Abstract: The design of the prosthetic replacement of the ocular surface ecosystem (PROSE) device allows it to serve as a novel drug delivery system. In this article, we describe the off-label administration of amphotericin B and cenegermin by instillation in the PROSE device reservoir for the treatment of Candida keratitis in the setting of a persistent epithelial defect.
Purpose: We aimed to compare the answers given by ChatGPT, Bard, and Copilot and that obtained from the American Academy of Ophthalmology (AAO) website to patient-written questions related to keratoconus in terms of accuracy, understandability, actionability, and readability to find out whether chatbots can be used in patient education.
Methods: Twenty patient-written questions obtained from the AAO website related to keratoconus were asked to ChatGPT, Bard, and Copilot. Two ophthalmologists independently assessed the answers obtained from chatbots and the AAO website in terms of accuracy, understandability, and actionability according to the Structure of Observed Learning Outcome taxonomy, Patient Education Materials Assessment Tool-Understandability, and Patient Education Materials Assessment Tool-Actionability tests, respectively. The answers were also compared for readability according to the Flesch Reading Ease scores obtained through the website.
Results: Bard had significantly higher scores compared with ChatGPT-3.5, Copilot, and AAO website according to Structure of Observed Learning Outcome taxonomy and Patient Education Materials Assessment Tool-Understandability (P<0.001 for each), whereas there was no significant difference between the other groups. Bard and ChatGPT achieved significantly higher scores than the AAO website according to the Patient Education Materials Assessment Tool-Actionability scale (P=0.001). The AAO website achieved significantly higher scores than the Bard on the Flesch Reading Ease scale, whereas there was no significant difference between the other groups (P=0.017).
Conclusion: Chatbots are promising to provide accurate, understandable, and actionable answers. Chatbots can be a valuable aid in the education of patients with keratoconus under clinician supervision. In this way, unnecessary hospital visits can be prevented, and the burden on the health care system can be alleviated, while patient awareness can be raised.
Objectives: This study compares the cosmetic and functional outcomes of corneal tattooing/keratopigmentation and ocular prostheses in rehabilitating disfigured eyes, focusing on esthetic appearance and emotional well-being.
Methods: Ninety-two patients were included: 48 received corneal tattooing, and 44 were fitted with ocular prostheses. Anophthalmic surgery was indicated for trauma, painful blind eye, endophthalmitis, tumor, and corneal ulcer, while corneal tattooing was performed for trauma, corneal ulcer, and endophthalmitis. Comprehensive ophthalmic examinations, a seven-item satisfaction questionnaire, and assessments of ocular movement in four directions and postoperative complications (e.g., infection, enophthalmos, fornix loss, and eyelid disorders) were conducted.
Results: Patients who underwent ocular cosmetic rehabilitation reported high satisfaction, with corneal tattooing yielding higher satisfaction rates across all measures (P<0.001). Patients with corneal tattooing exhibited significantly better ocular movement in all four cardinal directions (P<0.001 for temporal, nasal, superior, and inferior). The prosthesis group experienced more postoperative complications, including ocular surface disorders and structural anomalies.
Conclusion: Corneal tattooing and ocular prostheses both provide viable options for rehabilitating disfigured eyes. Corneal tattooing offers advantages in ocular movement, fewer complications, and higher patient satisfaction, while ocular prostheses are more suitable for addressing phthisis bulbi, tumors, and ocular pain.
Objectives: To assess the quality of life in Japanese patients with Fuchs endothelial corneal dystrophy (FECD) using The National Eye Institute Visual Function Questionnaire.
Methods: Here, 34 patients with FECD (FECD group) and 13 healthy individuals (control group) completed the National Eye Institute Visual Function Questionnaire Japanese version by interview format. The association between dominant eye corrected distance visual acuity and composite score (component 11) or subscales in the FECD group was evaluated using Spearman rank correlation coefficient.
Results: The average age was 65.8±11.9 and 60.1±7.9 years in the FECD and control groups, respectively. Corrected distance visual acuity was significantly lower in the FECD group (0.021±0.21 logarithm of the minimum angle of resolution) than in the control group (-0.61±0.055 logarithm of the minimum angle of resolution) (P<0.0001). Composite scores were significantly lower in the FECD group (77.6±11.0) than in the control group (89.2±7.0) (P=0.0006). All subscale scores were lower in the FECD group, particularly for distance vision and mental health (81.4±13.1 and 84.0±15.6, respectively) than in the control group (90.7±12.0 and 95.7±5.7) (P=0.022 and P=0.0046, respectively). Corrected distance visual acuity in the dominant eye did not significantly correlate with composite scores or subscales in the FECD group.
Conclusions: Quality of life is lower in patients with FECD than in healthy individuals, particularly regarding distance vision and mental health.
Purpose: To report interim results of a single center, randomized, double-blind, crossover-controlled clinical trial comparing wavefront-guided (wfg) scleral lenses (SLs) to traditional scleral lenses (tSLs) for patients with a history of irregular corneal astigmatism (ICA).
Methods: Thirty-one ICA eyes of 18 participants were reviewed, 23 with keratoconus, six postcorneal refractive ectasia, and two postpenetrating keratoplasty. Patients with corneal or lens opacities were not excluded from participating. Participants underwent a diagnostic lens-based fitting with a tSL with standard spherocylindrical optics. Once the tSL was finalized, a comprehensive wavefront aberrometer-based system was used to capture the residual aberration of the tSL under scotopic conditions without pharmacologic dilation, and these data were used to create a wfgSL. Once the tSL and wgfSL were finalized, a double-blinded, randomized, crossover was conducted where the participants received lens A (tSL or wgfSL) or lens B (the alternative), each worn for a 4±1 week interval. Measurements of the visual acuity (VA) and total higher-order root mean squared (HORMS) were recorded at each interval under controlled lighting conditions. At the final visit, patient subjective preference for lens A or lens B was recorded.
