01,1.12; <i>P</i> = 0.02). AMD was the main cause for vision impairment in 230 (24.7%) participants, for moderate-to-severe vision impairment in 75 (8.0%; 95% CI: 6.4, 10.0) individuals, and for blindness in 15 (1.6%; 95%CI: 0.8, 2.5) persons respectively.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>In this ethnically mixed, very old population, AMD prevalence (any AMD:47.1%;late AMD:13.7%) was statistically independent of most systemic and ocular parameters. Higher RPD prevalence correlated with shorter axial length.</p><h3 data-test=\"abstract-sub-heading\">Key messages</h3><p><i>What is known</i></p><ul>\u0000<li>\u0000<p>The prevalence of age-related macular degeneration (AMD) has been explored in many studies and societies. Information is missing about its prevalence and associations in very old individuals. The same holds true for reticular pseudodrusen of the macula.</p>\u0000</li>\u0000</ul><p><i>What is new</i></p><ul>\u0000<li>\u0000<p>In an ethnically mixed, very old population in Bashkortostan / Russia, the prevalence of AMD (any AMD: 47.1%; late AMD:13.7%) was statistically independent of most systemic and ocular parameters.</p>\u0000</li>\u0000<li","PeriodicalId":12748,"journal":{"name":"Graefe's Archive for Clinical and Experimental Ophthalmology","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-19DOI: 10.1007/s00417-024-06579-7
Georg Spital, Steffen Schmitz-Valckenberg, Bettina Müller, Erika Liczenczias, Petrus Chang, Britta Heimes-Bussmann, Focke Ziemssen, Sandra Liakopoulos
Purpose
As part of the prospective, non-interventional OCEAN study, the ORCA module evaluated physicians’ spectral domain optical coherence tomography (SD-OCT) image interpretations in the treatment of diabetic macular oedema (DME) or macular oedema (ME) secondary to retinal vein occlusion (RVO).
Methods
Presence of intraretinal fluid (IRF) and/or subretinal fluid (SRF) was evaluated independently by physicians and reading centres (RCs) on 1612 SD-OCT scans of 133 patients diagnosed with either DME or ME secondary to RVO. Agreement between physicians and RCs was calculated for both cohorts individually and as a combined ME cohort. Physicians’ treatment decisions were analysed related to the results of the OCT-evaluations.
Results
For the combined ME cohort, presence of IRF/SRF was recorded by RCs in 792/1612 (49.1%) visits and by physicians in 852/1612 (52.9%) visits, with an agreement regarding presence or absence of foveal fluid in 70.4% of cases. In 64.4% (510/792) of visits with RC-detected foveal IRF and/or SRF no injection was given. In 30.3% of these visits with foveal fluid no reason was identified for a ‘watch and wait’ approach indicating possible undertreatment. BCVA deterioration was seen in a quarter of these eyes at the following visit.
Conclusion
Despite good agreement between physicians and RCs to recognize SRF and IRF, our data indicate that omitting injections despite foveal involvement of fluid is frequent in routine clinical practice. This may put patients at risk of undertreatment, which may negatively impact real-life BCVA outcomes.
