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Young glaucoma specialist practice patterns: Why do you do what you do? 青光眼专科医生的实践模式:你为什么要这样做?
IF 3.4 Pub Date : 2025-07-04 DOI: 10.1016/j.aopr.2025.07.001
Nicole Miranda , Jason Y. Zhang , Mary Qiu

Background

Despite trabeculectomy having long been considered the gold standard surgery for treating severe or recalcitrant glaucoma, the popularity of this operation among glaucoma specialists has gradually declined in recent decades with a concurrent rise in alternative intraocular pressure (IOP)-lowering procedures being performed.

Purpose

This pilot study investigates how experiences of recently graduated glaucoma specialists during training might have influenced their choice to either perform trabeculectomy or favor alternative procedures in their current practice.

Methods

An anonymous questionnaire was distributed to American Glaucoma Society members who completed fellowship training between 2018 and 2022. Questionnaire items assessed respondents' experiences in residency and fellowship training as well as their current practice as attendings regarding four procedures: trabeculectomy, tube-shunt, XEN Gel Stent, and ab-interno angle procedures.

Results

Of 66 total respondents, 64 (93.9%) reported feeling somewhat or entirely comfortable performing trabeculectomy following training. However, 42 (63.6%) said they do not often perform trabeculectomy, whereas 13 (19.7%) reported that they do. Those who reported performing trabeculectomy often (N ​= ​13) were influenced by the surgery's high success rates (92.3%), preoperative (76.9%) and intraoperative (84.6%) processes, and low postoperative complications (61.5%). Those who reported not performing trabeculectomy often (N ​= ​42) were most discouraged by the postoperative process of trabeculectomy, as well as socioeconomic (66.7%) and sociocultural (52.4%) characteristics of their patients. Factors such as volume performed during training (47.6%), cost-effectiveness (19.0%), and reimbursement rates (19.0%) were not considerable contributors.

Conclusions

While most young glaucoma specialists in our study report being comfortable performing trabeculectomy, the majority stated that they do not often perform the procedure in practice. Low trabeculectomy surgical volume during training was not cited as a notable barrier, whereas patient factors and preference for alternative procedures, depending on the clinical scenario, appeared to drive this trend.
背景:尽管小梁切除术一直被认为是治疗严重或顽固性青光眼的金标准手术,但近几十年来,随着替代眼压(IOP)降低手术的增加,该手术在青光眼专家中的普及程度逐渐下降。目的:本初步研究调查了新近毕业的青光眼专科医生在培训期间的经历如何影响他们在当前实践中选择小梁切除术或选择其他手术。方法向2018 - 2022年间完成研究员培训的美国青光眼协会会员发放匿名问卷。问卷项目评估了受访者在住院医师和研究员培训方面的经历,以及他们目前作为主治医生的实践,涉及四种手术:小梁切除术、分流管、XEN凝胶支架和b-夹角手术。结果在66名受访者中,64名(93.9%)表示在训练后进行小梁切除术时感觉有些或完全舒服。然而,42人(63.6%)表示他们不经常进行小梁切除术,而13人(19.7%)报告他们经常进行小梁切除术。经常行小梁切除术的患者(N = 13)受到手术高成功率(92.3%)、术前(76.9%)和术中(84.6%)过程以及低术后并发症(61.5%)的影响。那些不常行小梁切除术的患者(N = 42)最气馁的原因是小梁切除术的术后过程,以及患者的社会经济(66.7%)和社会文化(52.4%)特征。诸如培训期间执行的数量(47.6%)、成本效益(19.0%)和报销率(19.0%)等因素都不是重要的影响因素。结论:虽然在我们的研究中,大多数年轻的青光眼专家报告说,他们对小梁切除术感到满意,但大多数人表示,他们在实践中并不经常实施该手术。训练期间的小梁切除术手术量不被认为是一个明显的障碍,而患者因素和对替代手术的偏好,取决于临床情况,似乎推动了这一趋势。
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引用次数: 0
Comparison of binocular visual function among patients with different types of anisometropia 不同类型屈光参差患者双眼视功能的比较
Pub Date : 2025-06-18 DOI: 10.1016/j.aopr.2025.04.005
Li Tang , Lei Li , Chunmei Li , Yulin Yu , Nan Shu , Li Zhang

Objective

To compare the perceived eye position, Titmus and stereopsis function across various types of anisometropia to identify differences in binocular visual function.

