American Academy Of Ophthalmology Research Articles

Demographic Trends at the American Academy of Ophthalmology Annual Cornea Subspecialty Day.

The purpose of this study was to identify trends in female representation and years since training completion among speakers and moderators at the American Academy of Ophthalmology (AAO) Annual Cornea Subspecialty Day between 2007 and 2022. Speakers and moderators at each AAO Cornea Subspecialty Day from 2007 to 2022 were sorted by sex and year of training completion. Sex and time from training completion were identified based on the individual's institutional profile or publicly available databases. Five hundred eighty-three speakers and 48 moderators were identified from the AAO Cornea Subspecialty Day meeting archives over 15 years. Overall, women represented 199 (34.1%) speakers and 19 (39.6%) moderators. The proportion of female speakers increased from 10.0% in 2007 to 54.8% in 2022 (P < 0.001). The ratio of female moderators increased from 4 of 21 (19.0%) in 2007 to 2014 to 15 of 27 (55.6%) in 2015 to 2022 (P = 0.017). In years where there were less than 50% female moderators, women represented 26.3% of speakers versus 44.4% of speakers in years with greater than 50% female moderators (P = 0.014). Female speakers were overall earlier in practice than male speakers, with fewer average years since training completion (16.4 ± 1.8 vs. 22.3 ± 2.1 years; P < 0.001). Female representation among speakers and moderators at AAO's Cornea Subspecialty Day increased between 2007 and 2022. Sessions with a majority of female moderators were associated with a higher number of female speakers. Female speakers were generally earlier in their career than male speakers. These trends highlight the overall increases in female representation in academic ophthalmology.

The association between perceived cause of glaucoma and illness perceptions.

The perceived cause of disease is an important factor that has been linked with treatment outcomes but has not been fully assessed in primary open-angle glaucoma (POAG). This study assessed the accuracy of patients' perceived cause of POAG and identified associations between accuracy, illness perceptions, medication adherence, and quality of life (QoL). The Brief Illness Perception Questionnaire (BIPQ) was used to assess illness perceptions and asked patients to rank the three most important causes of their disease in order of importance. POAG risk factors recognized by the American Academy of Ophthalmology were used to code responses as accurate or inaccurate based on the following three methods: (1) coding any reported cause, regardless of rank, (2) coding only the first-ranked cause, and (3) coding and weighting all reported causes. Medication adherence was measured electronically. QoL was measured using the Glaucoma Quality of Life questionnaire. Mann-Whitney U test was used to detect differences in illness perceptions, medication adherence, and QoL between accuracy groups. A total of 97 patients identified a cause of their POAG and were included in this analysis. A higher proportion of patients reported an accurate cause (86.6% using method 1, 78.4% using method 2, and 79.4% using method 3; all p < 0.001). Mean medication adherence was 86.0% ± 17.8 and was similar across accuracy groups (all p > 0.05). Using method 2 (p = 0.045) and method 3 (p = 0.028), patients who reported an accurate cause of their POAG believed that their illness would last for a longer time compared to patients who reported an inaccurate cause. Method 3 also revealed that patients who reported an accurate cause of their POAG had lower perceived understanding of their illness (p = 0.048) compared to patients who reported an inaccurate cause. There were no differences in QoL between accuracy groups (all p > 0.05). This study highlights the association between perceived cause of POAG and illness perceptions related to knowledge level and POAG duration. Future studies should assess associations between perceived cause of disease and other critical dimensions of illness perception.

Outcomes and Complications of Limbal Stem Cell Allograft Transplantation: A Report by the American Academy of Ophthalmology

