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Enhancing patient and parent education in pediatric ophthalmology using artificial intelligence: a report by the AAPOS Public Information Committee 利用人工智能加强儿童眼科患者和家长教育：AAPOS公共信息委员会的一份报告。

IF 1.3 4区医学 Q3 OPHTHALMOLOGY

Journal of Aapos

Pub Date : 2025-12-01 DOI: 10.1016/j.jaapos.2025.104693

Qais A. Dihan MD , Andrew D. Brown OD, MD , Ahmad F. Alzein BS , Ana T. Zaldivar MD , Kendall E. Montgomery MD , Mohamed M. Khodeiry MD, MSc , Reem H. ElSheikh MD , Michelle Attzs MD, MSc, FRCOphth , Mehmet C. Mocan MD, MPH , Douglas Fredrick MD , Catherine O. Jordan MD , Janine Collinge MD , Abdelrahman M. Elhusseiny MD, MSc

Background

Parental health literacy significantly affects pediatric ophthalmology follow-up care and adherence to treatment regimens. Yet patient education materials (PEMs) often exceed the American Medical Association’s recommended 6th-grade reading level. Large-language models (LLMs) can improve the readability of PEMs without sacrificing quality. This study evaluated the baseline readability, quality, and accuracy of PEMs by the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) and assessed how LLMs may improve these PEMs.

Methods

This cross-sectional study analyzed 111 PEMs from the AAPOS website. Readability was assessed using the Flesch-Kincaid Grade Level (FKGL) and Simple Measure of Gobbledygook (SMOG). Quality and understandability were evaluated using the DISCERN and the Patient Education Materials Assessment Tool (PEMAT), respectively. Accuracy was assessed using the Likert misinformation scale. Each PEM was separately rewritten by ChatGPT-4 and Gemini Advanced after initial analysis. Changes were analyzed.

Results

Baseline PEMs were written on average at a 9th-grade reading level (SMOG, 9.0 ± 1.6; FKGL, 9.6 ± 2.1), with only 3.6% meeting the 6th-grade recommendation. ChatGPT-4 rewrites improved readability to a 7th-grade level without compromising quality, while Gemini Advanced rewrites met the 6th-grade threshold but showed modestly reduced quality (DISCERN: 3; P < 0.001). Both models enhanced understandability (ChatGPT-4, 90.9%; Gemini Advanced, 91.3%; [P < 0.001]), and their rewrites contained no misinformation (Likert = 1).

Conclusions

AAPOS PEMs were high in quality and accurate at baseline, but written at a high school level. As supplemental tools, LLMs can improve PEMs’ readability and understandability. PEMs should be thoroughly reviewed by physicians to ensure optimal safety and education.

背景：父母健康素养显著影响儿童眼科随访护理和治疗方案的依从性。然而，患者教育材料（PEMs）经常超过美国医学协会推荐的六年级阅读水平。大语言模型（llm）可以在不牺牲质量的情况下提高PEMs的可读性。本研究评估了美国儿童眼科和斜视协会（AAPOS）的PEMs的基线可读性、质量和准确性，并评估了llm如何改善这些PEMs。方法：本横断面研究分析了来自AAPOS网站的111份PEMs。采用Flesch-Kincaid Grade Level （FKGL）和Simple Measure of Gobbledygook （SMOG）评估可读性。质量和可理解性分别使用DISCERN和患者教育材料评估工具（PEMAT）进行评估。使用李克特错误信息量表评估准确性。初步分析后，用ChatGPT-4和Gemini Advanced分别重写每个PEM。分析变化。结果：基线PEMs的平均阅读水平为9级（SMOG, 9.0±1.6；FKGL, 9.6±2.1），只有3.6%达到6级推荐水平。ChatGPT-4重写将可读性提高到7级水平，但不影响质量，而Gemini Advanced重写达到6级门槛，但质量略有下降（DISCERN, 3; P < 0.001）。两种模型都提高了可理解性（ChatGPT-4, 90.9%; Gemini Advanced, 91.3%; [P < 0.001]），并且它们的重写不包含错误信息（Likert = 1）。结论：AAPOS PEMs质量高，基线准确，但写作水平仅为高中水平。llm作为辅助工具，可以提高PEMs的可读性和可理解性。PEMs应由医生彻底审查，以确保最佳的安全性和教育。

