IMPORTANCE: ChatGPT is an artificial intelligence (AI) chatbot that has significant societal implications. Training curricula using AI are being developed in medicine, and the performance of chatbots ...in ophthalmology has not been characterized. OBJECTIVE: To assess the performance of ChatGPT in answering practice questions for board certification in ophthalmology. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used a consecutive sample of text-based multiple-choice questions provided by the OphthoQuestions practice question bank for board certification examination preparation. Of 166 available multiple-choice questions, 125 (75%) were text-based. EXPOSURES: ChatGPT answered questions from January 9 to 16, 2023, and on February 17, 2023. MAIN OUTCOMES AND MEASURES: Our primary outcome was the number of board certification examination practice questions that ChatGPT answered correctly. Our secondary outcomes were the proportion of questions for which ChatGPT provided additional explanations, the mean length of questions and responses provided by ChatGPT, the performance of ChatGPT in answering questions without multiple-choice options, and changes in performance over time. RESULTS: In January 2023, ChatGPT correctly answered 58 of 125 questions (46%). ChatGPT’s performance was the best in the category general medicine (11/14; 79%) and poorest in retina and vitreous (0%). The proportion of questions for which ChatGPT provided additional explanations was similar between questions answered correctly and incorrectly (difference, 5.82%; 95% CI, −11.0% to 22.0%; χ21 = 0.45; P = .51). The mean length of questions was similar between questions answered correctly and incorrectly (difference, 21.4 characters; SE, 36.8; 95% CI, −51.4 to 94.3; t = 0.58; df = 123; P = .22). The mean length of responses was similar between questions answered correctly and incorrectly (difference, −80.0 characters; SE, 65.4; 95% CI, −209.5 to 49.5; t = −1.22; df = 123; P = .22). ChatGPT selected the same multiple-choice response as the most common answer provided by ophthalmology trainees on OphthoQuestions 44% of the time. In February 2023, ChatGPT provided a correct response to 73 of 125 multiple-choice questions (58%) and 42 of 78 stand-alone questions (54%) without multiple-choice options. CONCLUSIONS AND RELEVANCE: ChatGPT answered approximately half of questions correctly in the OphthoQuestions free trial for ophthalmic board certification preparation. Medical professionals and trainees should appreciate the advances of AI in medicine while acknowledging that ChatGPT as used in this investigation did not answer sufficient multiple-choice questions correctly for it to provide substantial assistance in preparing for board certification at this time.
Microinvasive glaucoma surgery: A review of 3476 eyes Nichani, Prem; Popovic, Marko M.; Schlenker, Matthew B. ...
Survey of ophthalmology,
September-October 2021, 2021 Sep-Oct, 2021-09-00, 20210901, Volume:
66, Issue:
5
Journal Article
Peer reviewed
Microinvasive glaucoma surgery (MIGS) is a potentially safer and more efficacious method studied in patients with mild-to-moderate open-angle glaucoma requiring less invasive treatment goals; ...however, the literature on MIGS must be thoroughly evaluated. We conducted a review of MIGS by searching MEDLINE, EMBASE, and Cochrane CENTRAL. Primary efficacy indicators were reductions in intraocular pressure and topical medication use postoperatively. While all comparative randomized controlled trials assessing MIGS in English peer-reviewed journals were included, only observational studies with a target follow-up of at least one year and a high priority score were analyzed, resulting in a total of 3476 eyes across 20 trials. The mean age was 69.5 ± 2.9 years, 53.7% were female, and 77.4% were Caucasian. One study had last follow-up at less than one year, fifteen studies had follow-up extending 1-2 years, and four had longer than two years of follow-up. A pattern of more significant intraocular pressure and medication reduction was observed in patients who underwent MIGS (n = 2170) relative to control (n = 1306) interventions. iStent had the most literature supporting its efficacy, followed by Hydrus. The most common adverse events after MIGS implantation included stent obstruction, inflammation, and subsequent surgical intervention. Surgical complication rates and efficacy are favorable after MIGS. This review helps to consolidate the high-quality evidence that exists for various MIGS procedures and to identify gaps where further research is needed.