Methods

This study included 204 anisometropic patients (observation group, interocular spherical equivalent difference ≥1.5D or cylindrical ≥1.0D) and 57 non-anisometropic controls (interocular differences <1.5D spherical or <1.0D cylindrical). Participants were initially stratified based on documented amblyopia history (94 with vs. 110 without), followed by further subgrouping of the observation group into hyperopic, myopic, and astigmatic anisometropia types for comparative analysis with controls. Standardized assessments comprised best-corrected visual acuity (BCVA, logMAR), cycloplegic refraction, Titmus near stereopsis (arcsec), binocular perceptual eye position (PEP) deviation, and three-order stereopsis thresholds measured via a computerized binocular vision assessment system. Statistical analysis adhered to CONSORT guidelines (SPSS v26.0, α ​= ​0.05).

Results

(1) No significant differences were observed between patients with documented amblyopia history and those without regarding equivalent spherical lens difference, horizontal/vertical PEP, three-order stereopsis, or Titmus test results. (2) The control group demonstrated superior vertical PEP, three-order stereopsis, and Titmus performance compared to all anisometropia subgroups (myopic, hypermetropic, and astigmatic; P ​<0.05), though horizontal PEP showed no significant variation (P ​>0.05). (3) While Titmus results showed no difference between astigmatic and myopic anisometropia groups (P ​= ​0.72), significant differences existed among other groups (P <0.05). Notably, the hyperopic anisometropia group exhibited the poorest normal rates for vertical PEP, Titmus, and three-order stereopsis among all groups (P ​<0.001). Additionally, the astigmatism group outperformed both myopia and hypermetropia groups in 0-order and 1-order stereopsis (P ​<0.05).

Conclusions

The study revealed no significant difference in visual function between anisometropic amblyopia patients who achieved normal BCVA (≤0.0 LogMAR) and non-amblyopic anisometropic controls. However, all forms of anisometropia demonstrated varying degrees of impairment to binocular fusion and stereopsis, with hypermetropic anisometropia showing the most pronounced deficits, particularly in near stereopsis. Notably, vertical PEP instability may contribute to the progression of hyperopic anisometropia.
目的比较不同类型屈光参差患者的眼位、眼视功能和立体视功能的变化,探讨双眼视功能的差异。方法本研究纳入204例屈光参差患者(观察组,眼间球面等效差≥1.5D或柱状≥1.0D)和57例非屈光参差对照组(眼间球面等效差1.5D或柱状等效差1.0D)。参与者最初根据记录的弱视病史进行分层(94例有弱视,110例无弱视),随后观察组进一步分为远视、近视和散光参差,与对照组进行比较分析。标准化评估包括最佳矫正视力(BCVA, logMAR)、眼麻痹性屈光、近立体视(arcsec)、双眼感知眼位(PEP)偏差以及通过计算机化双目视觉评估系统测量的三阶立体视阈值。统计学分析遵循CONSORT指南(SPSS v26.0, α = 0.05)。结果(1)有弱视病史的患者与无弱视病史的患者在等效球晶状体差、水平/垂直PEP、三阶立体视或Titmus试验结果方面无显著差异。(2)与所有屈光参差亚组(近视、远视和散光)相比,对照组表现出更好的垂直PEP、三阶立体视和Titmus性能;水平PEP差异无统计学意义(P >0.05)。(3) Titmus结果散光组与近视参差组间差异无统计学意义(P = 0.72),其他组间差异有统计学意义(P <0.05)。值得注意的是,远视屈光参差组的垂直PEP、Titmus和三阶立体视正常率在所有组中最低(P <0.001)。散光组在0级和1级立体视觉上优于近视组和远视组(P <0.05)。结论本研究显示,在BCVA达到正常(≤0.0 LogMAR)的屈光参差性弱视患者和非屈光参差性对照之间,视功能无显著差异。然而,所有形式的屈光参差都表现出不同程度的双目融合和立体视觉损害,远视屈光参差表现出最明显的缺陷,尤其是近立体视觉。值得注意的是,垂直PEP不稳定可能导致远视屈光参差的进展。
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引用次数: 0
Research progress of in vivo measurement methods of myopia sclera biomechanics 近视巩膜生物力学体内测量方法的研究进展
Pub Date : 2025-06-14 DOI: 10.1016/j.aopr.2025.04.006
Xin Shi , Hao Gu , Hao Jiang , Su Zhao , Zhixuan Chen

Background

The study of the development mechanism of myopia involves many aspects, of which the remodeling and biomechanical changes of the sclera are currently recognized as some of the more important mechanisms. In recent years, new progress has been made in in vivo and ex vivo measurement methods to characterize scleral biomechanics. However, because ex vivo measurement methods cannot be used on the in vivo eyeball, there is still a lack of a reliable in vivo scleral biomechanical measurement method to assess the trend of myopia progression in clinical practice.