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引用次数: 0

Post-pandemic changes in demographics and outcomes of children at an inner-city vision outreach program: Give Kids Sight Day 流行病后人口统计数据的变化和儿童在市中心视力外展项目的结果：给孩子视力日。

IF 1.3 4区医学 Q3 OPHTHALMOLOGY

Journal of Aapos

Pub Date : 2025-10-01 DOI: 10.1016/j.jaapos.2025.104638

John E. Williamson III MD , Laurel Lam BS , Nina R. Spitofsky BA , Alexandra R. Zaloga BA , Sudheshna Vemula BS , Gabriella Baldassarre BS , Sara Flanagan , Rebecca J. Elias MFA , Bruce M. Schnall MD , Kammi B. Gunton MD , Barry N. Wasserman MD

Purpose

To characterize how pediatric screening demographic characteristics changed after the COVID-19 pandemic in children attending Give Kids Sight Day (GKSD), a free vision screening program in Philadelphia.

Methods

Three data sets were analyzed: (1) prospective survey from guardians attending GKSD 2023, (2) retrospective analysis of GKSD attendee records, and (3) pre-pandemic (2009-2020) GKSD data.

Results

A total of 293 children attended GKSD in 2023, and 189 surveys were completed. Compared with pre-pandemic GKSD events, there were more repeat participants (15% to 26% [P < 0.001]), greater percentage uninsured (26%-27% to 38% [P < 0.001]), and more insured without vision coverage (30% to 46% [P = 0.002]). More children required refractive correction (28%-61% to 76% [P < 0.001]) and subsequent follow-up (10%-15% to 17% [P = 0.004]). Of children receiving their first pair of glasses, 47% had not failed a previous vision screening. Ninety-one percent of missed appointments were for first-time attendees. Eye-care-naive attendees commonly learned of GKSD from school (59%). Perceived barriers to care were diverse and equally distributed among respondents.

Conclusions

Since the COVID-19 pandemic, insurance coverage for vision care has declined, with rising unmet ophthalmic needs in event attendees. Many children with refractive pathology had never failed prior school-based vision screening, suggesting lapses in current screening systems. School-based initiatives, funding, and community social worker support are needed to connect eye-care-naive patients with ophthalmic care, ensure community screening is completed effectively, and connect families to subsidized insurance plans.

目的：描述参加费城“给孩子视力日”（GKSD）免费视力筛查项目的儿童在COVID-19大流行后的儿科筛查人口统计学特征变化。方法：对3组数据进行分析：(1)对参加GKSD 2023的监护人进行前瞻性调查；(2)对GKSD出席者记录进行回顾性分析；(3)大流行前（2009-2020）GKSD数据。结果：2023年共有293名儿童入读GKSD，完成调查189项。与大流行前的GKSD事件相比，有更多的重复参与者（15%至26% [P < 0.001]），更多的未参保者（26%至27%至38% [P < 0.001]），更多参保者没有视力覆盖（30%至46% [P = 0.002]）。更多的儿童需要屈光矫正（28% ~ 61% ~ 76% [P < 0.001]）和后续随访（10% ~ 15% ~ 17% [P = 0.004]）。在接受第一副眼镜的儿童中，47%的人之前的视力筛查没有失败。91%的失约者是首次参加会议的人。没有眼保健经验的参与者通常是从学校了解到GKSD的（59%）。感知到的护理障碍是多种多样的，在受访者中分布均匀。结论：自2019冠状病毒病大流行以来，视力保健保险覆盖率下降，活动参与者未满足的眼科需求增加。许多患有屈光性病理的儿童从未在之前的学校视力筛查中失败过，这表明目前的筛查系统存在缺陷。需要以学校为基础的倡议、资金和社区社会工作者的支持，将初次接触眼科护理的患者与眼科护理联系起来，确保有效地完成社区筛查，并将家庭与补贴保险计划联系起来。

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引用次数: 0

Ophthalmic manifestations of Cousin syndrome 堂氏综合征的眼部表现。

IF 1.3 4区医学 Q3 OPHTHALMOLOGY

Journal of Aapos

Pub Date : 2025-10-01 DOI: 10.1016/j.jaapos.2025.104641

Manjushree Bhate MD , Venkatesh Pochaboina MSc , Ravi Varma MD, DM , Sarah Bailur DNB, FICG , Alex V. Levin MD, MHSc , Frank J. Martin FRANZCO

