Current Opinion in Ophthalmology最新文献

Purpose of review: Patient privacy protection is a critical focus in medical practice. Advances over the past decade in big data have led to the digitization of medical records, making medical data increasingly accessible through frequent data sharing and online communication. Periocular features, iris, and fundus images all contain biometric characteristics of patients, making privacy protection in ophthalmology particularly important. Consequently, privacy-preserving technologies have emerged, and are reviewed in this study.

Recent findings: Recent findings indicate that general medical privacy-preserving technologies, such as federated learning and blockchain, have been gradually applied in ophthalmology. However, the exploration of privacy protection techniques of specific ophthalmic examinations, like digital mask, is still limited. Moreover, we have observed advancements in addressing ophthalmic ethical issues related to privacy protection in the era of big data, such as algorithm fairness and explainability.

Summary: Future privacy protection for ophthalmic patients still faces challenges and requires improved strategies. Progress in privacy protection technology for ophthalmology will continue to promote a better healthcare environment and patient experience, as well as more effective data sharing and scientific research.

Purpose of review: Vision Language Models are an emerging paradigm in artificial intelligence that offers the potential to natively analyze both image and textual data simultaneously, within a single model. The fusion of these two modalities is of particular relevance to ophthalmology, which has historically involved specialized imaging techniques such as angiography, optical coherence tomography, and fundus photography, while also interfacing with electronic health records that include free text descriptions. This review then surveys the fast-evolving field of Vision Language Models as they apply to current ophthalmologic research and practice.

Recent findings: Although models incorporating both image and text data have a long provenance in ophthalmology, effective multimodal Vision Language Models are a recent development exploiting advances in technologies such as transformer and autoencoder models.

Summary: Vision Language Models offer the potential to assist and streamline the existing clinical workflow in ophthalmology, whether previsit, during, or post-visit. There are, however, also important challenges to be overcome, particularly regarding patient privacy and explainability of model recommendations.

Purpose of review: Technologies in healthcare incorporating artificial intelligence tools are experiencing rapid growth in static-image-based applications such as diagnostic imaging. Given the proliferation of artificial intelligence (AI)-technologies created for video-based imaging, ophthalmic microsurgery is likely to experience significant benefits from the application of emerging technologies to multiple facets of the care of the surgical patient.

Recent findings: Proof-of-concept research and early phase clinical trials are in progress for AI-based surgical technologies that aim to provide preoperative planning and decision support, intraoperative image enhancement, surgical guidance, surgical decision-making support, tactical assistive technologies, enhanced surgical training and assessment of trainee progress, and semi-autonomous tool control or autonomous elements of surgical procedures.

Summary: The proliferation of AI-based technologies in static imaging in clinical ophthalmology, continued refinement of AI tools designed for video-based applications, and development of AI-based digital tools in allied surgical fields suggest that ophthalmic surgery is poised for the integration of AI into our microsurgical paradigm.

Purpose of review: This article intends to briefly discuss AIDS, summarize the current literature on immune recovery uveitis, describe its ocular manifestations and complications, and tackle its complex management.

Recent findings: The clinical picture of immune recovery uveitis is still evolving. Up to today, there are still no definite criteria for immune recovery uveitis, and although closely associated with cytomegalovirus retinitis and HIV/AIDS, there are several cases of similar intraocular response in non-HIV patients. The exact pathology for this paradoxical inflammatory reaction remains unclear; however, there is an interest in identifying biomarkers to determine underlying mechanisms and identify patients at risk. The management of this disease also remains a challenge and no standardized treatment approach exists currently.

Summary: Immune recovery uveitis is an important cause of visual morbidity particularly in HIV/AIDS patients receiving highly active antiretroviral. It is a paradoxical reaction that is frequently associated with a prior cytomegalovirus retinitis infection. Although it can be a transient and self-limiting process, there is a complex decision on the timing of antiviral treatment and the initiation of antiretroviral treatment to prevent immune recovery uveitis. Furthermore, a substantial challenge arises in balancingtreatment decisions for complications in refractory cases.

Purpose of review: To review the pathophysiology, recent biomarkers related to the ocular aspects of Steven-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN), and to highlight notable evidence published in recent years.

Recent findings: Several studies reveal the relationship between tear cytokines and the pathological components in eyes of SJS/TEN patients. Specific clinical features and associated risk factors in the acute stage have shown significant correlations with chronic ocular sequelae. Recent treatment protocols, including early pulse systemic and topical steroids, as well as tumor necrosis factor-α inhibitors, have demonstrated positive effects on ocular outcomes. In addition to conventional surgical treatment, a new surgical technique, simple oral mucosal epithelial transplantation (SOMET), has been introduced as a simple ocular surface reconstruction for patient with SJS.

Summary: Advancements in knowledge and management strategies have notably enhanced ocular outcomes for SJS/TEN eyes. A deeper understanding of the biomarker changes in these eyes could facilitate the development of future targeted treatment options.