Main text

In this paper, the research progress of existing in vivo measurement methods of scleral biomechanics in myopia is reviewed, and the advantages and limitations of these methods are discussed. The purpose is to comprehensively introduce the current development status of in vivo measurement methods of scleral biomechanics, look forward to their clinical application and development, and to explore new directions and ideas for the application of scleral biomechanics in the prevention and control of myopia.

Conclusions

The review shows that the most urgent problem is to further prove and verify that the biomechanical properties of the sclera can be measured with sufficient sensitivity and accuracy in vivo. Its safety and feasibility in clinical application also need to be considered. Future studies should investigate the multi-level and multi-scale biomechanical properties of the myopic sclera, and develop non-contact and non-invasive in vivo measurement techniques to provide more methods for myopia prevention and control and early screening of myopia in adolescents.
近视发生机制的研究涉及多个方面,其中巩膜的重塑和生物力学变化是目前公认的较重要的机制。近年来,在体内和离体测量方法表征巩膜生物力学方面取得了新的进展。然而,由于离体测量方法不能用于在体眼球,在临床实践中仍缺乏可靠的在体巩膜生物力学测量方法来评估近视进展趋势。本文综述了现有近视巩膜生物力学在体测量方法的研究进展,并讨论了这些方法的优点和局限性。目的是全面介绍巩膜生物力学在体测量方法的发展现状,展望其临床应用和发展,为巩膜生物力学在近视防治中的应用探索新的方向和思路。结论目前最迫切的问题是进一步证明和验证在体内能够以足够的灵敏度和准确性测量巩膜的生物力学特性。其临床应用的安全性和可行性也有待考虑。未来的研究应进一步探索近视巩膜多层次、多尺度的生物力学特性,发展非接触、非侵入性体内测量技术,为青少年近视防治和早期筛查提供更多方法。
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引用次数: 0
Causal associations between smoking and ocular diseases: a Mendelian randomization study 吸烟与眼部疾病的因果关系:一项孟德尔随机研究
Pub Date : 2025-06-14 DOI: 10.1016/j.aopr.2025.06.002
Zhaohao Huang , Junjie Chen , Lu Shi , Jun Huang

Purpose

To explore the causal associations between smoking and ocular diseases using Mendelian randomization (MR).

Methods

A two-sample Mendelian randomization (MR) analysis based on publicly.
available genome-wide association studies were employed to infer the causal relationship. The effect estimates were calculated using the random-effects inverse-variance-weighted method.

Results

Genetically predicted smoking was positively associated with cataract [Odds ratio (OR) ​= ​1.14, 95% confidence interval (CI): ​1.01−1.29; P ​= ​0.027], w−AMD [OR ​= ​1.41, 95%CI: ​1.06−1.88; P ​= ​0.019], diabetic retinopathy [OR ​= ​1.06, 95%CI: ​1.04−1.30; P ​= ​0.01], disorders of optic nerve and visual pathways [OR ​= ​1.46, 95% CI: ​1.00−2.14; P ​= ​0.049] in inverse variance weighted analysis. Suggestive evidence of an inverse association between smoking and myopia was also observed [OR=0.75, 95%CI: ​0.57−0.97; P ​= ​0.031]. No associations were observed for glaucoma, allergic conjunctivitis, pterygium, keratitis, scleritis and episcleritis. After performing weighted median and MR-Egger analysis, consistent results were observed. There was no horizontal pleiotropy in the two-sample MR analysis.