We describe the ophthalmic features in 2 siblings with genetically confirmed Cousin syndrome. Each sibling had a very large–angle exotropia with minimal ocular motility in any position of gaze. The younger had severe ptosis. Magnetic resonance imaging of the brain revealed multiple skull abnormalities but normal cranial nerve pathways and normal extraocular muscles. On exploration, the lateral rectus muscles were extremely tight. Forced duction testing was positive for all rectus muscles, with no rotation of the globe toward adduction and least positive for abduction. A homozygous pathogenic variant in TBX15 was identified.

我们描述了2个兄弟姐妹的眼科特征与遗传确认表妹综合征。每个兄弟姐妹都有非常大角度的外斜视，在任何凝视位置都有最小的眼球运动。年轻人有严重的上睑下垂。脑磁共振成像显示多发性颅骨异常，但颅神经通路和眼外肌正常。探查时，外侧直肌极度紧绷。所有直肌强制内收试验均为阳性，未见球体内收旋转，外展试验阳性最小。鉴定出TBX15的纯合子致病变异。

引用次数: 0

Progress toward gender equity in leadership and representation in academic pediatric ophthalmology 在学术儿科眼科学的领导和代表中迈向性别平等的进展。

IF 1.3 4区医学 Q3 OPHTHALMOLOGY

Journal of Aapos

Pub Date : 2025-10-01 DOI: 10.1016/j.jaapos.2025.104608

Brenton T. Bicknell BS , Josephine Rudd Zhong Manis BS , Haley Chishom BS , Yejin Heo BS , Lance Dzubinski BS , Taylor L. Aaserud BS , Alvina Liang BS , Shayan Massoumi BS , Thanushri Srikantha BS , Stephanie Goei MD , Robert Tauscher MD

Background

Gender representation in academic pediatric ophthalmology has shifted significantly in recent decades, with increasing female participation. This study examines academic rank, leadership roles, and research productivity as a function of gender.

Methods

This cross-sectional study analyzed publicly available data from 126 US academic ophthalmology programs listed in the Fellowship and Residency Electronic Interactive Database (FREIDA) during August 2024. Data collected from institutional websites identified 451 fellowship-trained pediatric ophthalmologists. Variables included gender, fellowship graduation year, academic rank, leadership roles (eg, department chair, fellowship director, program director), and research productivity metrics (publications, citations, h-index). Statistical comparisons used Pearson’s χ² test, the Fisher exact test, and Mann-Whitney U or t tests, where appropriate, with significance defined as P < 0.05.

Results

Women now account for 55.9% (252/451) of academic pediatric ophthalmologists. Among those who completed fellowships before 2000, males constitute a larger proportion than females (69.7% vs 30.3%); since 2000, females comprise a greater share of fellowship graduates (65.3% vs 34.7% [P < 0.01]). Men more frequently serve as full professors (40.9% vs 18.0%, P <0.01]) and department chairs (6.5% vs 2.0% [P = 0.02]; women, more often as assistant professors (54.5% vs 40.1% [P = 0.01]) and program directors (3.6% vs 0.5% [P = 0.03]). Research productivity and academic rank are similar between genders in post-2000 graduates.

Conclusions

Gender disparities persist in senior roles, but recent cohorts of currently practicing faculty demonstrate similar levels of academic rank and research productivity. Women now account for 55.9% of academic pediatric ophthalmologists and 65.3% of post-2000 graduates.

