The substitution of reusable gonioscopy lenses for disposable gonioscopy lenses during selective laser trabeculoplasty (SLT) has occurred over the last few years to mitigate infection risk. However, ...concerns have been raised regarding the potential of laser damage to the lens itself during SLT, which can lead to laser scattering, increasing the possibility of unintended adverse effects. We have noticed that over 90% of the disposable lenses used for SLT sustained some sort of laser-induced damage with routine laser energies (0.4-1.0 mJ). Comparisons of clinical efficacy of SLT, measured by reductions in intraocular pressure (IOP), between the use of reusable and disposable lenses has shown no difference in IOP reduction, with both groups achieving a 20% reduction in IOP over the course of 12 months. While no clinical difference in outcomes was observed, further investigation into this issue, most notably the possibility of adverse effects due to laser scattering, is warranted.
Recent advances in artificial intelligence (AI), robotics, and chatbots have brought these technologies to the forefront of medicine, particularly ophthalmology. These technologies have been applied ...in diagnosis, prognosis, surgical operations, and patient-specific care in ophthalmology. It is thus both timely and pertinent to assess the existing landscape, recent advances, and trajectory of trends of AI, AI-enabled robots, and chatbots in ophthalmology.
Some recent developments have integrated AI enabled robotics with diagnosis, and surgical procedures in ophthalmology. More recently, large language models (LLMs) like ChatGPT have shown promise in augmenting research capabilities and diagnosing ophthalmic diseases. These developments may portend a new era of doctor-patient-machine collaboration.
Ophthalmology is undergoing a revolutionary change in research, clinical practice, and surgical interventions. Ophthalmic AI-enabled robotics and chatbot technologies based on LLMs are converging to create a new era of digital ophthalmology. Collectively, these developments portend a future in which conventional ophthalmic knowledge will be seamlessly integrated with AI to improve the patient experience and enhance therapeutic outcomes.
Purpose:
To introduce the use of the Kahook Dual Blade in the treatment of juvenile open-angle glaucoma.
Patients and methods:
A 14-year-old male was presented with juvenile open-angle glaucoma in ...the left eye. Ab interno trabeculectomy was performed using a dual-blade device.
Results:
Intraocular pressure was reduced from 28 to 15 mmHg in the left eye after 18 months. There were no complications.
Conclusion:
Dual blade ab interno trabeculectomy is a promising alternate to goniotomy in the treatment of juvenile open-angle glaucoma.
•Gender differences exist among ophthalmology fellowship directors.•There are variations in female representation by ophthalmic subspecialty.•Demographic differences were also observed in this study.
...Women are underrepresented in several medical specialties, including ophthalmology. Reducing disparities is critical in diversifying perspectives and increasing equity within ophthalmology, both of which can ultimately improve care delivery. We examined ophthalmic fellowship programs directors in the United States to investigate gender disparities by subspecialty.
Cross-sectional study.
This was a retrospective cross-sectional study of ophthalmology fellowship program directors in academic medical centers. The primary outcome measure was a descriptive analysis of current fellowship directors in 2022 when stratified by subspecialty and demographic features.
Analysis was conducted on 358 fellowship directors in the United States. Twenty-nine percent of directors were women. Female directors had significantly fewer years since residency graduation compared with male peers (17 vs 24; P < .001); however, no differences were observed by program type (P = .896) or location (P = 0.104). Differences in female director representation were observed by subspecialty (P < .001), with the greatest percentage of women in pediatric ophthalmology (54%), other (oncology and pathology) fellowships (50%), and medical retina (40%). The subspecialties with the lowest percentage of female directors were oculoplastic and reconstructive surgery (13%) surgical retina and vitreous (16%).
There are disparities in female representation in academic leadership positions across ophthalmic subspecialties. Addressing this difference may have critical impacts on career advancement and opportunities available for marginalized groups in medicine.
Both micropulse (MP-CPC) and continuous wave (CW-CPC) cyclophotocoagulation exhibited short-term effectiveness in lowering IOP, followed by reversion to near baseline levels 12 months after laser ...treatment.
To determine and compare the effectiveness and safety of MP-CPC and CW-CPC in patients diagnosed with pediatric glaucoma.
A retrospective cohort study was conducted on a total of 28 patients (81 eyes) diagnosed with pediatric glaucoma either undergoing MP-CPC or CW-CPC. Intraocular pressure (IOP) measurements, number of glaucoma medications, and the onset of complications were collected at baseline, 1-month, 3-month, 6-month, and 12-month intervals. Success rate (SR) was defined as eyes achieving IOP ≤21 mm Hg and ≥5 mm Hg and a 20% reduction in IOP at the last follow-up visit.
All patients either undergoing MP-CPC or CW-CPC were matched for age (mean ± SD; 1.76 ± 1.69 vs 1.56 ± 2.49 y). Patients undergoing MP-CPC had significant decreases in IOP from baseline IOP at 1, 3, and 6 months with a 22% SR at 12 months. CW-CPC had a significant decrease in IOP from baseline IOP at all follow-ups, with a 27% SR at 12 months. At the 12-month follow-up, the CW-CPC cohort exhibited a significantly larger overall drop in IOP when compared with the MP-CPC cohort, (7.99 ± 7.95 vs 1.78 ± 6.89, P < 0.05); however, the difference in SR between treatment groups (27% vs 22%) at 12 months was not significant ( P > 0.05). Complications were minimal for both groups.