Conclusions

Smoking may increase the risks of cataract, w−AMD, diabetic retinopathy, disorders of optic nerve and visual pathways. And smoking may decrease the risk of myopia.
目的应用孟德尔随机化方法探讨吸烟与眼部疾病的因果关系。方法采用两样本孟德尔随机化(MR)分析。可用的全基因组关联研究被用来推断因果关系。效应估计采用随机效应反方差加权法计算。结果基因预测吸烟与白内障呈正相关[优势比(OR) = 1.14, 95%可信区间(CI): 1.01 ~ 1.29;P = 0.027), w−AMD (OR = 1.41, 95% ci: 1.06−1.88;P = 0.019],糖尿病视网膜病变[OR = 1.06, 95%CI: 1.04 ~ 1.30;P = 0.01],视神经和视觉通路障碍[OR = 1.46, 95% CI: 1.00−2.14;P = 0.049]。还观察到吸烟与近视呈负相关的暗示证据[OR=0.75, 95%CI: 0.57−0.97;P = 0.031]。青光眼、过敏性结膜炎、翼状胬肉、角膜炎、巩膜炎和外膜炎未见相关性。在进行加权中位数和MR-Egger分析后,观察到一致的结果。双样本MR分析无水平多效性。结论吸烟可增加白内障、黄斑变性、糖尿病性视网膜病变、视神经和视通路病变的发生风险。吸烟可能会降低近视的风险。
{"title":"Causal associations between smoking and ocular diseases: a Mendelian randomization study","authors":"Zhaohao Huang ,&nbsp;Junjie Chen ,&nbsp;Lu Shi ,&nbsp;Jun Huang","doi":"10.1016/j.aopr.2025.06.002","DOIUrl":"10.1016/j.aopr.2025.06.002","url":null,"abstract":"<div><h3>Purpose</h3><div>To explore the causal associations between smoking and ocular diseases using Mendelian randomization (MR).</div></div><div><h3>Methods</h3><div>A two-sample Mendelian randomization (MR) analysis based on publicly.</div><div>available genome-wide association studies were employed to infer the causal relationship. The effect estimates were calculated using the random-effects inverse-variance-weighted method.</div></div><div><h3>Results</h3><div>Genetically predicted smoking was positively associated with cataract [Odds ratio (OR) ​= ​1.14, 95% confidence interval (CI): ​1.01−1.29; <em>P</em> ​= ​0.027], w−AMD [OR ​= ​1.41, 95%CI: ​1.06−1.88; <em>P</em> ​= ​0.019], diabetic retinopathy [OR ​= ​1.06, 95%CI: ​1.04−1.30; <em>P</em> ​= ​0.01], disorders of optic nerve and visual pathways [OR ​= ​1.46, 95% CI: ​1.00−2.14; <em>P</em> ​= ​0.049] in inverse variance weighted analysis. Suggestive evidence of an inverse association between smoking and myopia was also observed [OR=0.75, 95%CI: ​0.57−0.97; <em>P</em> ​= ​0.031]. No associations were observed for glaucoma, allergic conjunctivitis, pterygium, keratitis, scleritis and episcleritis. After performing weighted median and MR-Egger analysis, consistent results were observed. There was no horizontal pleiotropy in the two-sample MR analysis.</div></div><div><h3>Conclusions</h3><div>Smoking may increase the risks of cataract, w−AMD, diabetic retinopathy, disorders of optic nerve and visual pathways. And smoking may decrease the risk of myopia.</div></div>","PeriodicalId":72103,"journal":{"name":"Advances in ophthalmology practice and research","volume":"5 3","pages":"Pages 220-225"},"PeriodicalIF":0.0,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144696555","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}
引用次数: 0
Efficacy of image-guided accurate limbal relaxing incisions for astigmatism correction during cataract surgery 影像引导下准确角膜缘松弛切口在白内障手术中矫正散光的效果
Pub Date : 2025-06-04 DOI: 10.1016/j.aopr.2025.06.001
Xiaoxin Hu , Jiao Qi , Kaiwen Cheng , Wenwen He , Yu Du , Keke Zhang , Yi Lu , Xiangjia Zhu

Purpose

To investigate the efficacy of image-guided accurate limbal relaxing incisions (LRIs) for astigmatism correction during cataract surgery.

Methods

Consecutive cataract patients with regular corneal astigmatism ranging from 0.75 to 2.50 D, intended for cataract surgery with image-guided LRIs, were recruited in this prospective cohort study. The efficacy of astigmatism correction was evaluated 3 months after surgery, and compared among eyes with preoperative corneal with-the-rule (WTR), against-the-rule (ATR) and oblique astigmatism. Higher-order aberrations and visual quality indices obtained with iTrace were further compared between eyes with single and paired LRIs.

Results

Totally, 108 eyes of 108 patients were analyzed. The mean total surgical induced astigmatism (tSIA) vector of all participants was 0.76 ​± ​0.38 D (range: 0.11–1.79 D, preoperative vs. postoperative astigmatism: 1.46 ​± ​0.41 vs. 0.78 ​± ​0.44 D, P ​< ​0.001). Eyes with WTR astigmatism showed higher tSIA (0.89 ​± ​0.32 D vs. 0.42 ​± ​0.21 D vs. 0.48 ​± ​0.36 D, respectively, P ​< ​0.001), as well as higher correction index and lower difference vector and index of success than ATR and oblique astigmatism groups (all P ​< ​0.05). Eyes with paired LRIs exhibited better corneal average height of modulation transfer function, a better corneal performance index and a better quality of vision index than those with single LRI (all P ​< ​0.05).