背景：近几十年来，随着女性参与的增加，学术儿科眼科的性别代表性发生了显著变化。本研究考察了学术等级、领导角色和研究生产力作为性别的功能。方法：这项横断面研究分析了2024年8月在奖学金和住院医师电子互动数据库（FREIDA）中列出的126个美国学术眼科项目的公开数据。从机构网站收集的数据确定了451名接受过奖学金培训的儿科眼科医生。变量包括性别、奖学金毕业年份、学术等级、领导角色（如系主任、奖学金主任、项目主任）和研究效率指标（出版物、引用、h指数）。统计学比较采用Pearson χ2检验、Fisher精确检验和Mann-Whitney U或t检验，在适当的情况下，显著性定义为P < 0.05。结果：女性占学院派儿童眼科医生的55.9%（252/451）。在2000年以前完成奖学金的人中，男性的比例比女性大（69.7%比30.3%）；自2000年以来，女性占奖学金毕业生的比例更大（65.3%对34.7% [P < 0.01]）。男性更多地担任正教授（40.9% vs 18.0%）。结论：在高级职位上，性别差异仍然存在，但最近的在职教师群体显示出相似的学术等级和研究生产力水平。目前，女性在学术儿科眼科医生中占55.9%，在2000后毕业生中占65.3%。

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引用次数: 0

Effect of inferior turbinate infracture on outcomes of probing for congenital nasolacrimal duct obstruction 下鼻甲骨折对先天性鼻泪管阻塞探查效果的影响。

IF 1.3 4区医学 Q3 OPHTHALMOLOGY

Journal of Aapos

Pub Date : 2025-10-01 DOI: 10.1016/j.jaapos.2025.104644

B. Michelle Kim BS , Grayson B. Ashby MD , Brian G. Mohney MD

Background

Published reports, all of which are underpowered to detect a difference, demonstrate conflicting findings on the benefit of inferior turbinate infracture during congenital nasolacrimal duct (CNLD) probing. The purpose of this study was to report the effect of inferior turbinate infracture on outcomes of CNLD probing and assess for long-term complications from the procedure.

Methods

The medical records of all patients <6 years of age who underwent probing for congenital nasolacrimal duct obstruction (CNLDO) at a single referral center from January 1, 2002, through December 31, 2018, were retrospectively reviewed.

Results

Of 987 consecutive probing procedures, 184 (18.6%) underwent inferior turbinate infracture. The mean age at diagnosis and surgery, prevalence of prematurity, race, and sex did not differ between the infracture and control groups. Probing success was similar between infracture (80.4%) and control (80.6%) groups (P = 0.916). The subsequent development of long-term nasopharyngeal disorders including sleep apnea, chronic rhinitis, and chronic sinusitis was no different between groups. Subgroup analysis comparing outcomes of first-time probing versus first-time probing with infracture and single-surgeon analysis maintained no significant difference in outcomes between the two groups. Only late probings (age ≥24 months) tended to be more successful (but not significantly so; P = 0.16) when combined with an infracture (87.3%) compared with those without infracture (78.8%).

Conclusions

Concurrent inferior turbinate infracture did not significantly improve probing success for children with CNLDO in this cohort. However, because potential nasopharyngeal complications are unlikely, the procedure may safely be considered. Future studies should clarify the benefit of infracture for children ≥24 months of age.

背景：所有已发表的报告都不足以发现差异，在先天性鼻泪管（CNLD）探查时，下鼻甲基础设施的益处显示了相互矛盾的发现。本研究的目的是报道下鼻甲基础设施对CNLD探探结果的影响，并评估该手术的长期并发症。结果：987例患者中，184例（18.6%）行下鼻甲基础设施手术。诊断和手术时的平均年龄、早产的患病率、种族和性别在基础设施组和对照组之间没有差异。基础设施组（80.4%）与对照组（80.6%）探查成功率相似（P = 0.916）。长期鼻咽疾病包括睡眠呼吸暂停、慢性鼻炎和慢性鼻窦炎的后续发展在两组之间没有差异。亚组分析比较首次探探与首次探探合并基础设施的结果，以及单外科医生分析，两组之间的结果无显著差异。只有晚期探查（年龄≥24个月）合并基础设施（87.3%）比未合并基础设施（78.8%）更成功（但P = 0.16）。结论：在这个队列中，并发下鼻甲基础设施并没有显著提高CNLDO患儿的探查成功率。然而，由于潜在的鼻咽部并发症不太可能发生，因此可以安全地考虑该手术。未来的研究应阐明基础设施对≥24月龄儿童的益处。

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引用次数: 0

Phased multimodal consent in a Baltimore school-based vision program: a novel approach 巴尔的摩学校视觉项目的阶段性多模态同意：一种新方法。