{"title":"Interpretation of SD-OCT imaging data in real-life conditions versus standardized reading centre analysis in eyes with diabetic macular oedema or macular oedema secondary to retinal vein occlusion: 24-month follow-up of the ORCA study","authors":"Georg Spital, Steffen Schmitz-Valckenberg, Bettina Müller, Erika Liczenczias, Petrus Chang, Britta Heimes-Bussmann, Focke Ziemssen, Sandra Liakopoulos","doi":"10.1007/s00417-024-06579-7","DOIUrl":"https://doi.org/10.1007/s00417-024-06579-7","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>As part of the prospective, non-interventional OCEAN study, the ORCA module evaluated physicians’ spectral domain optical coherence tomography (SD-OCT) image interpretations in the treatment of diabetic macular oedema (DME) or macular oedema (ME) secondary to retinal vein occlusion (RVO).</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Presence of intraretinal fluid (IRF) and/or subretinal fluid (SRF) was evaluated independently by physicians and reading centres (RCs) on 1612 SD-OCT scans of 133 patients diagnosed with either DME or ME secondary to RVO. Agreement between physicians and RCs was calculated for both cohorts individually and as a combined ME cohort. Physicians’ treatment decisions were analysed related to the results of the OCT-evaluations.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>For the combined ME cohort, presence of IRF/SRF was recorded by RCs in 792/1612 (49.1%) visits and by physicians in 852/1612 (52.9%) visits, with an agreement regarding presence or absence of foveal fluid in 70.4% of cases. In 64.4% (510/792) of visits with RC-detected foveal IRF and/or SRF no injection was given. In 30.3% of these visits with foveal fluid no reason was identified for a ‘watch and wait’ approach indicating possible undertreatment. BCVA deterioration was seen in a quarter of these eyes at the following visit.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Despite good agreement between physicians and RCs to recognize SRF and IRF, our data indicate that omitting injections despite foveal involvement of fluid is frequent in routine clinical practice. This may put patients at risk of undertreatment, which may negatively impact real-life BCVA outcomes.</p><h3 data-test=\"abstract-sub-heading\">Trial registration</h3><p>www.clinicaltrials.gov, identifier NCT02194803.</p>","PeriodicalId":12748,"journal":{"name":"Graefe's Archive for Clinical and Experimental Ophthalmology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-19DOI: 10.1007/s00417-024-06634-3
Malena Daich Varela, Alejandro Sanders Villa, Nikolas Pontikos, Michael D. Crossland, Michel Michaelides
Digital health is wielding a growing influence across all areas of healthcare, encompassing various facets such as telemedicine, artificial intelligence (AI), and electronic healthcare records. In Ophthalmology, digital health innovations can be broadly divided into four categories: (i) self-monitoring home devices and apps, (ii) virtual and augmented reality visual aids, (iii) AI software, and (iv) wearables. Wearable devices can work in the background, collecting large amounts of objective data while we do our day-to-day activities, which may be ecologically more valid and meaningful to patients than that acquired in traditional hospital settings. They can be a watch, wristband, piece of clothing, glasses, cane, smartphone in our pocket, earphones, or any other device with a sensor that we carry with us. Focusing on retinal diseases, a key challenge in developing novel therapeutics has been to prove a meaningful benefit in patients’ lives and the creation of objective patient-centred endpoints in clinical trials. In this review, we will discuss wearable devices collecting different aspects of visual behaviour, visual field, central vision, and functional vision, as well as their potential implementation as outcome measures in research/clinical trial settings. The healthcare landscape is facing a paradigm shift. Clinicians have a key role of collaborating with the development and fine-tuning of digital health innovations, as well as identifying opportunities where they can be leveraged to enhance our understanding of retinal diseases and improve patient outcomes.