To review the published literature on the safety and outcomes of keratolimbal allograft (KLAL) transplantation and living-related conjunctival limbal allograft (lr-CLAL) transplantation for bilateral severe/total limbal stem cell deficiency (LSCD). Literature searches were last conducted in the PubMed database in February 2023 and were limited to the English language. They yielded 523 citations; 76 were reviewed in full text, and 21 met the inclusion criteria. Two studies were rated level II, and the remaining 19 studies were rated level III. There were no level I studies. After KLAL surgery, best-corrected visual acuity (BCVA) improved in 42% to 92% of eyes at final follow-up (range, 12-95 months). The BCVA was unchanged in 17% to 39% of eyes and decreased in 8% to 29% of eyes. Two of 14 studies that evaluated the results of KLAL reported a notable decline in visual acuity over time postoperatively. Survival of KLAL was variable, ranging from 21% to 90% at last follow-up (range, 12-95 months) and decreased over time. For patients undergoing lr-CLAL surgery, BCVA improved in 31% to 100% of eyes at final follow-up (range, 16-49 months). Of the 9 studies evaluating lr-CLAL, 4 reported BCVA unchanged in 30% to 39% of patients, and 3 reported a decline in BCVA in 8% to 10% of patients. The survival rate of lr-CLAL ranged from 50% to 100% at final follow-up (range, 16-49 months). The most common complications were postoperative elevation of intraocular pressure, persistent epithelial defects, and acute allograft immune rejections. Given limited options for patients with bilateral LSCD, both KLAL and lr-CLAL are viable choices that may provide improvement of vision and ocular surface findings. The studies trend toward a lower rejection rate and graft failure with lr-CLAL. However, the level and duration of immunosuppression vary widely between the studies and may impact allograft rejections and long-term graft survival. Complications related to immunosuppression are minimal. Repeat surgery may be needed to maintain a viable ocular surface. Reasonable long-term success can be achieved with both KLAL and lr-CLAL with appropriate systemic immunosuppression. Proprietary or commercial disclosure may be found after the references.

Treatment of Noninfectious Uveitic Macular Edema with Periocular and Intraocular Corticosteroid Therapies: A Report by the American Academy of Ophthalmology

To review the evidence on the effectiveness and complications of periocular and intraocular corticosteroid therapies for noninfectious uveitic macular edema. A literature search of the PubMed database was conducted last in December 2021 and a post-assessment search was conducted in March 2023. The searches were limited to articles published in English and no date restrictions were imposed. The combined searches yielded 739 citations; 53 articles were selected for inclusion because the studies (1) evaluated periocular corticosteroid injection, intraocular corticosteroid injection or implant, suprachoroidal corticosteroid injection, or a combination thereof for uveitic macular edema; (2) had outcomes that included visual acuity (VA) or macular edema assessed clinically or imaged by OCT or fluorescein angiography; and (3) included more than 20 patients. This assessment reviewed 23 articles that provided level I or level II evidence from 18 studies on the use of periocular, suprachoroidal, and intravitreal triamcinolone acetonide injections and intravitreal dexamethasone and fluocinolone acetonide implants or inserts in noninfectious uveitic macular edema. These reports consistently demonstrated that all investigated periocular and intraocular corticosteroid therapies improved VA, macular structure, or both. One comparative study showed that intravitreal triamcinolone acetonide injection and the dexamethasone intravitreal implant had effectiveness superior to that of periocular triamcinolone acetonide injection for these outcomes. As a group, the studies highlighted the potential for these therapies to elevate intraocular pressure and to accelerate cataract formation. The published literature provides high-quality evidence that periocular and intraocular corticosteroid therapies are effective and safe for the treatment of noninfectious uveitic macular edema. However, information on the relative effectiveness and complication rates across the different therapies is limited. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Performance of Artificial Intelligence Chatbots on Glaucoma Questions Adapted From Patient Brochures.

Introduction With the potential for artificial intelligence (AI) chatbots to serve as the primary source of glaucoma information to patients, it is essential to characterize the information that chatbots provide such that providers can tailor discussions, anticipate patient concerns, and identify misleading information. Therefore, the purpose of this study was to evaluate glaucoma information from AI chatbots, including ChatGPT-4, Bard, and Bing, by analyzing response accuracy, comprehensiveness, readability, word count, and character count in comparison to each other and glaucoma-related American Academy of Ophthalmology (AAO) patient materials. Methods Section headers from AAO glaucoma-related patient education brochures were adapted into question form and asked five times to each AI chatbot (ChatGPT-4, Bard, and Bing). Two sets of responses from each chatbot were used to evaluate the accuracy of AI chatbot responses and AAO brochure information, and the comprehensiveness of AI chatbot responses compared to the AAO brochure information, scored 1-5 by three independent glaucoma-trained ophthalmologists. Readability (assessed with Flesch-Kincaid Grade Level (FKGL), corresponding to the United States school grade levels), word count, and character count were determined for all chatbot responses and AAO brochure sections. Results Accuracy scores for AAO, ChatGPT, Bing, and Bard were 4.84, 4.26, 4.53, and 3.53, respectively. On direct comparison, AAO was more accurate than ChatGPT (p=0.002), and Bard was the least accurate (Bard versus AAO, p<0.001; Bard versus ChatGPT, p<0.002; Bard versus Bing, p=0.001). ChatGPT had the most comprehensive responses (ChatGPT versus Bing, p<0.001; ChatGPT versusBard p=0.008), with comprehensiveness scores for ChatGPT, Bing, and Bard at 3.32, 2.16, and 2.79, respectively. AAO information and Bard responses were at the most accessible readability levels (AAO versus ChatGPT, AAO versusBing, Bard versusChatGPT, Bard versusBing, all p<0.0001), with readability levels for AAO, ChatGPT, Bing, and Bard at 8.11, 13.01, 11.73, and 7.90, respectively. Bing responses had the lowest word and character count. Conclusion AI chatbot responses varied in accuracy, comprehensiveness, and readability. With accuracy scores and comprehensiveness below that of AAO brochuresand elevated readability levels, AI chatbots require improvements to be a more useful supplementary source of glaucoma information for patients. Physicians must be aware of these limitations such that patients are asked about existing knowledge and questions and are then provided with clarifying and comprehensive information.