Conclusions

Image-guided LRIs can effectively correct low-to-moderate corneal astigmatism during cataract surgery, especially in eyes with WTR astigmatism.
目的探讨图像引导下准确角膜缘松弛切口(LRIs)在白内障手术中矫正散光的效果。方法前瞻性队列研究招募了角膜散光在0.75 - 2.50 D范围内的常规白内障患者,这些患者拟接受图像引导下的LRIs白内障手术。术后3个月评估散光矫正效果,并与术前角膜顺位(WTR)、顺位(ATR)和斜向散光进行比较。用iTrace获得的高阶像差和视觉质量指数进一步比较了单眼和双眼LRIs。结果共分析108例患者108只眼。所有参与者的平均总手术性散光(tSIA)矢量为0.76±0.38 D(范围:0.11-1.79 D,术前与术后散光:1.46±0.41 vs 0.78±0.44 D, P <;0.001)。WTR散光组tSIA较高(分别为0.89±0.32 D、0.42±0.21 D、0.48±0.36 D);0.001),校正指数高于ATR和斜像散组,差矢量和成功指数低于斜像散组(P <;0.05)。配对LRI的眼比单LRI的眼表现出更好的角膜调制传递函数平均高度、更好的角膜性能指数和更好的视力质量指数(P <;0.05)。结论图像引导下的LRIs可有效矫正白内障手术中低、中度角膜散光,尤其对WTR型散光眼效果更好。
{"title":"Efficacy of image-guided accurate limbal relaxing incisions for astigmatism correction during cataract surgery","authors":"Xiaoxin Hu ,&nbsp;Jiao Qi ,&nbsp;Kaiwen Cheng ,&nbsp;Wenwen He ,&nbsp;Yu Du ,&nbsp;Keke Zhang ,&nbsp;Yi Lu ,&nbsp;Xiangjia Zhu","doi":"10.1016/j.aopr.2025.06.001","DOIUrl":"10.1016/j.aopr.2025.06.001","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the efficacy of image-guided accurate limbal relaxing incisions (LRIs) for astigmatism correction during cataract surgery.</div></div><div><h3>Methods</h3><div>Consecutive cataract patients with regular corneal astigmatism ranging from 0.75 to 2.50 D, intended for cataract surgery with image-guided LRIs, were recruited in this prospective cohort study. The efficacy of astigmatism correction was evaluated 3 months after surgery, and compared among eyes with preoperative corneal with-the-rule (WTR), against-the-rule (ATR) and oblique astigmatism. Higher-order aberrations and visual quality indices obtained with iTrace were further compared between eyes with single and paired LRIs.</div></div><div><h3>Results</h3><div>Totally, 108 eyes of 108 patients were analyzed. The mean total surgical induced astigmatism (tSIA) vector of all participants was 0.76 ​± ​0.38 D (range: 0.11–1.79 D, preoperative vs. postoperative astigmatism: 1.46 ​± ​0.41 vs. 0.78 ​± ​0.44 D, <em>P</em> ​&lt; ​0.001). Eyes with WTR astigmatism showed higher tSIA (0.89 ​± ​0.32 D vs. 0.42 ​± ​0.21 D vs. 0.48 ​± ​0.36 D, respectively, <em>P</em> ​&lt; ​0.001), as well as higher correction index and lower difference vector and index of success than ATR and oblique astigmatism groups (all <em>P</em> ​&lt; ​0.05). Eyes with paired LRIs exhibited better corneal average height of modulation transfer function, a better corneal performance index and a better quality of vision index than those with single LRI (all <em>P</em> ​&lt; ​0.05).</div></div><div><h3>Conclusions</h3><div>Image-guided LRIs can effectively correct low-to-moderate corneal astigmatism during cataract surgery, especially in eyes with WTR astigmatism.</div></div>","PeriodicalId":72103,"journal":{"name":"Advances in ophthalmology practice and research","volume":"5 3","pages":"Pages 212-219"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686855","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}
引用次数: 0
DeepSeek-R1 outperforms Gemini 2.0 Pro, OpenAI o1, and o3-mini in bilingual complex ophthalmology reasoning DeepSeek-R1在双语复杂眼科推理方面优于Gemini 2.0 Pro、OpenAI o1和o3-mini
Pub Date : 2025-05-09 DOI: 10.1016/j.aopr.2025.05.001
Pusheng Xu , Yue Wu , Kai Jin , Xiaolan Chen , Mingguang He , Danli Shi

Purpose

To evaluate the accuracy and reasoning ability of DeepSeek-R1 and three recently released large language models (LLMs) in bilingual complex ophthalmology cases.

Methods

A total of 130 multiple-choice questions (MCQs) related to diagnosis (n ​= ​39) and management (n ​= ​91) were collected from the Chinese ophthalmology senior professional title examination and categorized into six topics. These MCQs were translated into English. Responses from DeepSeek-R1, Gemini 2.0 Pro, OpenAI o1 and o3-mini were generated under default configurations between February 15 and February 20, 2025. Accuracy was calculated as the proportion of correctly answered questions, with omissions and extra answers considered incorrect. Reasoning ability was evaluated through analyzing reasoning logic and the causes of reasoning errors.