{"title":"Digital health and wearable devices for retinal disease monitoring","authors":"Malena Daich Varela, Alejandro Sanders Villa, Nikolas Pontikos, Michael D. Crossland, Michel Michaelides","doi":"10.1007/s00417-024-06634-3","DOIUrl":"https://doi.org/10.1007/s00417-024-06634-3","url":null,"abstract":"<p>Digital health is wielding a growing influence across all areas of healthcare, encompassing various facets such as telemedicine, artificial intelligence (AI), and electronic healthcare records. In Ophthalmology, digital health innovations can be broadly divided into four categories: (i) self-monitoring home devices and apps, (ii) virtual and augmented reality visual aids, (iii) AI software, and (iv) wearables<b>. </b>Wearable devices can work in the background, collecting large amounts of objective data while we do our day-to-day activities, which may be ecologically more valid and meaningful to patients than that acquired in traditional hospital settings. They can be a watch, wristband, piece of clothing, glasses, cane, smartphone in our pocket, earphones, or any other device with a sensor that we carry with us. Focusing on retinal diseases, a key challenge in developing novel therapeutics has been to prove a meaningful benefit in patients’ lives and the creation of objective patient-centred endpoints in clinical trials. In this review, we will discuss wearable devices collecting different aspects of visual behaviour, visual field, central vision, and functional vision, as well as their potential implementation as outcome measures in research/clinical trial settings. The healthcare landscape is facing a paradigm shift. Clinicians have a key role of collaborating with the development and fine-tuning of digital health innovations, as well as identifying opportunities where they can be leveraged to enhance our understanding of retinal diseases and improve patient outcomes.</p>","PeriodicalId":12748,"journal":{"name":"Graefe's Archive for Clinical and Experimental Ophthalmology","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-18DOI: 10.1007/s00417-024-06641-4
Brendan Portengen, Saskia Imhof, Marnix Naber, Giorgio Porro
<h3 data-test="abstract-sub-heading">Purpose</h3><p>To determine the diagnostic performance and reliability of two pupil perimetry (PP) methods in homonymous hemianopia.</p><h3 data-test="abstract-sub-heading">Methods</h3><p>This cross-sectional monocenter cohort study performed gaze-contingent flicker PP (gcFPP) and a virtual reality version of gcFPP (VRgcFPP) twice on separate occasions in all patients suffering from homonymous hemianopia due to neurological impairment. The main outcomes were (1) test accuracy and (2) test–retest reliability: (1) was measured through area under the receiver operating characteristics curve (AUC) calculation of (VR)gcFPP results with comparators being SAP and healthy controls, respectively; (2) was evaluated by comparing tests 1 and 2 of both methods within patients.</p><h3 data-test="abstract-sub-heading">Results</h3><p>Both gcFPP and VRgcFPP were performed in 15 patients (12 males, M<sub>Age</sub> = 57, SD<sub>Age</sub> = 15) and 17 controls (6 males, M<sub>Age</sub> = 53, SD<sub>Age</sub> = 12). Mean test accuracy was good in separating damaged from intact visual field regions (gcFPP: M<sub>auc</sub> = 0.83, SD<sub>auc</sub> = 0.09; VRgcFPP: M<sub>auc</sub> = 0.69, SD<sub>auc</sub> = 0.13) and in separating patients from controls (gcFPP: M<sub>auc</sub> = 0.92, SD<sub>auc</sub> = 0.13; VRgcFPP: M<sub>auc</sub> = 0.96, SD<sub>auc</sub> = 0.15). A high test–retest reliability was found for the proportion intact versus damaged visual field (gcFPP: <i>r</i> = 0.95, <i>P</i> < .001, VRgcFPP: <i>r</i> = 1.00, <i>P</i> < .001).</p><h3 data-test="abstract-sub-heading">Conclusions</h3><p>Overall, these results can be summarized as follows: (1) the comparison of pupil response amplitudes between intact versus damaged regions per patient indicate that gcFPP allows for cleaner imaging of intact versus damaged visual field regions than VRgcFPP, (2) the comparisons of average differences in intact versus damaged amplitudes between patients and controls demonstrate high diagnostic performance of both gcFPP and VRgcFPP, and (3) the test–retest reliabilities confirm that both gcFPP and VRgcFPP reliably and consistently measure defects in homonymous hemianopia.</p><h3 data-test="abstract-sub-heading">Key messages</h3><p><b><i>What is known</i></b> </p><ul> <li> <p>Standard automated perimetry is the current gold standard for visual field examination, but not always suited for the evaluation of the VF in neurologically impaired patients.</p> </li> <li> <p>Pupil perimetry consists of the measurement of pupillary responses to light stimuli as a measure of visual sensitivity.</p> </li> </ul><p><b><i>What is new</i></b> </p><ul> <li> <p>This study reports the highest diagnostic accuracy of pupil perimetry so far in patients with homonymous hemianopia.</p> </li> <li> <p>Gaze-contingent flicker pupil perimetry reliably and consistently measures defects in homonymous hemianopia under standard and virtual reality viewing condition