Epidemiology of Orbital Inflammatory Disease: An AAO IRIS Registry Study

ABSTRACT Purpose The current study queries the American Academy of Ophthalmology (AAO) Intelligent Research in Sight (IRIS) registry for data on the epidemiology, work-up, and management patterns of autoimmune orbital inflammation. Methods Analysis and description of patient data from the IRIS registry between 2013 and 2019 reviewing patients with autoimmune or idiopathic orbital inflammation with filters based on International Classification of Disease (ICD) and Current Procedural Terminology (CPT) codes. Patients with thyroid eye disease, orbital cellulitis, and orbital abscess were excluded. Main Outcome Measures Demographic descriptions included gender, age, geographic region, and treatment. Sub-analysis was performed by assessing rates of imaging, biopsy, lab work-up, and diagnostic categories. Results In a final cohort of 20,584 patients, the mean age of onset of orbital inflammation was 51.7 years; 67% female; and 63% Caucasian, 21% unknown, 12% Black, 2.6% Asian, and 1.5% other. Only 49 had imaging, 78 had laboratory work-up, and 1,411 had biopsy codes. Treatment results showed 166 patients receiving antibiotics, 224 patients receiving steroids, and 35 patients receiving both. Conclusions This study assessed the epidemiology, diagnostic patterns, and treatment patterns for orbital inflammation through the AAO IRIS registry. Practise patterns suggest a relatively low overall rate of imaging and laboratory studies compared to biopsies, although this certainly under-represents the actual number of imaging and laboratory studies and exemplifies the inherent imprecision of using a large database. However, the methodology of this study provides a framework of approaching the IRIS registry for oculoplastic research.

Dermatologists' and Rheumatologists' Adherence to the Latest Recommendations for Screening of Hydroxychloroquine Retinopathy in Saudi Arabia: A Cross-Sectional Study.

Hydroxychloroquine (HCQ) is used to manage the symptoms of inflammatory rheumatic and dermatologic disorders. However, HCQ retinopathy is aserious side effect becauseeven after the drug is discontinued, irreversible vision loss may occur and may continue to progress.According to the American Academy of Ophthalmology (AAO),the recent recommendation for HCQ dosing is ≤5 mg/kg of real body weight, with baseline ophthalmologic screening during the first year of HCQ treatment and yearly screening after five years of continuous use of HCQ medication, unless the patient is at high risk or symptoms have developed.Nonetheless, this study aims to assess dermatologists' and rheumatologists' adherence in Saudi Arabia to the 2016 AAO HCQ retinal toxicity guidelines. A questionnaire-based cross-sectional study was conducted on dermatologists and rheumatologists in Saudi Arabia. It was conducted between August and September 2022 and questionnaires were sent to dermatologists and rheumatologists via their professional emails or accounts. The collected sample consisted of 635 participants; males and females represented 54% and 46%, respectively; 47.6% were consultants; 50.1% were rheumatologists; and 49.9% were dermatologists. Approximately 28.2% of the participants reported treating one to three patients with HCQ in the previous year. Only 45.4% of the respondents stated that the ideal recommended HCQ dose for reducing the risk of retinopathy is "≤ 5 mg/kg of the real body weight." More than 50% of the respondents stated that systemic lupus erythematosus was the most common disease for which they used HCQ. Additionally, 36.5% of the physicians screened patients during the first year of HCQ treatment. We found significant associations between practice levels and specialty practice-related questions with a p-value of less than 0.05, except for the specialty practice-related question, "What is the most common disease for which you use HCQ?" with a p-value of 0.074. Also, we found significant associations between all demographic variables and screening-related variables with a p-value of less than 0.05, with two exceptions: no significant associations were found between specialty area and the screening-related question, "Do you recommend screening tests for all patients starting treatment with HCQ?" at p = 0.270, and gender and the screening-related question, "When would you recommend screening tests for a patient without risk?" at p = 0.142. Dermatologists and rheumatologists in Saudi Arabia have shown poor adherence to the most recent AAO recommendations. Educating physicians and patients about the AAO guidelines is needed for HCQ to be used in a way that is both effective and safe.

