Seminars in Ophthalmology最新文献

Purpose: Patients are using online search modalities to learn about their eye health. While Google remains the most popular search engine, the use of large language models (LLMs) like ChatGPT has increased. Cataract surgery is the most common surgical procedure in the US, and there is limited data on the quality of online information that populates after searches related to cataract surgery on search engines such as Google and LLM platforms such as ChatGPT. We identified the most common patient frequently asked questions (FAQs) about cataracts and cataract surgery and evaluated the accuracy, safety, and readability of the answers to these questions provided by both Google and ChatGPT. We demonstrated the utility of ChatGPT in writing notes and creating patient education materials.

Methods: The top 20 FAQs related to cataracts and cataract surgery were recorded from Google. Responses to the questions provided by Google and ChatGPT were evaluated by a panel of ophthalmologists for accuracy and safety. Evaluators were also asked to distinguish between Google and LLM chatbot answers. Five validated readability indices were used to assess the readability of responses. ChatGPT was instructed to generate operative notes, post-operative instructions, and customizable patient education materials according to specific readability criteria.

Results: Responses to 20 patient FAQs generated by ChatGPT were significantly longer and written at a higher reading level than responses provided by Google (p < .001), with an average grade level of 14.8 (college level). Expert reviewers were correctly able to distinguish between a human-reviewed and chatbot generated response an average of 31% of the time. Google answers contained incorrect or inappropriate material 27% of the time, compared with 6% of LLM generated answers (p < .001). When expert reviewers were asked to compare the responses directly, chatbot responses were favored (66%).

Conclusions: When comparing the responses to patients' cataract FAQs provided by ChatGPT and Google, practicing ophthalmologists overwhelming preferred ChatGPT responses. LLM chatbot responses were less likely to contain inaccurate information. ChatGPT represents a viable information source for eye health for patients with higher health literacy. ChatGPT may also be used by ophthalmologists to create customizable patient education materials for patients with varying health literacy.

Purpose: The aim of this study is to analyze the scientific literature about the effect of VR on the accommodative and binocular function of healthy subjects with both normal visual conditions and binocular anomalies assessing the quality of the existing studies to detect possible limitations and improve future study designs.

Methods: A search was performed in PubMed, Web of Science and Scopus databases with the search equation (Virtual reality OR head-mounted displays) AND (accommodation OR accommodative) AND (vergence* OR convergence OR divergence OR binocular vision). A limitation was made in terms of the date of publication from 2010 onwards, identifying a total of 198 publications. Finally, 15 publications were included in the quality analysis. After a comprehensive analysis of the publications, a quality assessment was performed using a Quality Appraisal Checklist.

Results: Research on effects of immersive VR on accommodative and binocular function to this date was focused on quasi-experimental pre-post studies well written and with results supporting their conclusions. Unfortunately, this scientific evidence provides heterogeneous outcomes, being the results in some cases even contradictory.

Conclusions: Information about the devices, its interpupillary distance adjustment, the software characteristics and type of task performed by users should be better controlled in future studies. Additionally, participants accommodative and binocular baseline characteristics should be better analyzed to obtain firm conclusions about the consequences of the proper immersive VR experience on visual function.

Purpose: The academic success of ophthalmology fellows may be significantly impacted by their research engagement. Evaluating the research activity of fellows by subspecialty may provide insight into trends useful for prospective applicants. The objective of this study was to assess the research activity of ophthalmology fellows in the year 2023.

Methods: Ophthalmology fellowship programs were compiled using the Association of University Professors of Ophthalmology and the American Society of Ophthalmic Plastic and Reconstructive Surgery websites. Program subspecialties were categorized as: Cornea and External Disease [CED]; Cornea, External Disease, and Refractive Surgery [CEDRS]; Glaucoma; Medical Retina [MR]; Neuro-Ophthalmology [NO]; Oculoplastics; Pediatric Ophthalmology [PO]; Surgical Retina [SR]; Uveitis; and Other. "Other" consisted of Oncology, Pathology, combined Oncology and Pathology fellowships. We identified current fellows using publicly available online information. Programs and fellows that did not have information available were excluded. Total publications, Hirsch index (h-index), and weighted-relative citation ration (w-RCR) were utilized as measures of research output, while total citations and mean-RCR (m-RCR) served as proxies for research impact. Duration of publishing was calculated using the years of the oldest and most recent publications. Statistical analysis was performed using Kruskal-Wallis H tests with an alpha value of .05.