{"title":"Diagnostic performance of pupil perimetry in detecting hemianopia under standard and virtual reality viewing conditions","authors":"Brendan Portengen, Saskia Imhof, Marnix Naber, Giorgio Porro","doi":"10.1007/s00417-024-06641-4","DOIUrl":"https://doi.org/10.1007/s00417-024-06641-4","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>To determine the diagnostic performance and reliability of two pupil perimetry (PP) methods in homonymous hemianopia.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>This cross-sectional monocenter cohort study performed gaze-contingent flicker PP (gcFPP) and a virtual reality version of gcFPP (VRgcFPP) twice on separate occasions in all patients suffering from homonymous hemianopia due to neurological impairment. The main outcomes were (1) test accuracy and (2) test–retest reliability: (1) was measured through area under the receiver operating characteristics curve (AUC) calculation of (VR)gcFPP results with comparators being SAP and healthy controls, respectively; (2) was evaluated by comparing tests 1 and 2 of both methods within patients.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Both gcFPP and VRgcFPP were performed in 15 patients (12 males, M<sub>Age</sub> = 57, SD<sub>Age</sub> = 15) and 17 controls (6 males, M<sub>Age</sub> = 53, SD<sub>Age</sub> = 12). Mean test accuracy was good in separating damaged from intact visual field regions (gcFPP: M<sub>auc</sub> = 0.83, SD<sub>auc</sub> = 0.09; VRgcFPP: M<sub>auc</sub> = 0.69, SD<sub>auc</sub> = 0.13) and in separating patients from controls (gcFPP: M<sub>auc</sub> = 0.92, SD<sub>auc</sub> = 0.13; VRgcFPP: M<sub>auc</sub> = 0.96, SD<sub>auc</sub> = 0.15). A high test–retest reliability was found for the proportion intact versus damaged visual field (gcFPP: <i>r</i> = 0.95, <i>P</i> < .001, VRgcFPP: <i>r</i> = 1.00, <i>P</i> < .001).</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>Overall, these results can be summarized as follows: (1) the comparison of pupil response amplitudes between intact versus damaged regions per patient indicate that gcFPP allows for cleaner imaging of intact versus damaged visual field regions than VRgcFPP, (2) the comparisons of average differences in intact versus damaged amplitudes between patients and controls demonstrate high diagnostic performance of both gcFPP and VRgcFPP, and (3) the test–retest reliabilities confirm that both gcFPP and VRgcFPP reliably and consistently measure defects in homonymous hemianopia.</p><h3 data-test=\"abstract-sub-heading\">Key messages</h3><p><b><i>What is known</i></b>\u0000</p><ul>\u0000<li>\u0000<p>Standard automated perimetry is the current gold standard for visual field examination, but not always suited for the evaluation of the VF in neurologically impaired patients.</p>\u0000</li>\u0000<li>\u0000<p>Pupil perimetry consists of the measurement of pupillary responses to light stimuli as a measure of visual sensitivity.</p>\u0000</li>\u0000</ul><p><b><i>What is new</i></b>\u0000</p><ul>\u0000<li>\u0000<p>This study reports the highest diagnostic accuracy of pupil perimetry so far in patients with homonymous hemianopia.</p>\u0000</li>\u0000<li>\u0000<p>Gaze-contingent flicker pupil perimetry reliably and consistently measures defects in homonymous hemianopia under standard and virtual reality viewing condition","PeriodicalId":12748,"journal":{"name":"Graefe's Archive for Clinical and Experimental Ophthalmology","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-18DOI: 10.1007/s00417-024-06643-2
Rian Vilar Lima, Mateus Pimenta Arruda, Maria Carolina Rocha Muniz, Helvécio Neves Feitosa Filho, Daiane Memória Ribeiro Ferrerira, Samuel Montenegro Pereira
{"title":"Artificial intelligence methods in diagnosis of retinoblastoma based on fundus imaging: a systematic review and meta-analysis","authors":"Rian Vilar Lima, Mateus Pimenta Arruda, Maria Carolina Rocha Muniz, Helvécio Neves Feitosa Filho, Daiane Memória Ribeiro Ferrerira, Samuel Montenegro Pereira","doi":"10.1007/s00417-024-06643-2","DOIUrl":"https://doi.org/10.1007/s00417-024-06643-2","url":null,"abstract":"","PeriodicalId":12748,"journal":{"name":"Graefe's Archive for Clinical and Experimental Ophthalmology","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-18DOI: 10.1007/s00417-024-06638-z
Michael Bach
Purpose
Visual acuity is a psychophysical threshold that we want to determine as precisely and efficiently as possible. The Freiburg Vision Test FrACT employs the automated Bayesian “Best PEST” algorithm for this purpose: the next optotype size is always selected to be at threshold based on the information acquired so far, thereby maximizing information gain.
Methods
We assessed the test–retest Limits of Agreement (LoA, Bland & Altman 1986) across 6 to 48 trials in 2 × 78 runs involving 26 participants; visual acuity (in part artificially reduced) ranged from 1.22 to -0.59 LogMAR.