Screening Practices and Late Diagnosis of Hydroxychloroquine Retinopathy in Asian Patients.

To investigate the associations between screening practices and late diagnosis in Asian patients with hydroxychloroquine retinopathy. In total, 92 Korean patients with hydroxychloroquine retinopathy were included and separated into late diagnosis and earlier diagnosis groups according to the retinopathy stage at the time of diagnosis. Details of screening practices regarding timing and modalities for baseline and annual monitoring examinations were compared between the two groups. Adherence to the current American Academy of Ophthalmology (AAO) guidelines was compared between the two groups. Timing of baseline and initial monitoring examinations was appropriate as per the AAO guidelines in only 5.3% of patients with late diagnosis. There were significant differences in the proportions of patients receiving initial monitoring at 5 years of use and those receiving annual monitoring between the late and earlier diagnosis groups (P=0.003 and <0.001, respectively). The duration from the start date of hydroxychloroquine therapy to the first monitoring examination was significantly prolonged in the late diagnosis group (P<0.001). Multivariate logistic regression revealed significant association of the time duration to the first monitoring exam (P=0.042) and age (P=0.028) with late diagnosis. Our results suggest that poor adherence to the AAO guideline, particularly delayed initial monitoring, may be associated with late diagnosis of hydroxychloroquine retinopathy.

NANOS had a Prominent Showing at the American Academy of Ophthalmology.

NANOS had a Prominent Showing at the American Academy of Ophthalmology.

Reliability and accuracy of artificial intelligence ChatGPT in providing information on ophthalmic diseases and management to patients.

To assess the accuracy of ophthalmic information provided by an artificial intelligence chatbot (ChatGPT). Five diseases from 8 subspecialties of Ophthalmology were assessed by ChatGPT version 3.5. Three questions were asked to ChatGPT for each disease: what is x?; how is x diagnosed?; how is x treated? (x = name of the disease). Responses were graded by comparing them to the American Academy of Ophthalmology (AAO) guidelines for patients, with scores ranging from -3 (unvalidated and potentially harmful to a patient's health or well-being if they pursue such a suggestion) to 2 (correct and complete). Accuracy of responses from ChatGPT in response to prompts related to ophthalmic health information in the form of scores on a scale from -3 to 2. Of the 120 questions, 93 (77.5%) scored ≥ 1. 27. (22.5%) scored ≤ -1; among these, 9 (7.5%) obtained a score of -3. The overall median score amongst all subspecialties was 2 for the question "What is x", 1.5 for "How is x diagnosed", and 1 for "How is x treated", though this did not achieve significance by Kruskal-Wallis testing. Despite the positive scores, ChatGPT on its own still provides incomplete, incorrect, and potentially harmful information about common ophthalmic conditions, defined as the recommendation of invasive procedures or other interventions with potential for adverse sequelae which are not supported by the AAO for the disease in question. ChatGPT may be a valuable adjunct to patient education, but currently, it is not sufficient without concomitant human medical supervision.

Patients with floaters: Answers from virtual assistants and large language models.