Introduction: The Canadian Treat-and-Extend Analysis Trial with Ranibizumab (CANTREAT) was a 2-year, multicentred, randomized clinical trial to evaluate treat-and-extend (T&E) relative to monthly ...administration of ranibizumab in neovascular age-related macular degeneration (nAMD). This post hoc analysis of the CANTREAT trial explores the relationship between the maximal extension interval tolerated by patients receiving T&E ranibizumab and visual acuity outcomes. Methods: Treatment-naïve patients with nAMD were randomized to receive either a once-monthly dosing or T&E regimen of ranibizumab across 27 treatment centres in Canada and were followed for 24 months. For this post hoc analysis, patients in the T&E cohort were subdivided into the following groups based on maximum extension interval: 4 weeks, 6 weeks, 8 weeks, 10 weeks, and 12 weeks. The primary outcome was the change in ETDRS best-corrected visual acuity (BCVA) from baseline to month 24 while secondary outcomes included change in central retinal thickness (CRT). All results were reported using descriptive statistics. Results: A total of 285 participants undergoing T&E were enrolled in this post hoc analysis. At month 24, the change in BCVA from baseline was +8.5 ± 9.3, +7.7 ± 13.8, +4.4 ± 9.6, +4.4 ± 18.5, and +7.8 ± 14.8 letters in the 4-, 6-, 8-, 10-, and 12-week cohorts, respectively. The change in CRT at month 24 was −79.2 ± 95.0, −143.9 ± 128.9, −97.7 ± 101.1, −120.9 ± 105.3, and −133.2 ± 108.8 μm in the 4-, 6-, 8-, 10-, and 12-week cohorts, respectively. Conclusion: The capacity to extend does not necessarily associate with improved visual acuity outcomes, with the poorest change in BCVA seen in those extended 8–10 weeks. The highest change in BCVA and lowest decrease in CRT was in the group maximally extended for 4 weeks. There was a correlation between change in BCVA and change in CRT for other extension groups. Future studies should establish the predictive factors for successful extension in patients undergoing T&E in nAMD.
To describe the impact of the coronavirus disease 2019 (COVID-19) pandemic on the characteristics of retinal detachments (RD) at a tertiary centre.
Retrospective consecutive case series.
One hundred ...and ninety eyes of 188 patients with primary, rhegmatogenous RD.
Patients with RD who presented over a 1-year period (September 14, 2019 to September 13, 2020). The relationship between demographic, anatomic, and visual acuity parameters were compared before and after onset of the pandemic using generalized estimating equations.
Macular status and corrected distance visual acuity on presentation.
One hundred and eighty-seven eyes, divided into 2 cohorts: pre-COVID (n = 100 September 14, 2019 to March 13, 2020) and post-COVID (n = 87, March 14, 2020 to September 13, 2020). Of the eyes, 63.2% (n = 87) presented with macular detachment in the post-COVID group compared with 45% (n = 100) in the pre-COVID group (odds ration OR, 2.14; 95% confidence interval CI,1.19–3.86; p = 0.011). As well, eyes in the pre-pandemic cohort had significantly fewer detached quadrants on initial examination (OR, 0.53; 95% CI, 0.30–0.93; p = 0.026). Patients in the post-COVID group had a significantly worse corrected distance visual acuity at baseline (mean difference MD = –0.35 logMAR, 95% CI, –0.60 to –0.09; p = 0.008), but not at 1 month or at final follow-up. No differences were seen between groups with respect to demographics, lens status, treatment, time to presentation, or chronicity. Pneumatic retinopexy was the most commonly performed procedure in both cohorts, with a 71.5% success rate.
Closures after the COVID-19 pandemic affected the characteristics of RDs at presentation with respect to macular detachment, extent of RD, and presenting visual acuity. At final follow-up, final visual acuity and anatomic outcomes were similar between the 2 groups. These data are helpful for future patient education, triaging, and treatment decision making.
Décrire l'effet de la pandémie de COVID-19 sur les caractéristiques des décollements de la rétine (DR) dans un centre de soins tertiaires.