Results
LoA exhibited a steep decline from ± 0.46 LogMAR at six trials to ± 0.17 at 18 trials; with more trials, LoA showed less change, reaching ± 0.12 LogMAR at 48 trials. LoA did not significantly change over the wide acuity range assessed here.
Conclusion
These findings suggest that 18 trials represent an efficient balance between precision and burden on the participant and examiner. This observation holds for the eight response alternatives used in this study (8 Landolt C orientations) and is anticipated to apply to the ten Sloan letters as well. With only four choices (e.g., tumbling E), more trials will be necessary.
Key messages
What is known
When assessing visual acuity, a tradeoff between precision and effort is necessary.
What is new
A run length of 18 trials is a good compromise between effort and precision for an 8-alternative task (the Landolt C).
With 18 trials a 95% confidence interval of ± 0.17 LogMAR for test–retest is found.
The test–retest precision is independent of the acuity level over the 1.5 LogMAR range studied here.
{"title":"Freiburg vision test (FrACT): optimal number of trials?","authors":"Michael Bach","doi":"10.1007/s00417-024-06638-z","DOIUrl":"https://doi.org/10.1007/s00417-024-06638-z","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Visual acuity is a psychophysical threshold that we want to determine as precisely and efficiently as possible. The Freiburg Vision Test FrACT employs the automated Bayesian “Best PEST” algorithm for this purpose: the next optotype size is always selected to be at threshold based on the information acquired so far, thereby maximizing information gain.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We assessed the test–retest Limits of Agreement (LoA, Bland & Altman 1986) across 6 to 48 trials in 2 × 78 runs involving 26 participants; visual acuity (in part artificially reduced) ranged from 1.22 to -0.59 LogMAR.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>LoA exhibited a steep decline from ± 0.46 LogMAR at six trials to ± 0.17 at 18 trials; with more trials, LoA showed less change, reaching ± 0.12 LogMAR at 48 trials. LoA did not significantly change over the wide acuity range assessed here.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>These findings suggest that 18 trials represent an efficient balance between precision and burden on the participant and examiner. This observation holds for the eight response alternatives used in this study (8 Landolt C orientations) and is anticipated to apply to the ten Sloan letters as well. With only four choices (e.g., tumbling E), more trials will be necessary.</p><h3 data-test=\"abstract-sub-heading\">Key messages</h3><p><b><i>What is known</i></b></p><ul>\u0000<li>\u0000<p>When assessing visual acuity, a tradeoff between precision and effort is necessary.</p>\u0000</li>\u0000</ul><p><b><i>What is new</i></b></p><ul>\u0000<li>\u0000<p>A run length of 18 trials is a good compromise between effort and precision for an 8-alternative task (the Landolt C).</p>\u0000</li>\u0000<li>\u0000<p>With 18 trials a 95% confidence interval of ± 0.17 LogMAR for test–retest is found.</p>\u0000</li>\u0000<li>\u0000<p>The test–retest precision is independent of the acuity level over the 1.5 LogMAR range studied here.</p>\u0000</li>\u0000</ul>","PeriodicalId":12748,"journal":{"name":"Graefe's Archive for Clinical and Experimental Ophthalmology","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-17DOI: 10.1007/s00417-024-06628-1
Juan J. Miret, Vicente J. Camps, Celia García, Maria T. Caballero, Juan M. Gonzalez-Leal
<h3 data-test="abstract-sub-heading">Purpose</h3><p>The aim of this study was to develop a methodology, based on profilometer measurements to assess the optical behaviour of Intraocular Lenses (IOls). The “Modulation Transfer Function through-object” (MTF through-object) based on vergence object displacement was calculated for different pupil sizes and pseudophakic eyes. Tilt and decentration were also analysed in a realistic cornea eye model.</p><h3 data-test="abstract-sub-heading">Methods</h3><p>For comparison between the different IOLs, an optical quality criterion based on a minimum value the MTF through-object and the recognition of simulated vision optotypes was introduced. Five IOLs were used in this study: Tecnis Eyhance, Mini Well, Tecnis Symfony, Tecnis Synergy and RayOne EMV.</p><h3 data-test="abstract-sub-heading">Results</h3><p>The technique was validated with previous methodologies. A general narrowing of the through-object MTF curve compared to the through-focus MTF curve was shown, resulting in greater distances between near and intermediate points and less depth of field around the far peak. The comparison between the IOLs showed that variations in corneal aberrations, pupil size and decentration caused relevant changes in IOL performance. A decrease of the SA produced a hypermetropic shift of the far focus between + 0.3 D and + 0.4 D. Most of IOLs worsen the optical quality as pupil size increased, even the MTF through-object shape changed. Decentration was an important factor in IOL implantation, causing a significant change in MTF through-object shape in most of IOLs.