Results

DeepSeek-R1 demonstrated the highest overall accuracy, achieving 0.862 in Chinese MCQs and 0.808 in English MCQs. Gemini 2.0 Pro, OpenAI o1, and OpenAI o3-mini attained accuracies of 0.715, 0.685, and 0.692 in Chinese MCQs (all P ​<0.001 compared with DeepSeek-R1), and 0.746 (P ​= ​0.115), 0.723 (P ​= ​0.027), and 0.577 (P ​<0.001) in English MCQs, respectively. DeepSeek-R1 achieved the highest accuracy across five topics in both Chinese and English MCQs. It also excelled in management questions conducted in Chinese (all P ​<0.05). Reasoning ability analysis showed that the four LLMs shared similar reasoning logic. Ignoring key positive history, ignoring key positive signs, misinterpretation of medical data, and overuse of non–first-line interventions were the most common causes of reasoning errors.

Conclusions

DeepSeek-R1 demonstrated superior performance in bilingual complex ophthalmology reasoning tasks than three state-of-the-art LLMs. These findings highlight the potential of advanced LLMs to assist in clinical decision-making and suggest a framework for evaluating reasoning capabilities.
目的评价DeepSeek-R1和最近发布的三种大型语言模型(llm)在复杂的双语眼科病例中的准确性和推理能力。方法收集中国眼科高级职称考试中与诊断(n = 39)和管理(n = 91)相关的多项选择题130道,分为6个题目。这些mcq被翻译成英文。DeepSeek-R1、Gemini 2.0 Pro、OpenAI o1和o3-mini在2025年2月15日至2月20日之间的默认配置下生成响应。准确度是根据正确回答问题的比例来计算的,遗漏和多余的答案被认为是不正确的。通过分析推理逻辑和推理错误的原因来评价推理能力。结果deepseek - r1在中文mcq和英文mcq中表现出最高的总体准确率,分别达到0.862和0.808。Gemini 2.0 Pro、OpenAI 01和OpenAI 03 -mini在中文mcq中的准确率分别为0.715、0.685和0.692(与DeepSeek-R1相比均P <;0.001),在英文mcq中的准确率分别为0.746 (P = 0.115)、0.723 (P = 0.027)和0.577 (P <0.001)。DeepSeek-R1在中文和英文mcq的五个主题中都取得了最高的准确率。它在中文管理问题上也表现出色(P <0.05)。推理能力分析表明,四个llm具有相似的推理逻辑。忽视关键的阳性病史、忽视关键的阳性体征、对医疗数据的误解以及过度使用非一线干预措施是导致推理错误的最常见原因。结论deepseek - r1在复杂的双语眼科推理任务中表现优于3种最先进的llm。这些发现强调了高级llm在临床决策方面的潜力,并提出了一个评估推理能力的框架。
{"title":"DeepSeek-R1 outperforms Gemini 2.0 Pro, OpenAI o1, and o3-mini in bilingual complex ophthalmology reasoning","authors":"Pusheng Xu ,&nbsp;Yue Wu ,&nbsp;Kai Jin ,&nbsp;Xiaolan Chen ,&nbsp;Mingguang He ,&nbsp;Danli Shi","doi":"10.1016/j.aopr.2025.05.001","DOIUrl":"10.1016/j.aopr.2025.05.001","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the accuracy and reasoning ability of DeepSeek-R1 and three recently released large language models (LLMs) in bilingual complex ophthalmology cases.</div></div><div><h3>Methods</h3><div>A total of 130 multiple-choice questions (MCQs) related to diagnosis (n ​= ​39) and management (n ​= ​91) were collected from the Chinese ophthalmology senior professional title examination and categorized into six topics. These MCQs were translated into English. Responses from DeepSeek-R1, Gemini 2.0 Pro, OpenAI o1 and o3-mini were generated under default configurations between February 15 and February 20, 2025. Accuracy was calculated as the proportion of correctly answered questions, with omissions and extra answers considered incorrect. Reasoning ability was evaluated through analyzing reasoning logic and the causes of reasoning errors.</div></div><div><h3>Results</h3><div>DeepSeek-R1 demonstrated the highest overall accuracy, achieving 0.862 in Chinese MCQs and 0.808 in English MCQs. Gemini 2.0 Pro, OpenAI o1, and OpenAI o3-mini attained accuracies of 0.715, 0.685, and 0.692 in Chinese MCQs (all <em>P</em> ​&lt;0.001 compared with DeepSeek-R1), and 0.746 (<em>P</em> ​= ​0.115), 0.723 (<em>P</em> ​= ​0.027), and 0.577 (<em>P</em> ​&lt;0.001) in English MCQs, respectively. DeepSeek-R1 achieved the highest accuracy across five topics in both Chinese and English MCQs. It also excelled in management questions conducted in Chinese (all <em>P</em> ​&lt;0.05). Reasoning ability analysis showed that the four LLMs shared similar reasoning logic. Ignoring key positive history, ignoring key positive signs, misinterpretation of medical data, and overuse of non–first-line interventions were the most common causes of reasoning errors.</div></div><div><h3>Conclusions</h3><div>DeepSeek-R1 demonstrated superior performance in bilingual complex ophthalmology reasoning tasks than three state-of-the-art LLMs. These findings highlight the potential of advanced LLMs to assist in clinical decision-making and suggest a framework for evaluating reasoning capabilities.</div></div>","PeriodicalId":72103,"journal":{"name":"Advances in ophthalmology practice and research","volume":"5 3","pages":"Pages 189-195"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522646","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}
引用次数: 0
TOC TOC
Pub Date : 2025-05-01 DOI: 10.1016/S2667-3762(25)00023-X
{"title":"TOC","authors":"","doi":"10.1016/S2667-3762(25)00023-X","DOIUrl":"10.1016/S2667-3762(25)00023-X","url":null,"abstract":"","PeriodicalId":72103,"journal":{"name":"Advances in ophthalmology practice and research","volume":"5 2","pages":"Pages iii-iv"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144146742","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}
引用次数: 0
Comparative analysis of artificial intelligence tools in generating diabetic retinopathy guidelines 人工智能工具在糖尿病视网膜病变指南生成中的比较分析
Pub Date : 2025-04-18 DOI: 10.1016/j.aopr.2025.04.004
Fan Cao, Shengping Hou
{"title":"Comparative analysis of artificial intelligence tools in generating diabetic retinopathy guidelines","authors":"Fan Cao,&nbsp;Shengping Hou","doi":"10.1016/j.aopr.2025.04.004","DOIUrl":"10.1016/j.aopr.2025.04.004","url":null,"abstract":"","PeriodicalId":72103,"journal":{"name":"Advances in ophthalmology practice and research","volume":"5 3","pages":"Pages 180-181"},"PeriodicalIF":0.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522647","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}
引用次数: 0
Early postoperative changes in corneal densitometry after SMILE with 120-μm and 130-μm cap thickness: a comparative study 帽厚为120 μm和130 μm的SMILE术后早期角膜密度变化的比较研究
Pub Date : 2025-04-16 DOI: 10.1016/j.aopr.2025.04.003
Shirou Wu , Hongying Jin , Ting Wan