Étude rétrospective portant sur une série de cas consécutifs.
190 yeux de 188 patients présentant un DR rhegmatogène primitif.
On a comparé, chez des patients qui ont consulté en raison d'un DR sur une période de 1 an (du 14 septembre 2019 au 13 septembre 2020), le lien entre les paramètres démographiques, les caractéristiques anatomiques et l'acuité visuelle avant et après le début de la pandémie au moyen d’équations d'estimation généralisées.
État maculaire et acuité visuelle corrigée de loin au moment de l'examen initial.
187 yeux ont été répartis en 2 cohortes: 100 yeux qui ont été examinés avant la pandémie de COVID-19 (du 14 septembre 2019 au 13 mars 2020 – période pré-COVID) et 87 qui ont été examinés après le début de la pandémie (du 14 mars 2020 au 13 septembre 2020 – période post-COVID). On a observé un décollement maculaire dans 63,2 % des cas (n = 87 yeux) dans le groupe post-COVID, comparativement à 45,0 % des cas (n = 100 yeux) dans le groupe pré-COVID (rapport de cotes RC = 2,14; intervalle de confiance IC à 95 % = 1,19 à 3,86; p = 0,011). De même, les yeux de la cohorte pré-COVID présentaient significativement moins de quadrants décollés lors de l'examen initial (RC = 0,53; IC à 95 % = 0,30 à 0,93; p = 0,026). L'acuité visuelle corrigée de loin des patients du groupe post-COVID était significativement moindre au départ (DM = -0,35 logMAR; IC à 95 % = -0,60 à -0,09; p = 0,008), mais ce n’était plus le cas lors du suivi à 1 mois ou du suivi final. Aucune différence n'a été observée entre les groupes quant aux paramètres démographiques, à l’état du cristallin, au traitement, au moment de l'examen initial et au caractère chronique. Le traitement le plus fréquent dans les 2 cohortes a été la rétinopexie pneumatique, et le taux de réussite s'est élevé à 71,5 %.
La fermeture des services médicaux dans le contexte de la pandémie de COVID-19 a eu des répercussions sur les caractéristiques des DR observées au moment de l'examen initial quant au décollement maculaire, à l'ampleur du DR et à l'acuité visuelle. Au moment de la visite finale, l'acuité visuelle et les résultats anatomiques étaient semblables dans les 2 groupes. Ces données seront utiles pour ce qui est de la sensibilisation des patients, du processus de triage et des décisions thérapeutiques.
Retinopathy of prematurity (ROP) is the most common cause of preventable blindness in preterm infants. First-line treatments include intravitreal bevacizumab (IVB) or laser photocoagulation (LPC).
...The aim of the study was to evaluate neurodevelopmental safety of IVB compared to LPC for ROP.
MEDLINE, Embase, and Cochrane library were searched up to September 2022. Studies were included with at least 12-month follow-up of primary outcomes such as severe neurodevelopmental impairment (sNDI), cerebral palsy (CP), and hearing impairment (HI). Secondary outcomes were moderate-to-severe neurodevelopmental impairment (msNDI), Bayley Scores of Infant Development (BSID-III), and visual impairment.
1,231 patients from 11 comparative studies were included. Quality of evidence was rated low for all outcomes. IVB was associated with a higher risk for sNDI (risk ratio RR = 1.25, 95% confidence interval CI: 1.01, 1.53, p = 0.04); and CP (RR = 1.40, CI: 1.08, 1.81, p = 0.01) compared to LPC. There was no significant difference between IVB and LPC for msNDI (RR = 1.15, CI: 0.98, 1.35, p = 0.08) and HI (RR = 1.43, CI: 0.86, 2.39, p = 0.17). BSID-III percentile scores were similar between IVB and LPC, with weighted mean differences of 1.51 CI = -1.25, 4.27, 2.43 CI = -1.36, 6.22, and 1.97 CI = -1.06, 5.01 for cognitive, language, and motor domains, respectively (p > 0.05).