</p><h3 data-test="abstract-sub-heading">Conclusions</h3><p>This study highlights the need to evaluate pre-operative patients for corneal aberrations and pupillary size to have the best optical success after cataract surgery in multifocal or extended depth of focus IOLs.</p><h3 data-test="abstract-sub-heading">Key messages</h3><p><b><i>What is known</i></b></p><ul> <li> <p>MTF(Modulation Transfer Function) through-focus curves (calculated in image space by moving the detector plane) can be obtained from optical bench assembly or from commercial devices.</p> </li> <li> <p>Recently, some studies proposed to characterize the lens surface design based on the profilometric measurements</p> </li> </ul><p><b><i>What is new</i></b></p><ul> <li> <p>A novel methodology based on profilometer measurements to assess the optical behaviour of Intraocular Lenses (IOls) was shown.</p> </li> <li> <p>The “Modulation Transfer Function through-object” based on vergence object displacement was introduced in order to analyse five premium IOLs.</p> </li> <li> <p>MTF through-object curve is more appropriate for studying clinical behaviour, as it provides further near and intermediate points distances and lower depth of focus around far peak compare to MTF through-focus curves.</p> </li> <li> <p>The optical behaviour of the five IOLs can vary considerably depending on the eye model and pup
{"title":"Analysis of the optical performance of intraocular lenses using profilometric measurements","authors":"Juan J. Miret, Vicente J. Camps, Celia García, Maria T. Caballero, Juan M. Gonzalez-Leal","doi":"10.1007/s00417-024-06628-1","DOIUrl":"https://doi.org/10.1007/s00417-024-06628-1","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>The aim of this study was to develop a methodology, based on profilometer measurements to assess the optical behaviour of Intraocular Lenses (IOls). The “Modulation Transfer Function through-object” (MTF through-object) based on vergence object displacement was calculated for different pupil sizes and pseudophakic eyes. Tilt and decentration were also analysed in a realistic cornea eye model.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>For comparison between the different IOLs, an optical quality criterion based on a minimum value the MTF through-object and the recognition of simulated vision optotypes was introduced. Five IOLs were used in this study: Tecnis Eyhance, Mini Well, Tecnis Symfony, Tecnis Synergy and RayOne EMV.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The technique was validated with previous methodologies. A general narrowing of the through-object MTF curve compared to the through-focus MTF curve was shown, resulting in greater distances between near and intermediate points and less depth of field around the far peak. The comparison between the IOLs showed that variations in corneal aberrations, pupil size and decentration caused relevant changes in IOL performance. A decrease of the SA produced a hypermetropic shift of the far focus between + 0.3 D and + 0.4 D. Most of IOLs worsen the optical quality as pupil size increased, even the MTF through-object shape changed. Decentration was an important factor in IOL implantation, causing a significant change in MTF through-object shape in most of IOLs.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>This study highlights the need to evaluate pre-operative patients for corneal aberrations and pupillary size to have the best optical success after cataract surgery in multifocal or extended depth of focus IOLs.</p><h3 data-test=\"abstract-sub-heading\">Key messages</h3><p><b><i>What is known</i></b></p><ul>\u0000<li>\u0000<p>MTF(Modulation Transfer Function) through-focus curves (calculated in image space by moving the detector plane) can be obtained from optical bench assembly or from commercial devices.</p>\u0000</li>\u0000<li>\u0000<p>Recently, some studies proposed to characterize the lens surface design based on the profilometric measurements</p>\u0000</li>\u0000</ul><p><b><i>What is new</i></b></p><ul>\u0000<li>\u0000<p>A novel methodology based on profilometer measurements to assess the optical behaviour of Intraocular Lenses (IOls) was shown.</p>\u0000</li>\u0000<li>\u0000<p>The “Modulation Transfer Function through-object” based on vergence object displacement was introduced in order to analyse five premium IOLs.</p>\u0000</li>\u0000<li>\u0000<p>MTF through-object curve is more appropriate for studying clinical behaviour, as it provides further near and intermediate points distances and lower depth of focus around far peak compare to MTF through-focus curves.</p>\u0000</li>\u0000<li>\u0000<p>The optical behaviour of the five IOLs can vary considerably depending on the eye model and pup","PeriodicalId":12748,"journal":{"name":"Graefe's Archive for Clinical and Experimental Ophthalmology","volume":"194 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-16DOI: 10.1007/s00417-024-06629-0
James Park, Charu Vyas, Onur İnam, Henry W. Zhou, Zachary E. Snow, Rabia Karani, Dvir Koenigstein, Tongalp H. Tezel
What is known
• The existing Scheie classification schema for hypertension is subjective in nature with challenges in consistent identification of early hypertensive changes in the retina.