Results: A total of 373 fellows from 229 programs met our inclusion criteria. More than half of fellows were men (54.4%), and the most common degree type was MD (93.0%). Across all subspecialties, the median h-index was 3.0 (IQR = 4), m-RCR was .9 (IQR = 1.2) and w-RCR was 3.2 (IQR = 9.8). The median number of publications was six (IQR = 10, with 34 citations (IQR = 110) and 4 years of publishing (IQR = 6). We observed significant differences in h-index (p = .038), total publications (p < .001), and w-RCR (p = .028) by subspecialty.

Conclusion: We observed significant differences in research output, but no differences in research impact by subspecialty. Overall, Uveitis and Oculoplastics fellows had higher research activity, while Medical Retina and Other fellows had the lowest. This data is pertinent to better understand the landscape of ophthalmology fellowship applications.

Background: A pallor optic nerve head (ONH) is one of the three features of retinitis pigmentosa (RP). This study aimed to assess the ONH prospectively by color tone, presence of hyper-reflective tissue, blood flow, retinal nerve fiber layer (RNFL) thickness, ganglion cell complex (GCC) and investigate the change in these parameters with and without ONH pallor.

Methods: The presence of ONH pallor was assessed by three independent examiners through careful examination using fundus photographs. The presence of a hyper-reflective structure on the ONH was carefully evaluated using a volume scan optical coherence tomography (OCT). RNFL thickness and ellipsoid zone (EZ) width around the macula were also evaluated by OCT. Laser speckle flowgraphy was used to measure the mean blur rate of the entire ONH area, which was subsequently divided into the vessel area (MV) and tissue area (MT).

Results: Twenty-eight eyes of 28 patients with RP (55.4 ± 16.23 years of age) were included. The pale ONH was observed in 10 (35%) eyes. Hyper-reflective structures were observed in seven (25%) eyes. No significant correlation was found between the pale ONH and the presence of a hyper-reflective structure (Pearson's chi-squared test, p = .364). The average of the ONH area, MV, and MT was 8.65 ± 3.08 AU, 17.81 ± 7.54 AU, and 6.4 ± 2.66 AU, respectively, which significantly decreased in patients with pallor ONH (all p < .05). The global RNFL thickness was 73.54 ± 18.82 μm. The nasal and superior quadrants and global RNFL thickness in patients with a pale ONH were significantly thinner than in patients without a pale ONH (all p < .05). The global and superior and inferior GCC thickness in patients with a pale ONH were significantly thinner than in patients without a pale ONH(all p < .05).There was no difference in the EZ width between patients with and without a pale ONH (p = .107).

Conclusion: We conducted multiple assessments of the ONH in RP patients and investigated its clinical significance. Our findings suggest that ONH pallor may indicate a comprehensive change that emerges alongside the progression of retinal degeneration in RP.

Trial registration: This trial was retrospectively registered in the UMIN Clinical Trial Registry (UMIN ID: 000048168).

Purpose: Topical prostaglandin analogues are commonly used to treat patients with glaucoma, but may cause periocular and periorbital complications known as prostaglandin-associated periorbitopathy syndrome (PAPS).

Methods: A literature review was conducted on PAPS. Given the lack of consensus on grading PAPS, glaucoma specialists from Asia convened to evaluate current PAPS grading systems and propose additional considerations in grading PAPS.

Results: Existing grading systems are limited by the lack of specificity in defining grades and consideration for patients' subjective perception of symptoms. Patient-reported symptoms (e.g., via a self-assessment tool) and additional clinical assessments (e.g., exophthalmometry, lid laxity, differences between tonometry results, baseline measurements, and external ocular photographs) would be beneficial for grading PAPS systematically.