To our knowledge, this is the largest meta-analysis on neurodevelopmental outcomes and the first to rigorously examine IVB monotherapy in ROP treatment. Compared to LPC, there was a marginally increased risk for sNDI and CP with IVB but little or no difference in the risk of msNDI and HI. Further randomized studies are needed to strengthen these findings.
Background: Intravitreal anti-vascular endothelial growth factor (anti-VEGF) and steroid treatment are both used for macular edema (ME) secondary to retinal vein occlusion (RVO), however a continual ...reevaluation of their comparative efficacy is required. Objectives: This meta-analysis aimed to compare the efficacy and safety of intravitreal anti-VEGF agents and intravitreal steroids for the treatment of ME secondary to RVO. Methods: A systematic literature search was conducted on Ovid MEDLINE, EMBASE, and the Cochrane Controlled Register of Trials for studies published between January 2005 and November 2021. Randomized controlled trials (RCTs) reporting on patients with ME secondary to RVO who were treated with intravitreal steroids or anti-VEGF agents were included. A random effects meta-analysis was performed. Results: 879 eyes from 11 RCTs were included. At the last study observation, intravitreal anti-VEGF agents were associated with a significantly better best corrected visual acuity (WMD = −0.14 logMAR, 95% CI = −0.19, −0.09, p < 0.00001) and lower retinal thickness (WMD = −38.01 µm, 95% CI = −56.17, −19.85, p < 0.0001) relative to intravitreal steroids. Similar findings were found at 3–12 month time points. Intravitreal anti-VEGF agents were associated with a significantly lower incidence of IOP-related adverse events (RR = 0.28, 95% CI = 0.15, 0.51, p < 0.0001), cataract development/progression (RR = 0.22, 95% CI = 0.09, 0.49, p = 0.0003), and conjunctival hemorrhage (RR = 0.52, 95% CI = 0.32, 0.86, p = 0.01). Conclusions: Our meta-analysis found superiority of intravitreal anti-VEGF agents relative to intravitreal steroids for the treatment of ME secondary to RVO with regards to visual acuity, anatomic outcomes, and safety endpoints.
A 93-year-old woman presented with a 1-day history of sudden painless vision loss in her right eye with a background of new temporal headaches and jaw claudication. Dilated fundus examination of the ...right eye showed mild retinal whitening and edema throughout the right fundus with selective sparing in the distribution of the cilioretinal artery. A diagnosis of giant-cell arteritis (GCA) was made and confirmed with temporal artery biopsy. Oral prednisone was initiated and her vision improved to 20/200 in the right eye at 3-month follow-up. GCA-related cilioretinal artery sparing central retinal artery occlusion is rare and may have mild improvement with promt treatment.
This cross-sectional study assesses the accuracy of answers generated by an updated version of a popular chatbot to board certification examination preparation questions.
We reviewed the literature on the efficacy and safety of pars plana vitrectomy (PPV), scleral buckle (SB), and pneumatic retinopexy (PR) for the management of rhegmatogenous retinal detachments ...(RRDs). A systematic search was performed on three databases from inception to September 2020. Randomized controlled trials (RCTs) comparing RRD management options were included. Meta-analysis was performed using a random effects model. Eighteen RCTs and 2,751 eyes were included. For PPV versus SB, early postoperative corrected distance visual acuity (CDVA) favored SB (weighted mean <1 month postoperatively: ~counting fingers for PPV versus ~20/260 for SB, P = 0.02), but differences were nonsignificant at other time points. There was no difference for primary reattachment (P = 0.08). PPV had a lower incidence of choroidal detachment (P = 0.004), hypotony (P = 0.01), and strabismus/diplopia (P = 0.04) but a higher incidence of iatrogenic breaks (P = 0.003) and cataract development/progression (P = 0.05) relative to SB. Combination management was nonsignificantly different relative to PPV alone for CDVA, complications and reattachment rate.
In closing, PPV is associated with a slower visual recovery, but similar final visual acuity and primary reattachment rate relative to SB. Combination procedures did not improve primary reattachment rates or vision relative to standalone PPV. Heterogeneity was seen across the included trials, and further randomized trials are needed to reduce the uncertainty of these estimates.
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