IF 1.3 4区医学 Q3 OPHTHALMOLOGY

Journal of Aapos

Pub Date : 2025-10-01 DOI: 10.1016/j.jaapos.2025.104654

Jenny Chun Ling Kuo MD, MPH , Xinxing Guo MD, PhD , Megan E. Collins MD, MPH

Obtaining parental consent is a crucial step for students to receive eye examinations in school-based vision programs (SBVPs). Using paper consent forms is challenging and may limit responses. We explored a novel, phased, multimodal consent approach in a Baltimore SBVP to increase program participation during the 2022-23 school year. Vision screenings were provided for all students as part of the program. Consent outreach was conducted for all students prior to vision screening (universal phase) and again after for students who failed a vision screening (targeted phase). Email consent only was used during the universal phase, whereas a tiered approach that combined email, paper, and telephone was used in the targeted phase. Of the 46 schools that implemented multimodal consenting, the mean overall consent response rate was 86% ± 9.3% (range, 62%-99%). Mean universal and targeted consent response rate was 15% (95% CI, 13%-18%) and 71% (95% CI, 68%-74%), respectively. Among targeted consent responses, 10% were obtained by email, 26% by paper, and 64% by telephone.

获得家长同意是学生在学校视力项目（SBVPs）中接受视力检查的关键一步。使用纸质同意书具有挑战性，可能会限制回应。我们在巴尔的摩SBVP探索了一种新的、分阶段的、多模式的同意方法，以增加2022-23学年的项目参与。作为项目的一部分，为所有学生提供视力检查。在视力筛查之前（普遍阶段）对所有学生进行同意外展，在视力筛查失败的学生之后（目标阶段）再次进行同意外展。在普遍阶段仅使用电子邮件同意，而在目标阶段则使用结合电子邮件，纸张和电话的分层方法。在实施多模式同意的46所学校中，平均总体同意反应率为86%±9.3%（范围为62%-99%）。平均普遍同意反应率和目标同意反应率分别为15% （95% CI, 13%-18%）和71% （95% CI, 68%-74%）。在有针对性的同意回复中，10%是通过电子邮件获得的，26%是通过书面方式获得的，64%是通过电话获得的。

引用次数: 0

Horner syndrome secondary to otomastoiditis 耳乳突炎继发的Horner综合征。

IF 1.3 4区医学 Q3 OPHTHALMOLOGY

Journal of Aapos

Pub Date : 2025-10-01 DOI: 10.1016/j.jaapos.2025.104648

Praveen Jeyaseelan MD, Daniel Timothy Harrast

A 5-year-old girl was brought to the emergency room with unequal pupil size, fever, and ear pain. Computed tomography and magnetic resonance imaging showed left otomastoiditis complicated with a subperiosteal abscess in the posteromedial left temporomandibular joint. Magnetic resonance angiography revealed enhancement of the left canalicular carotid vessel wall due to adjacent inflammatory process, with irritation of post synaptic sympathetic fibers, causing left Horner syndrome. Horner syndrome can be caused by apical lung tumors, carotid artery dissection, and metastatic neuroblastoma, but otomastoiditis is an uncommon etiology. Recognition and further workup of anisocoria is crucial to management of extracranial complications of otomastoiditis.

一名5岁女孩因瞳孔大小不等、发烧和耳痛被送往急诊室。计算机断层扫描和磁共振成像显示左侧耳乳突炎并发骨膜下脓肿在左颞下颌关节后内侧。磁共振血管造影显示左侧颈小管血管壁因邻近炎性过程而增强，突触后交感纤维受到刺激，导致左侧Horner综合征。霍纳综合征可由肺顶端肿瘤、颈动脉夹层和转移性神经母细胞瘤引起，但耳乳突炎是一种罕见的病因。识别和进一步检查异角是处理耳乳突炎颅外并发症的关键。

引用次数: 0

How do we fix this mess? 我们如何解决这个烂摊子？

IF 1.3 4区医学 Q3 OPHTHALMOLOGY

Journal of Aapos

Pub Date : 2025-10-01 DOI: 10.1016/j.jaapos.2025.104649

R. Michael Siatkowski MD, MBA

引用次数: 0

Modified Nishida’s procedure combined with medial rectus recession in a case of Moebius syndrome 改良西田手术合并内侧直肌萎缩一例莫比乌斯综合征。