"Floaters," a common complaint among patients of all ages, was used as a query term because it affects 30% of all people searching for eye care. The American Academy of Ophthalmology website's "floaters" section was used as a source for questions and answers (www.aao.org). Floaters is a visual obstruction that moves with the movement of the eye. They can be associated with retinal detachment, which can lead to vision loss. With the advent of large language model (LLM) chatbots ChatGPT, Bard versus virtual assistants (VA), Google Assistant, and Alexa, we analyzed their responses to "floaters." Using AAO.org, "Public & Patients," and its related subsection, "EyeHealth A-Z": Floaters and Flashes link, we asked four questions: (1) What are floaters? (2) What are flashes? (3) Flashes and Migraines? (4) Floaters and Flashes Treatment? to ChatGPT, Bard, Google Assistant, and Alexa. The American Academy of Ophthalmology (AAO) keywords were identified if they were highlighted. The "Flesch-Kincaid Grade Level" formula approved by the U.S. Department of Education, was used to evaluate the reading comprehension level for the responses. Of the chatbots and virtual assistants, Google Assistant is the only one that uses the term "ophthalmologist." There is no mention of the urgency or emergency nature of floaters. AAO.org shows a lower reading level vs the LLMs and VA (p = .11). The reading comprehension levels of ChatGPT, Bard, Google Assistant, and Alexa are higher (12.3, 9.7, 13.1, 8.1 grade) vs the AAO.org (7.3 grade). There is a higher word count for LLMs vs VA (p < .0286). Currently, ChatGPT, Bard, Google Assistant, and Alexa are similar. Factual information is present but all miss the urgency of the diagnosis of a retinal detachment. Translational relevance: Both the LLM and virtual assistants are free and our patients will use them to obtain "floaters" information. There may be errors of omission with ChatGPT and a lack of urgency to seek a physician's care.

Effects of low-vision rehabilitation on reading speed and depression in age-related macular degeneration: A systematic review and meta-analysis

Age-related macular degeneration (AMD) is a prevalent eye disease, which can lead to vision loss, impacting daily functioning. This study aimed to evaluate the effect of low-vision rehabilitation techniques such as magnifiers, telescopes, and microperimeter feedback, on improving reading speed and reducing depression in AMD patients. This study is a systematic review and meta-analysis. A systematic search of databases MEDLINE (OVID), EMBASE (OVID), and CINHAL (EBSCO), gray literature including ClinicalTrials.gov and ProQuest Dissertations and Theses Global (ProQuest), Conferences of The Association for Research in Vision and Ophthalmology, American Academy of Ophthalmology, and Canadian Ophthalmological Society were done from inception to 27 July 2022. Fixed-effect and random-effect models were applied to account for heterogeneity between studies. Publication bias was checked through funnel plots. A total of 33 studies (2611 subjects) were included;14 studies were included in the meta-analysis (1123 subjects) and 19 were included in the qualitative analysis. We found a non-significant increase in reading speed (effect size [ES] = 0.02, 95% confidence interval [CI] = [−0.18, 0.23]) for studies comparing patients who received no low-vision rehabilitation, versus the intervention group of AMD patients who received low-vision rehabilitation. We also found a significant decrease in reading speed (ES = −0.92, 95% CI = [−1.46, −0.39]) between studies evaluating the difference in reading speed at baseline visits compared to the follow-up visits in AMD patients who received low-vision rehabilitation. Low-vision rehabilitation was also found to result in a decrease in depression severity when compared to control groups, as well as from initial assessment to subsequent follow-up visits. Individuals with AMD who engaged in low-vision rehabilitation demonstrated improved reading speeds compared to their own baseline and to those who did not receive any interventions. Furthermore, these interventions also contributed to a reduction in symptoms of depression.

Toric Monofocal Intraocular Lenses for the Correction of Astigmatism during Cataract Surgery: A Report by the American Academy of Ophthalmology

To review the published literature evaluating the visual and refractive outcomes and rotational stability of eyes implanted with toric monofocal intraocular lenses (IOLs) for the correction of keratometric astigmatism during cataract surgery and to compare those outcomes with outcomes of eyes implanted with nontoric monofocal IOLs and other astigmatism management methods performed during cataract surgery. This assessment was restricted to the toric IOLs available in the United States. A literature search of English-language publications in the PubMed database was last conducted in July 2022. The search identified 906 potentially relevant citations, and after review of the abstracts, 63 were selected for full-text review. Twenty-one studies ultimately were determined to be relevant to the assessment criteria and were selected for inclusion. The panel methodologist assigned each a level of evidence rating; 12 studies were rated level I and 9 studies were rated level II. Eyes implanted with toric IOLs showed excellent postoperative uncorrected distance visual acuity (UCDVA), reduction of postoperative refractive astigmatism, and good rotational stability. Uncorrected distance visual acuity was better and postoperative cylinder was lower with toric IOLs, regardless of manufacturer, when compared with nontoric monofocal IOLs. Correcting pre-existing astigmatism with toric IOLs was more effective and predictable than using corneal relaxing incisions (CRIs), especially in the presence of higher magnitudes of astigmatism. Toric monofocal IOLs are effective in neutralizing pre-existing corneal astigmatism at the time of cataract surgery and result in better UCDVA and significant reductions in postoperative refractive astigmatism compared with nontoric monofocal IOLs. Toric IOLs result in better astigmatic correction than CRIs, particularly at high magnitudes of astigmatism. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Aqueous Shunts with Extraocular Reservoir for Open-Angle Adult Glaucoma: A Report by the American Academy of Ophthalmology