Results: The average HORMS for a fixed 5-mm pupil was 0.68±0.31 μm for tSL and 0.29±0.18 μm for wfgSL. Wavefront-guided SL provided an average HORMS improvement of 56% ( P <0.001). All eyes showed a reduction in HORMS, ranging from 18% to 83%. Wavefront-guided SL provided an average VA improvement of 0.12±0.11 logMAR ( P <0.01). Seventy-one percent of eyes showed one line or greater improvement, 26% showed no improvement, and 3% showed a reduction of VA with the wfgSL. The average VA with tSL was 0.14±0.16 logMAR and 0.03±0.11 logMAR for wfgSL. Seventeen of 18 patients subjectively preferred wfgSL.
Conclusion: In eyes with ICA, wfgSL reduced HORMS and improved VA when compared with tSL. Patients subjectively preferred wfgSL to tSL. These interim results demonstrate the feasibility and generalizability of wfgSL in a typical clinical practice environment.
Objective: This study aimed to document the treatment success of eyelid hygiene with liposomal suspension using new diagnostic tools and to determine whether additional lipid substitution provided measurable benefits in meibomian gland dysfunction.
Methods: A single-center controlled, partially single masked study was conducted. Group A used eyelid hygiene only, whereas group B additionally applied a liposomal eye spray. Subjective perception using the Ocular Surface Disease Index (OSDI) questionnaire, measurement of tear film osmolarity, noninvasive tear film break-up time, assessment of the lipid layer, meibography, inspection of lid margins, assessment of the meibomian glands, and measurement of matrix-metallopeptidase-9 were collected at baseline and after 12 weeks.
Results: Eighty-two patients were included and randomized into two groups. Both groups showed a decrease in OSDI score (P<0.001), an increase in lipid layer thickness (P<0.001), significant improvement in the degree of loss of meibomian glands (P<0.001), in the damage pattern of the eyelid margins (P<0.001), in the quality of meibomian gland secretion, and in matrix-metallopeptidase-9 after 12 weeks.
Conclusions: Our study confirms the success of treatment with eyelid hygiene measures using a liposomal suspension. The additional benefit of lipid substitution was not significant after 12 weeks of treatment.
Objectives: To evaluate demographic, socioeconomic, and clinical factors associated with nonadherence with initial follow-up after a diagnosis of infectious keratitis.
Methods: A retrospective chart review of patients aged 18 to 60 years who were diagnosed with infectious keratitis at the Wills Eye Hospital Emergency Room from March 2019 to September 2019 was conducted. The primary outcome was nonadherence with initial follow-up recommendation and included patients who did not follow-up in the time frame requested by the diagnosing physician and those who were lost to follow-up.
Results: Two hundred and seventeen patients were included with a mean age of 39.0±11.6 years, and 38.2% of patients were nonadherent. Patients who identified as non-Hispanic White were more likely to be nonadherent compared with Hispanic White patients (odds ratio [OR]=5.00, 95% confidence interval [CI]: 1.27-20.00, P=0.021). Additional variables associated with nonadherence included lower income (OR=0.92, 95% CI: 0.85-0.99, P=0.020) and government versus private insurance (OR=2.13, 95% CI: 1.09-4.15, P=0.027). Among clinical variables, patients not cultured at the initial evaluation were more likely to be nonadherent (OR=2.54, 95% CI: 1.36-4.77, P=0.004).
Conclusions: Race, income, insurance, and corneal culturing had associations with follow-up nonadherence. Identifying barriers to follow-up for infectious keratitis may have important implications in preventing vision loss and other complications.
Abstract: The increased usage of nonrefractive cosmetic contact lenses in Asia and a trend toward increased online purchasing of both refractive and cosmetic contact lenses poses unique challenges in the management of contact lens-related complications. However, regulations have lagged behind this increased uptake in the community. This paper reviews regulations surrounding the manufacturing, import, and distribution of contact lenses in the Asia Pacific region and compares them with international regulations from the European Union and United States. It found a need for more specific regulations and closer surveillance targeted at new trends in contact lens purchasing and usage. This paper also found a need for more effective enforcement of current regulations.
Objectives: Large language models (LLMs) are increasingly being used today and are becoming increasingly important for providing accurate clinical information to patients and physicians. This study aimed to evaluate the effectiveness of generative pre-trained transforme-4.0 (ChatGPT-4.0), Google Gemini, and Microsoft Copilot LLMs in responding to patient questions regarding keratoconus.
Methods: The LLMs' responses to the 25 most common questions about keratoconus asked by real-life patients were blindly rated by two ophthalmologists using a 5-point Likert scale. In addition, the DISCERN scale was used to evaluate the responses of the language models in terms of reliability, and the Flesch reading ease and Flesch-Kincaid grade level indices were used to determine readability.
Results: ChatGPT-4.0 provided more detailed and accurate answers to patients' questions about keratoconus than Google Gemini and Microsoft Copilot, with 92% of the answers belonging to the "agree" or "strongly agree" categories. Significant differences were observed between all three LLMs on the Likert scale (P<0.001).
Conclusions: Although the answers of ChatGPT-4.0 to questions about keratoconus were more complex for patients than those of other language programs, the information provided was reliable and accurate.
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