Evaluation of a digital ophthalmologist app built by GPT4-V(ision)

Backgrounds: GPT4-V(ision) has generated great interest across various fields, while its performance in ocular multimodal images is still unknown. This study aims to evaluate the capabilities of a GPT-4V-based chatbot in addressing queries related to ocular multimodal images. Methods: A digital ophthalmologist app was built based on GPT-4V. The evaluation dataset comprised various ocular imaging modalities: slit-lamp, scanning laser ophthalmoscopy (SLO), fundus photography of the posterior pole (FPP), optical coherence tomography (OCT), fundus fluorescein angiography (FFA), and ocular ultrasound (OUS). Each modality included images representing 5 common and 5 rare diseases. The chatbot was presented with ten questions per image, focusing on examination identification, lesion detection, diagnosis, decision support, and the repeatability of diagnosis. The responses of GPT-4V were evaluated based on accuracy, usability, and safety. Results: There was a substantial agreement among three ophthalmologists. Out of 600 responses,30.5% were accurate,22.8% of 540 responses were highly usable, and 55.5% of 540 responses were considered safe by ophthalmologists. The chatbot excelled in interpreting slit-lamp images, with 42.0%,42.2%, and 68.5% of the responses being accurate, highly usable, and no harm, respectively. However, its performance was notably weaker in FPP images, with only 13.7%,3.7%, and 38.5% in the same categories. It correctly identified 95.6% of the imaging modalities. For lesion identification, diagnosis, and decision support, the chatbot's accuracy was 25.6%,16.1%, and 24.0%, respectively. The average proportions of correct answers, highly usable, and no harm for GPT-4V in common diseases were 37.9%,30.5%, and 60.1%, respectively. These proportions were all higher compared to those in rare diseases, which were 23.2% (P<0.001),15.2% (P<0.001), and 51.1% (P=0.032), respectively. The overall repeatability of GPT4-V in diagnosing ocular images was 63% (38/60). Conclusion: Currently, GPT-4V lacks the reliability required for clinical decision-making and patient consultation in ophthalmology. Ongoing refinement and testing are essential for improving the efficacy of large language models in medical applications.