To evaluate the recently published literature on the efficacy and safety of the use of aqueous shunts with extraocular reservoir for the management of adult open-angle glaucomas (OAGs). A search of peer-reviewed literature was last conducted in April 2023 of the PubMed database and included only articles published since the last aqueous shunt Ophthalmic Technology Assessment, which assessed articles published before 2008. The abstracts of these 419 articles were examined, and 58 studies were selected for full-text analysis. After inclusion and exclusion criteria were applied, 28 articles were selected and assigned ratings by the panel methodologist according to the level of evidence. Twenty-five articles were rated level I and 3 articles were rated level II. There were no level III articles. Implantation of aqueous shunts with extraocular reservoir can lower intraocular pressure (IOP) by between one-third and one-half of baseline IOP, depending on whether it is undertaken as the primary or secondary glaucoma surgery. Success rates for aqueous shunts were found to be better than for trabeculectomies in eyes with prior incisional surgery. Conversely, in eyes without prior incisional surgery, implantation of aqueous shunts was found to have an overall lower success rate as the primary glaucoma procedure compared with trabeculectomy. Although both valved and nonvalved aqueous shunts with extraocular reservoir were effective, the nonvalved device generally achieved slightly lower long-term IOPs with fewer glaucoma medications and less need for additional glaucoma surgery. Both devices slow the rates of visual field progression with efficacy comparable with that of trabeculectomy. Early aqueous humor suppression after aqueous shunt implantation is recommended for the management of the postoperative hypertensive phase and long-term IOP control. No strong evidence supports the routine use of mitomycin C with aqueous shunt implantation for OAG. Implantation of aqueous shunts with extraocular reservoir, including valved or nonvalved devices, has been shown to be an effective strategy to lower IOP. Strong level I evidence supports the use of aqueous shunts with extraocular reservoir by clinicians for the management of adult OAG. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Trabecular Procedures Combined with Cataract Surgery for Open-Angle Glaucoma: A Report by the American Academy of Ophthalmology

To determine the intraocular pressure (IOP) reduction of various trabecular procedures (a form of minimally invasive glaucoma surgery [MIGS]) combined with cataract surgery compared with cataract surgery alone, to compare the safety of the various trabecular procedures, and to highlight patient characteristics that may favor one trabecular procedure over another. A search of English-language peer-reviewed literature in the PubMed database was initially conducted in February 2021 and updated in April 2023. This yielded 279 articles. Twenty studies met initial inclusion and exclusion criteria and were assessed for quality by the panel methodologist. Of these, 10 were rated level I, 3 were rated level II, and 7 were rated level III. Only the 10 level I randomized controlled trials (RCTs) were included in this assessment, and all were subject to potential industry-sponsorship bias. The current analysis focuses on the amount of IOP reduction (in studies that involved medication washout) and on IOP reduction with concurrent medication reduction (in studies that did not involve medication washout). Based on studies that performed a medication washout, adding a trabecular procedure to cataract surgery provided an additional 1.6 to 2.3 mmHg IOP reduction in subjects with hypertensive, mild to moderate open-angle glaucoma (OAG) at 2 years over cataract surgery alone, which itself provided approximately 5.4 to 7.6 mmHg IOP reduction. In other words, adding a trabecular procedure provided an additional 3.8% to 8.9% IOP reduction over cataract surgery alone, which itself provided 21% to 28% IOP reduction. There was no clear benefit of one trabecular procedure over another. Patient-specific considerations that can guide procedure selection include uveitis predisposition, bleeding risk, metal allergy, and narrowing of Schlemm's canal. There are no level I data on the efficacy of trabecular procedures in subjects with pretreatment IOP of 21 mmHg or less. Trabecular procedures combined with cataract surgery provide an additional mild IOP reduction over cataract surgery alone in hypertensive OAG subjects. Additional research should standardize outcome definitions, avoid industry sponsorship bias, and study the efficacy of these procedures in normotensive OAG. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Central Visual Field Testing in Early Glaucoma: A Report by the American Academy of Ophthalmology