Objective

To compare early postoperative changes in corneal densitometry after small incision lenticule extraction using 120-μm and 130-μm cap thicknesses.

Methods

69 eyes of 39 patients who underwent small incision lenticule extraction (SMILE) with cap thicknesses of 120-μm (n ​= ​34) and 130-μm (n ​= ​35) were included in this study. The corneal densitometry (CD) of three zones (0–2 ​mm, 2–6 ​mm, and 6–10 ​mm) of the anterior, central, and posterior corneal layers was evaluated before, one week, and one month after surgery. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical degree, cylinder degree, and spherical equivalent (SE) were also analyzed and compared between the two groups before and after surgery.

Results

Little difference was detected between the two groups in postoperative UCVA, BCVA, SE, and cylinder degree at one month. No statistically significant differences were found between the preoperative and postoperative CD values for the overall (0–12 ​mm) cornea and the 6–10 ​mm zone in either group. A significant increase in CD was observed in the 0–2 ​mm and 2–6 ​mm zones of the anterior layer in the 120-μm group, and the 0–2 ​mm zone of the central layer in the 130-μm group, one week postoperatively. These changes persisted for one month after surgery (P ​< ​0.05). The CD in the central layer (0–2 ​mm and 2–6 ​mm) in the 120-μm group, as well as the total layer (0–2 ​mm and 2–6 ​mm) in both groups, significantly increased at the first postoperative week but returned to preoperative levels by one month after surgery. Additionally, the CD of the anterior layer (0–2 ​mm and 2–6 ​mm) increased significantly in the first week postoperatively, decreased significantly one month postoperatively, but remained significantly higher than baseline in the 130-μm group. In both groups, the CD of the posterior 0–2 ​mm zone decreased. Moreover, the increase in CD in the anterior 2–6 ​mm zone one week postoperatively was significantly higher in the 120-μm group compared to the 130-μm group (ΔCD 2.4 ​± ​1.55 vs. 1.64 ​± ​0.87, P ​= ​0.014). Postoperative corneal wavefront aberrations were significantly higher in the 120-μm group than in the 130-μm group.