What is new
• Perifoveal arteriolar tortuosity differs significantly between early hypertensive and control patients.
• Arteriolar tortuosity may be a potential biomarker that is useful in identifying patients who have early hypertensive changes in the retina.
{"title":"The role of Perifoveal Arteriolar Tortuosity in Optical Coherence Tomography Angiography (OCTA) images as an early indicator of hypertensive retinopathy","authors":"James Park, Charu Vyas, Onur İnam, Henry W. Zhou, Zachary E. Snow, Rabia Karani, Dvir Koenigstein, Tongalp H. Tezel","doi":"10.1007/s00417-024-06629-0","DOIUrl":"https://doi.org/10.1007/s00417-024-06629-0","url":null,"abstract":"<p>\u0000<b><i>What is known</i></b></p>\u0000<p> • The existing Scheie classification schema for hypertension is subjective in nature with challenges in consistent identification of early hypertensive changes in the retina.</p>\u0000<p>\u0000<b><i>What is new</i></b></p>\u0000<p> • Perifoveal arteriolar tortuosity differs significantly between early hypertensive and control patients.</p>\u0000<p> • Arteriolar tortuosity may be a potential biomarker that is useful in identifying patients who have early hypertensive changes in the retina.</p>","PeriodicalId":12748,"journal":{"name":"Graefe's Archive for Clinical and Experimental Ophthalmology","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-15DOI: 10.1007/s00417-024-06625-4
Daniel Bahir, Omri Zur, Leah Attal, Zaki Nujeidat, Ariela Knaanie, Joseph Pikkel, Michael Mimouni, Gilad Plopsky
<h3 data-test="abstract-sub-heading">Introduction</h3><p>The rapid advancement of artificial intelligence (AI), particularly in large language models like ChatGPT and Google's Gemini AI, marks a transformative era in technological innovation. This study explores the potential of AI in ophthalmology, focusing on the capabilities of ChatGPT and Gemini AI. While these models hold promise for medical education and clinical support, their integration requires comprehensive evaluation. This research aims to bridge a gap in the literature by comparing Gemini AI and ChatGPT, assessing their performance against ophthalmology residents using a dataset derived from ophthalmology board exams.</p><h3 data-test="abstract-sub-heading">Methods</h3><p>A dataset comprising 600 questions across 12 subspecialties was curated from Israeli ophthalmology residency exams, encompassing text and image-based formats. Four AI models – ChatGPT-3.5, ChatGPT-4, Gemini, and Gemini Advanced – underwent testing on this dataset. The study includes a comparative analysis with Israeli ophthalmology residents, employing specific metrics for performance assessment.</p><h3 data-test="abstract-sub-heading">Results</h3><p>Gemini Advanced demonstrated superior performance with a 66% accuracy rate. Notably, ChatGPT-4 exhibited improvement at 62%, Gemini at 58%, and ChatGPT-3.5 served as the reference at 46%. Comparative analysis with residents offered insights into AI models' performance relative to human-level medical knowledge. Further analysis delved into yearly performance trends, topic-specific variations, and the impact of images on chatbot accuracy.</p><h3 data-test="abstract-sub-heading">Conclusion</h3><p>The study unveils nuanced AI model capabilities in ophthalmology, emphasizing domain-specific variations. The superior performance of Gemini Advanced superior performance indicates significant advancements, while ChatGPT-4's improvement is noteworthy. Both Gemini and ChatGPT-3.5 demonstrated commendable performance. The comparative analysis underscores AI's evolving role as a supplementary tool in medical education. This research contributes vital insights into AI effectiveness in ophthalmology, highlighting areas for refinement. As AI models evolve, targeted improvements can enhance adaptability across subspecialties, making them valuable tools for medical professionals and enriching patient care.</p><h3 data-test="abstract-sub-heading">Key Messages</h3><p><i>What is known</i></p><ul> <li> <p>AI breakthroughs, like ChatGPT and Google's Gemini AI, are reshaping healthcare. In ophthalmology, AI integration has overhauled clinical workflows, particularly in analyzing images for diseases like diabetic retinopathy and glaucoma.</p> </li> </ul><p><i>What is new</i></p><ul> <li> <p>This study presents a pioneering comparison between Gemini AI and ChatGPT, evaluating their performance against ophthalmology residents using a meticulously curated dataset derived from real-world ophthalmolo