Both MP-CPC and CW-CPC exhibited short-term effectiveness in lowering IOP, followed by reversion to near baseline levels 12 months after laser treatment. Both MP-CPC and CW-CPC exhibited similar SR at 12 months, 22% and 27% respectively.
The use of marijuana for the treatment of glaucoma has been widely debated amongst ophthalmologists and glaucoma specialists. Recent evidence suggests the majority of ophthalmologists do not support ...the use of marijuana as active treatment for glaucoma. However, there has been no investigation into understanding the public's direct perception of the efficacy of marijuana in glaucoma treatment. By using Twitter as a tool to understand the public's thoughts, tweets were analyzed over the last 2 years. Of the 700 tweets analyzed, 72% (n=503) of tweets were in favor of cannabis use in the treatment of glaucoma, whereas 18% (n=124) were evidently opposed. The majority of those in favor came from accounts of individual users (n=391; 56%) whereas those that opposed marijuana as a treatment came from accounts of health care media, ophthalmologists, and other health care workers. The discrepancy between the public and ophthalmologists and other health care professionals requires recognition and further action to better educate the public on the role of marijuana in glaucoma treatment.
To determine the effectiveness of netarsudil, 0.02% in lowering intraocular pressure (IOP) in patients with secondary forms of glaucoma.
A total of 77 patients (98 eyes) with either primary ...open-angle glaucoma (POAG) or secondary glaucoma were reviewed retrospectively over the course of 1 year after starting netarsudil. The secondary glaucoma group was comprised of patients with uveitic, pseudoexfoliative, neovascular, congenital, and other forms of secondary glaucoma. Patient IOP measurements were collected at baseline and at 1-, 3-, 6-, and 12-month intervals. Two sample t tests and 1-way analysis of variance were used to determine differences in IOP reductions following netarsudil treatment.
Patients with POAG or secondary glaucomas were matched for age (mean ± SD: 69.1 ± 16.0 years vs. 64.5 ± 21.2 years; p = 0.30). Both the POAG and secondary glaucoma patients exhibited significant decreases in IOP at each time point (1, 3, 6, and 12 months) when compared with baseline (p < 0.05). Both groups showed similar overall decreases in IOP from baseline after 1 year of treatment (6.0 ± 4.5 mm Hg vs. 6.6 ± 8.4 mm Hg; p = 0.70). Forty-sex percent of POAG patients achieved an IOP of <14 mm Hg compared with 17% of secondary glaucoma patients. Among the secondary glaucoma subtypes, netarsudil was found to be most effective for treating uveitic glaucoma, showing a decrease in IOP of 9.5 mm Hg after 12 months (p = 0.02).
Netarsudil is effective in lowering IOP in patients with certain forms of secondary glaucoma and should be considered for IOP management in those with uveitic glaucoma.
Déterminer l'efficacité du nétarsudil à 0,02 % pour abaisser la pression intraoculaire (PIO) dans le glaucome secondaire.
Un total de 77 patients (98 yeux) qui présentaient soit un glaucome primitif à angle ouvert (GPAO), soit un glaucome secondaire, ont fait l'objet d'un examen rétrospectif pendant l'année suivant la mise en route d'un traitement par le nétarsudil. Les patients du groupe glaucome secondaire présentaient un glaucome uvéitique, pseudo-exfoliatif, néovasculaire ou congénital ou encore une autre forme de glaucome secondaire. La mesure de la PIO a eu lieu au départ de même qu’à des intervalles de 1, de 3, de 6 et de 12 mois. On a eu recours à un test t à 2 échantillons et à une analyse de variance univariée pour comparer les baisses de la PIO entraînées par le nétarsudil dans chaque groupe.
Les patients qui présentaient un GPAO ou un glaucome secondaire étaient appariés pour l’âge (moyenne + é.-t.: 69,1 ± 16,0 ans vs 64,5 ± 21,2 ans; p = 0,30). Les patients des 2 groupes ont bénéficié de baisses significatives de la PIO lors de chacune des mesures (1, 3, 6 et 12 mois), comparativement aux valeurs de départ (p < 0,05). De même, les patients des 2 groupes ont présenté des baisses globales semblables de la PIO par rapport aux valeurs de départ après 1 an de traitement (6,0 ± 4,5 mm Hg vs 6,6 ± 8,4 mm Hg; p = 0,70). Ainsi, 46 % des patients du groupe GPAO ont obtenu une PIO de < 14 mm Hg, comparativement à 17 % des patients du groupe glaucome secondaire. Le sous-type de glaucome secondaire pour lequel le nétarsudil était le plus efficace était le glaucome uvéitique : il a permis une baisse de la PIO de 9,5 mm Hg après 12 mois (p = 0,02).
Le nétarsudil a abaissé efficacement la PIO en présence de certaines formes de glaucome secondaire et doit être envisagé pour la prise en charge de la PIO dans le glaucome uvéitique.
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