Purpose of review: To prospectively review the advances in diagnostics for refractive cataract surgery, focusing on multimodal corneal analysis.

Recent findings: The article explores the considerations related to planning refractive cataract surgery, emphasizing its potential to enhance patients' vision performance and quality of life. This review explores preoperative analysis in cataract surgery, focusing on assessing the cornea and ocular surface using multimodal diagnostics, including Placido disk-based corneal topography, Scheimpflug tomography OCT (optical coherence tomography), and biomechanical assessment. Wavefront technology, gene therapy, and artificial intelligence are also relevant in enhancing surgical precision and outcomes. It highlights the importance of preoperative thorough evaluations and technological advancements in ophthalmology.

Summary: The rapid evolution and advancement of technology enable excellent refractive outcomes in most cases following cataract surgery. Consideration of appropriate preoperative factors is essential for achieving the desired postoperative outcome.

Purpose of review: This review presents guidelines for designing studies and reporting efficacy and safety outcomes in minimally invasive glaucoma surgery (MIGS) research.

Recent findings: Adherence to reporting guidelines in MIGS studies is crucial for providers and patients to appraise surgical options. Recent guidelines have outlined appropriate methodology, efficacy outcomes, and safety reporting, so that study results are presented in an interpretable and uniform manner.

Summary: MIGS are changing the glaucoma treatment paradigm by offering safer, less invasive alternatives to traditional filtering surgery. However, inconsistent reporting of outcomes in MIGS trials hampers comparison and clinical decision-making. Recent guidelines have aimed to highlight appropriate methodology and encourage standardization in reporting outcomes to improve the quality of MIGS literature. Key considerations include defining baseline intraocular pressure, reporting standardized demographic data, using consistent endpoints, presenting standardized figures, evaluating medication use, and documenting adverse events. By adhering to these guidelines, MIGS trials can offer clearer insights into surgical outcomes, aiding both surgeons and patients in treatment decisions.

Purpose of review: Pseudophakic cystoid macular edema (PCME) is the most common postoperative complication of cataract surgery, resulting in visual decline. In this review, we discuss its pathophysiology, epidemiology, clinical presentation, and the current available evidence on therapeutic management.

Recent findings: Patients with diabetes mellitus have twice the risk of developing PCME as compared to nondiabetic individuals. Recent large database studies have revealed an increased risk among young, male, and black patients. A previous history of PCME is perhaps the strongest risk factor for fellow eye involvement.

Summary: PCME generally occurs around 6 weeks postoperatively and is likely a consequence of postoperative inflammation with disruption of the blood-queous and blood-retina barriers. Optical coherence tomography of the macula servers as a key diagnostic tool. There is a lack of large controlled clinical trials to guide treatment approaches. We recommend a stepwise approach for PCME that includes observation if not visually significant versus treatment with topical nonsteroidal anti-inflammatory drugs and steroids if symptomatic. Refractory cases can be treated with a periocular steroid injection, followed by intravitreal steroids if still nonresponsive.

Purpose of review: As the surge in large language models (LLMs) and generative artificial intelligence (AI) applications in ophthalmology continue to expand, this review seeks to update physicians of the current progress, to catalyze further work to harness its capabilities to enhance healthcare delivery in ophthalmology.

Recent findings: Generative AI applications have shown promising performance in Ophthalmology. Beyond native LLMs and question-answering based tasks, there has been increasing work in employing novel LLM techniques and exploring wider use case applications.

Summary: In this review, we first look at existing LLM use case applications specific to Ophthalmology, followed by an overview of commonly used LLM techniques. We finally focus on the emerging trends of the generative AI space with an angle from ophthalmology.

Purpose of review: To summarize recent evidence about the association between different lifestyle modifications and environmental risk factors and glaucoma.

Recent findings: Incorporating moderate exercise into the routine of glaucoma patients may help slow the progression of the condition. However, caution should be taken when using swim goggles, and it may be advisable to avoid certain yoga positions and heavy weight-lifting exercises, as they have been linked to intraocular pressure (IOP) spikes and potential risks for glaucoma patients. Various relaxation techniques may lower IOP. The evidence remains inconclusive about the association between vitamins intake and glaucoma. Dietary nitric oxide has been associated with a lower risk of glaucoma. Higher smoking intensity has been linked to faster visual field decline and retinal nerve fiber layer thinning. Additionally, there is currently insufficient evidence to support the use of marijuana in managing glaucoma, with side effects outweighing the proposed benefits. A significant association has been found between air pollutants and ganglion cell layer thinning, as well as a greater burden of glaucoma.

Summary: Lifestyle and environmental factors are increasingly recognized as significant contributors to glaucoma development and progression. These modifications should be integrated into a comprehensive treatment approach alongside medications or surgical interventions.