Conclusions: Effective management of PAPS could be facilitated by a common clinical grading system to consistently and accurately diagnose and characterise symptoms. Further research is required to validate specific recommendations and approaches to stage and monitor PAPS.

Background: The capsular tension ring is a novel assistant tool for cataract surgery; however, controversy exists in its co-implantation. The potential for hyperopic or myopic shift resulting from the co-implantation of the capsular tension ring and intraocular lens remains unclear. This study aimed to determine the postoperative refractive prediction error and the direction of refractive shift in cataract patients who underwent capsular tension ring co-implantation.

Methods: We conducted a systematic review and meta-analysis,searching electronic databases for studies of individuals diagnosed with cataracts receiving surgery with or without capsular tension ring implantation. Systematic searches were performed based on five databases: PubMed, Cochrane Library, Web of Science, Medline, and China National Knowledge Infrastructure. The primary outcome was the mean arithmetic refractive prediction error. Secondary outcomes were mean absolute refractive prediction error and the number of eyes within a certain refractive prediction error range. We applied a fixed-effectsmodel to pool effect sizes across trials using weighted mean differences (WMD) and risk ratios (RR) with their 95% confidence intervals (95% CI). Statistical heterogeneity scores were assessed with the I²statistic.

Results: A total of 407 affected eyes were included in eight independent clinical studies. Meta-analysis suggested significant differences both in short-term (≤1 month) co-implantation (WMD = 0.16, p < .001, 95% CI: -0.13 ~ 0.19) and long-term (≥3 months) co-implantation between the capsular tension ring co-implantation group and the control group (WMD = 0.19, p < .001, 95% CI: 0.15 ~ 0.23). However, no significant difference was observed in the high myopia subgroup whether capsular tension ring co-implantation (WMD = 0.03, p = .083, 95% CI: -0.27 ~ 0.34). Heterogeneity was not found among the studies.

Conclusion: Compared to simple intraocular lens implantation, capsular tension ring co-implantation is more susceptible to developing hyperopic shifts in non-myopic cataract patients, probably related to anterior chamber depth. It requires careful consideration by clinicians when determining the target diopter preoperatively. However, interpretation is limited, because there is a lack of studies available for analysis. There still needs to be additional studies to expand the evidence base.

Purpose: To assess a novel Virtual Reality (VR) tool designed to enhance understanding of the nasal anatomy in patients eligible for DCR surgery.

Methods: Preoperative Computed Tomography (CT) scans of the orbit were obtained and loaded as DICOM (Digital Imaging and Communications in Medicine) files onto the D2P software (3D Systems Inc. Littleton, CO) for tissue segmentation and 3D model preparation. Segmentation was performed on several anatomical structures, including the skull, lacrimal sac, nasal septum, inferior and middle turbinate. The resulting 3D model was visualized using a VR headset. After completing the segmentation procedure, ten cases were evaluated by a panel of six surgeons, including both senior and resident physicians from ENT and oculoplastic specialties.

Results: The dataset under examination comprised images from 10 preoperative CT scans of the orbits of patients eligible for Endo-DCR. When evaluating the CT using the VR tool, in 73.3% of the cases ENT surgeons were right about the side of pathology, while only 43.3% ophthalmologists were right (chi-square, p = .018). In 72.8% of the cases ENT surgeons were evaluated right that there is a septum deviation, while only in 47.2% of the cases the ophthalmologists were right (chi-square, p = .094).When evaluating the CT using the VR tool, in 60% of the cases consultants were right about the pathology, while 57.7% of the residents were right (chi-square, p = .853). In 81.7% of the cases consultants were evaluated right that there is a septum deviation, while only in 58.3% of the cases the ophthalmologists were right (chi-square, p = .198).

Discussion: ENT surgeons, as well as consultants, interpreted the CT better than the ophthalmologists and residents. Surprisingly, the VR system did not help them to interpret the CT better. Further, more extensive studies should be done to build a VR system that assists in the correct interpretation of the preoperative CT before DCR surgery as well as during DCR surgery.