IF 1.3 4区医学 Q3 OPHTHALMOLOGY

Journal of Aapos

Pub Date : 2025-10-01 DOI: 10.1016/j.jaapos.2025.104652

Sowmya Raveendra Murthy MS, FICO, Sahil Sharma MS, FPOS

Moebius syndrome is a rare congenital disorder in which bilateral abduction is impaired, resulting in moderate- to large-angle esotropia. Various surgical procedures have been developed to correct esotropia in Moebius syndrome, including bilateral medial rectus (bimedial) recessions for moderate angles and bimedial recessions combined with vertical rectus transpositions or superior rectus transpositions for larger deviations. We describe a case of Moebius syndrome treated with modified Nishida’s procedure and bimedial recession to correct large-angle esotropia.

莫比乌斯综合征是一种罕见的先天性疾病，其双侧外展受损，导致中到大角度内斜视。各种外科手术已经发展到矫正莫比乌斯综合征的内斜视，包括双侧内侧直肌（双内侧）衰退用于中等角度，双内侧衰退联合垂直直肌转位或上直肌转位用于较大偏差。我们描述一例莫比乌斯综合征的治疗与改进的西田手术和双内侧退行矫正大角度内斜视。

引用次数: 0

Socioeconomic trends of adult strabismus in the United States: an analysis of the All of Us database 美国成人斜视的社会经济趋势：对全美数据库的分析。

IF 1.3 4区医学 Q3 OPHTHALMOLOGY

Journal of Aapos

Pub Date : 2025-10-01 DOI: 10.1016/j.jaapos.2025.104655

Alexander C. Lieu BS, Evan H. Walker MS, Shira L. Robbins MD, David B. Granet MD , Jolene C. Rudell MD, PhD

Purpose

To determine associations of income and education level with a diagnosis of strabismus and to identify socioeconomic variables that may affect timely access to diagnosis.

Methods

Annual income, highest level of education completed, and ZIP code income, high school completion, poverty, and socioeconomic deprivation metrics were collected from 413,360 participants in the database. A χ² test was used to determine significant differences in distributions of income, education, and ZIP code metrics in 3,734 strabismus patients compared with the overall database.

Results

Participants living in ZIP codes with lower multidimensional deprivation indices (less deprivation) are more likely to be diagnosed with strabismus. Participants with annual income below $10,000 (10.10%) or who completed education between fifth grade and a high school diploma or GED (20.06%) are less likely to receive a diagnosis for certain strabismus subtypes. Participants with annual income over $200,000 (7.07%), advanced degrees (27.02%), living in ZIP codes with higher income, and higher high school completion rates were more likely to be diagnosed with certain strabismus subtypes.

Conclusions

Participants diagnosed with strabismus tend to have higher incomes, an advanced degree, and reside in more affluent ZIP codes, whereas those with lower income and education levels are less likely to be diagnosed. These findings reveal potential socioeconomic disparities in access to ophthalmic diagnostic services and care. Findings emphasize the importance of addressing socioeconomic barriers in eye care to enable equitable access.

目的：确定收入和教育水平与斜视诊断的关系，并确定可能影响及时获得诊断的社会经济变量。方法：从数据库中收集了413360名参与者的年收入、高教育水平、邮政编码收入、高中毕业程度、贫困和社会经济剥夺指标。采用χ2检验来确定3734名斜视患者的收入、教育程度和邮政编码指标分布与整个数据库的显著差异。结果：居住在多维剥夺指数较低的邮政编码地区的参与者更容易被诊断为斜视。年收入低于10,000美元（10.10%）或完成五年级到高中文凭或GED教育（20.06%）的参与者不太可能被诊断为某些斜视亚型。年收入超过20万美元（7.07%）、高学历（27.02%）、居住在收入较高的邮政编码地区、高中毕业率较高的参与者更有可能被诊断为某些斜视亚型。结论：被诊断为斜视的参与者往往收入较高，学历较高，居住在更富裕的邮政编码，而那些收入和教育水平较低的人不太可能被诊断为斜视。这些发现揭示了在获得眼科诊断服务和护理方面潜在的社会经济差异。研究结果强调了解决眼科保健中的社会经济障碍以实现公平获取的重要性。

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