Conclusions

CD increased mainly in the 0–6 ​mm zone of the anterior layer in the early phase after the SMILE procedure with both the 120-μm and 130-μm groups. The increase in CD in the anterior 2–6 ​mm zone one week postoperatively was higher in the 120-μm group than in the 130-μm group. SMILE with 120-μm and 130-μm cap thickness were both efficient and safe, but eyes with a 120-μm cap thickness showed higher postoperative corneal wavefront aberrations.
目的比较120 μm和130 μm帽厚小切口晶状体摘除术后早期角膜密度测定的变化。方法采用小切口晶状体摘除术(SMILE),术者39例69眼,帽厚分别为120-μm (n = 34)和130-μm (n = 35)。术前、术后1周和1个月分别测定角膜前、中、后3个区域(0 - 2mm、2 - 6mm和6 - 10mm)的角膜密度。分析比较两组患者术前、术后未矫正距离视力(UDVA)、矫正距离视力(CDVA)、球形度、圆柱体度、球形等效度(SE)。结果两组术后1个月UCVA、BCVA、SE、椎体度差异无统计学意义。两组术前和术后整体(0-12 mm)角膜和6-10 mm区域的CD值均无统计学差异。术后1周,120-μm组前层0- 2mm、2 - 6mm区CD明显增高,130-μm组中央层0- 2mm区CD明显增高。这些变化在手术后持续了一个月(P <;0.05)。120 μm组中心层(0 - 2mm和2 - 6mm)和总层(0 - 2mm和2 - 6mm)的CD在术后第一周显著增加,但在术后1个月恢复到术前水平。此外,前层(0-2 mm和2-6 mm)的CD在术后第1周显著增加,术后1个月显著降低,但在130 μm组仍显著高于基线。两组后0 - 2mm区CD均降低。此外,术后1周,120 μm组2-6 mm前区CD的增加明显高于130 μm组(ΔCD 2.4±1.55 vs. 1.64±0.87,P = 0.014)。120-μm组术后角膜波前像差明显高于130-μm组。结论120-μm组和130-μm组术后早期scd主要在前层0-6 mm区增加。术后1周,120 μm组前路2 ~ 6mm区CD增加明显高于130 μm组。帽厚为120 μm和130 μm的SMILE均有效且安全,但帽厚为120 μm的眼睛术后角膜波前像差较高。
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引用次数: 0
From stress to sight: The role of mechanical forces in the retinal diseases 从压力到视力:机械力在视网膜疾病中的作用
Pub Date : 2025-04-15 DOI: 10.1016/j.aopr.2025.04.002
Di Wu , Ye Liu , Xiaogang Luo , Chengshou Zhang , Yifei Zheng , Jianfeng Meng , Mei Yang , Hemlata Bisnauthsing , Ping Rao , Baohua Ji , Wai Kit Chu

Background

The retina, a light-sensitive neural tissue critical for vision, exists in a dynamic mechanical environment where it is continuously exposed to mechanical forces. These forces, including traction forces, intraocular pressure-related stress, and hemodynamic forces, are closely linked to the progression of retinal diseases. A comprehensive understanding of retinal mechanosensation and mechanotransduction is essential for understanding the pathological mechanisms under aberrant mechanical conditions.

Main Text

This review synthesizes current knowledge on advanced biomechanical assessment techniques, and aging-associated biomechanical alterations in retinal tissues, emphasizing how mechanical forces drive structural and functional pathology.

Conclusions

By elucidating the mechanosensitive mechanisms remodeling retinal cell behavior and fate, this review highlights the critical role of biomechanics in retinal disease pathogenesis. The integration of mechanistic insights with biomechanical assessment techniques offers transformative potential for diagnosing mechanical dysfunction and developing mechanotargeted therapies.
视网膜是一种对视觉至关重要的光敏神经组织,它存在于一个动态的机械环境中,不断地暴露在机械力下。这些力,包括牵引力、眼压相关应力和血流动力学力,与视网膜疾病的进展密切相关。全面了解视网膜机械感觉和机械转导对于理解异常机械条件下的病理机制至关重要。本文综合了目前先进的生物力学评估技术和视网膜组织中与衰老相关的生物力学变化的知识,强调了机械力如何驱动结构和功能病理。结论通过阐明视网膜细胞行为和命运的机械敏感性机制,强调了生物力学在视网膜疾病发病机制中的重要作用。机械力学见解与生物力学评估技术的整合为诊断机械功能障碍和开发机械靶向治疗提供了变革性的潜力。
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引用次数: 0
期刊
Advances in ophthalmology practice and research
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