To evaluate the current published literature on the utility of the 10-2 visual field (VF) testing strategy for the evaluation and management of early glaucoma, defined here as mean deviation (MD) better than -6 decibels (dB). A search of the peer-reviewed literature was last conducted in June 2023 in the PubMed database. Abstracts of 986 articles were examined to exclude reviews and non-English-language articles. After inclusion and exclusion criteria were applied, 26 articles were selected, and the panel methodologist rated them for strength of evidence. Thirteen articles were rated level I, and 8 articles were rated level II. The 5 level III articles were excluded. Data from the 21 included articles were abstracted and reviewed. The central 12 locations on the 24-2 VF test grid lie within the central 10 degrees covered by the 10-2 VF test. In early glaucoma, defects detected within the central 10 degrees generally agree between the 2 tests. Defects within the central 10 degrees of the 24-2 VF test can predict defects on the 10-2 VF test, although the 24-2 may miss defects detected on the 10-2 VF test. In addition, results from the 10-2 VF test show better association with findings from OCT scans of the macular ganglion cell complex. Modifications of the 24-2 test that include extra test locations within the central 10 degrees improve detection of central defects found on 10-2 VF testing. Evidence to date does not support routine testing using 10-2 VF for patients with early glaucoma. However, early 10-2 VF testing may provide sufficient additional information for some patients, particularly those with a repeatabledefect within the central 12 locations of the standard 24-2 VF test or who have inner retinal layer thinning on OCT scans of the macula. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

A Survey of Ophthalmologists in 52 Cities in the Southern United States

Background: The United States (US) supply of surgical specialty practitioners in 2025 is projected to fall short by 24,340 physician full-time equivalents. The greatest deficit is projected for ophthalmology with the most affected region noted to be the southern US. Aims: To better understand the distribution of our ophthalmology workforce in the southern US and to identify cities with less access to subspecialty-specific vision care. Objective: To determine the prevalence of ophthalmologists as well as rates of ophthalmology subspecialists and practice types in the three largest cities of each state within the southern US. Methods: The American Academy of Ophthalmology’s “Find an Ophthalmologist” online listing was queried on a city-by-city basis from December 2020 to April 2021. The number and location of ophthalmologists were determined in the three largest cities, according to population, in the southern US. Data collected on each ophthalmologist included sex, primary subspecialty, practice type, year of first board certification, and academic affiliation. Results: There were 1,735 total ophthalmologists identified in the three largest cities of each state, 52 cities in total, within the southern US. The majority were male (n= 1,369, 78.90%) and board-certified prior to or during 1997 (n= 913, 52.62%). There were 12,308 persons per ophthalmologist (P/O) in the southern US. Cities with the highest P/O ratio were Rio Rancho, NM (101,475 P/O), Southaven, MS (28,691 P/O), and Houston, TX (27,868 P/O). The lowest P/O ratios included Morgantown, WV (1,587 P/O), Charleston, WV (2,263 P/O), and Wilmington, DE (3,025 P/O). Less populated cities (&lt;300,000 persons) had a significantly higher proportion of comprehensive ophthalmologists in the southern US (p-value=0.007). Conclusion: A total of 550 ophthalmologists were evaluated in southwestern cities and 1,185 were evaluated in southeastern cities. Our results suggest that less populated cities are driven by comprehensive ophthalmology practices. This data suggests greater vulnerability in certain cities with less access to subspecialty-specific vision care.

213. Do Patients with Candidemia Need an Ophthalmology Exam?

Abstract Background Candidemia can lead to hematogenous seeding of the eye resulting in chorioretinitis or endophthalmitis. IDSA recommends a screening dilated retinal examination for patients with candidemia, whilst American Academy of Ophthalmology (AAO) recently declared this a low value practice. Using an inter-disciplinary team, we evaluated ophthalmology examination for patients with candidemia. Methods We performed a retrospective study of patients with candidemia at an academic medical center and affiliated hospitals between January 2011 – June 2022. Electronic medical records were reviewed for demographics and baseline characteristics. The primary outcome was chorioretinitis and/or endophthalmitis. The study was adjudicated by independent review from infectious disease and ophthalmology providers. Results We included 308 patients with a blood culture positive for candida species. 149 patients (48%) received an ophthalmologic exam, of which 55% (82) were asymptomatic. Abnormal ocular findings concerning for presumed ocular candida complications were found in 12 patients (8%, 12/149), of which 4 had alternative diagnoses to candida choriorentinits or endophthalmitis. All of the remaining 8 patients (5%, 8/149) had presumed candida chorioretinitis with no cases of candida endophthalmitis and this led to a change in management in 88% (7/8) of patients (Table 1). Of the 8 patients, 3 patients were asymptomatic, making the number needed to screen 28 to detect presumed candida chorioretinitis amongst asymptomatic patients. We did not identify statistically significant risk factors for development of abnormal ocular findings (Table 2). Table 1 Clinical diagnosis and management of patients with candida chorioretinitis and/or endophthalmitis Table 2 Clinical features of patients with and without ocular candidiasis Conclusion IDSA and AAO recommend ophthalmologic examination in symptomatic and intubated patients with candidemia. We found a 5% incidence of presumed ocular candidiasis in patients with candidemia. Given the limitations of our study, we could not conclude for or against screening in asymptomatic patients as this did not lead to a significant change in patient outcomes. Inter-disciplinary decisions involving ophthalmology and infectious diseases can help inform best practices for screening in asymptomatic patients. Future studies should evaluate ocular photography and teleophthalmology as screening strategies. Disclosures All Authors: No reported disclosures