{"title":"Gemini AI vs. ChatGPT: A comprehensive examination alongside ophthalmology residents in medical knowledge","authors":"Daniel Bahir, Omri Zur, Leah Attal, Zaki Nujeidat, Ariela Knaanie, Joseph Pikkel, Michael Mimouni, Gilad Plopsky","doi":"10.1007/s00417-024-06625-4","DOIUrl":"https://doi.org/10.1007/s00417-024-06625-4","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction</h3><p>The rapid advancement of artificial intelligence (AI), particularly in large language models like ChatGPT and Google's Gemini AI, marks a transformative era in technological innovation. This study explores the potential of AI in ophthalmology, focusing on the capabilities of ChatGPT and Gemini AI. While these models hold promise for medical education and clinical support, their integration requires comprehensive evaluation. This research aims to bridge a gap in the literature by comparing Gemini AI and ChatGPT, assessing their performance against ophthalmology residents using a dataset derived from ophthalmology board exams.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>A dataset comprising 600 questions across 12 subspecialties was curated from Israeli ophthalmology residency exams, encompassing text and image-based formats. Four AI models – ChatGPT-3.5, ChatGPT-4, Gemini, and Gemini Advanced – underwent testing on this dataset. The study includes a comparative analysis with Israeli ophthalmology residents, employing specific metrics for performance assessment.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Gemini Advanced demonstrated superior performance with a 66% accuracy rate. Notably, ChatGPT-4 exhibited improvement at 62%, Gemini at 58%, and ChatGPT-3.5 served as the reference at 46%. Comparative analysis with residents offered insights into AI models' performance relative to human-level medical knowledge. Further analysis delved into yearly performance trends, topic-specific variations, and the impact of images on chatbot accuracy.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>The study unveils nuanced AI model capabilities in ophthalmology, emphasizing domain-specific variations. The superior performance of Gemini Advanced superior performance indicates significant advancements, while ChatGPT-4's improvement is noteworthy. Both Gemini and ChatGPT-3.5 demonstrated commendable performance. The comparative analysis underscores AI's evolving role as a supplementary tool in medical education. This research contributes vital insights into AI effectiveness in ophthalmology, highlighting areas for refinement. As AI models evolve, targeted improvements can enhance adaptability across subspecialties, making them valuable tools for medical professionals and enriching patient care.</p><h3 data-test=\"abstract-sub-heading\">Key Messages</h3><p><i>What is known</i></p><ul>\u0000<li>\u0000<p>AI breakthroughs, like ChatGPT and Google's Gemini AI, are reshaping healthcare. In ophthalmology, AI integration has overhauled clinical workflows, particularly in analyzing images for diseases like diabetic retinopathy and glaucoma.</p>\u0000</li>\u0000</ul><p><i>What is new</i></p><ul>\u0000<li>\u0000<p>This study presents a pioneering comparison between Gemini AI and ChatGPT, evaluating their performance against ophthalmology residents using a meticulously curated dataset derived from real-world ophthalmolo","PeriodicalId":12748,"journal":{"name":"Graefe's Archive for Clinical and Experimental Ophthalmology","volume":"75 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248586","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}
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