ChatGPT: is it good for our glaucoma patients?

PurposeOur study investigates ChatGPT and its ability to communicate with glaucoma patients.MethodsWe inputted eight glaucoma-related questions/topics found on the American Academy of Ophthalmology (AAO)’s website into ChatGPT. We used the Flesch–Kincaid test, Gunning Fog Index, SMOG Index, and Dale–Chall readability formula to evaluate the comprehensibility of its responses for patients. ChatGPT’s answers were compared with those found on the AAO’s website.ResultsChatGPT’s responses required reading comprehension of a higher grade level (average = grade 12.5 ± 1.6) than that of the text on the AAO’s website (average = 9.4 grade ± 3.5), (0.0384). For the eight responses, the key ophthalmic terms appeared 34 out of 86 times in the ChatGPT responses vs. 86 out of 86 times in the text on the AAO’s website. The term “eye doctor” appeared once in the ChatGPT text, but the formal term “ophthalmologist” did not appear. The term “ophthalmologist” appears 26 times on the AAO’s website. The word counts of the answers produced by ChatGPT and those on the AAO’s website were similar (p = 0.571), with phrases of a homogenous length.ConclusionChatGPT trains on the texts, phrases, and algorithms inputted by software engineers. As ophthalmologists, through our websites and journals, we should consider encoding the phrase “see an ophthalmologist”. Our medical assistants should sit with patients during their appointments to ensure that the text is accurate and that they fully comprehend its meaning. ChatGPT is effective for providing general information such as definitions or potential treatment options for glaucoma. However, ChatGPT has a tendency toward repetitive answers and, due to their elevated readability scores, these could be too difficult for a patient to read.

Prevalence and Risk Factors of Blindness Among Primary Angle Closure Glaucoma Patients in the United States: An IRIS Registry Analysis

PurposeTo assess the prevalence and risk factors of blindness among patients newly diagnosed with primary angle closure glaucoma (PACG) in the United States (US). DesignRetrospective cross-sectional study. MethodsEligible patients from the American Academy of Ophthalmology (AAO) IRIS® Registry (Intelligent Research in Sight) had newly diagnosed PACG, defined as: 1) observable during a 24-month lookback period from index date of PACG diagnosis; 2) no prior history of eye drops, laser, or cataract surgery unless preceded by a diagnosis of anatomical narrow angle (ANA); 3) no prior history of glaucoma surgery. Logistic regression models were developed to identify risk factors for any (one or both eyes) or bilateral (both eyes) blindness (visual acuity ≤ 20/200) at first diagnosis of PACG. ResultsAmong 43,901 eligible patients, overall prevalence of any and bilateral blindness were 11.5% and 1.8%, respectively. Black and Hispanic patients were at higher risk of any (OR=1.42 and 1.21, respectively; p<0.001) and bilateral (OR=2.04 and 1.53, respectively; p<0.001) blindness compared to non-Hispanic White patients adjusted for ocular comorbidities. Age <50 or >80 years, male sex, Medicaid or Medicare insurance product, and Southern or Western practice region also conferred higher risk of blindness (OR>1.28; p≤0.01). Conclusions and RelevanceBlindness affects 1 out of 9 patients with newly diagnosed PACG in the IRIS® Registry. Black and Hispanic patients and Medicaid and Medicare recipients are at significantly higher risk. These findings highlight the severe ocular morbidity among PACG patients and the need for improved disease awareness and detection methods.