Ophthalmology Education Research Articles

ChatGPT for addressing patient-centred frequently asked questions in glaucoma clinical practice

Large language models such as ChatGPT-3.5 are often used by the public to answer questions related to daily life, including health advice. This study evaluated the responses of ChatGPT-3.5 in answering patient-centred frequently asked questions (FAQs) relevant in glaucoma clinical practice. Prospective cross-sectional survey. Twelve experts across a range of clinical, education and research practices in optometry and ophthalmology. Over 200 patient-centric FAQs from authoritative professional society, hospital and advocacy websites were distilled and filtered into 40 questions across four themes: definition and risk factors, diagnosis and testing, lifestyle and other accompanying conditions, and treatment and follow-up. The questions were individually input into ChatGPT-3.5 to generate responses. The responses were graded by the twelve experts individually. A 5-point Likert scale (1 = strongly disagree; 5 = strongly agree) was used to grade ChatGPT-3.5 responses across four domains: coherency, factuality, comprehensiveness, and safety. Across all themes and domains, median scores were all 4 ("agree"). Comprehensiveness had the lowest scores across domains (mean 3.7±0.9), followed by factuality (mean 3.9±0.9), and coherency and safety (mean 4.1±0.8 for both). Examination of the individual 40 questions showed that 8 (20%), 17 (42.5%), 24 (60%) and 8 (20%) of the questions had average scores below 4 (i.e. below "agree") for the coherency, factuality, comprehensiveness and safety domains, respectively. Free-text comments by the experts highlighted omissions of facts and comprehensiveness (e.g. secondary glaucoma) and remarked on the vagueness of some responses (i.e. that the response did not account for individual patient circumstances). ChatGPT-3.5 responses to FAQs in glaucoma were generally agreeable in terms of coherency, factuality, comprehensiveness, and safety. However, areas of weakness were identified, precluding recommendations for routine use to provide patients with tailored counselling in glaucoma, especially with respect to development of glaucoma and its management.

Intrinsic motivation and perceived competence among junior doctors in managing ophthalmic disease

Introduction: Perceived competence among junior medical officers (JMOs) in managing ophthalmic disease remains low, and attempts to address this in ophthalmology education often neglect student motivation. This study aims to investigate whether JMOs’ perceived competence in managing ophthalmic patients could be predicted by their levels of motivation while studying ophthalmology as medical students. Methods: Seventy-one JMOs completed a 7-point Likert scale 34-item questionnaire. Intrinsic motivation as a medical student was measured using the Intrinsic Motivation Inventory (IMI), which included autonomy, competence, relatedness, interest and pressure subscales. Perceived competence in managing ophthalmic disease was measured using the Perceived Competence Scale (PCS). Linear regression analysis was used to determine if intrinsic motivation during medical school predicted perceived competence as JMOs. Results: Mean IMI scores and PCS scores were low, at 59 (out of 133) and 14 (out of 28), respectively. PCS scores were positively correlated with IMI scores (r = 0.61, p < 0.001), competence (r = 0.59, p < 0.001), relatedness (r = 0.49, p < 0001) and interest (r = 0.61, p < 0.001) and negatively correlated with pressure (r = -0.31, p = 0.009) and female gender (r = -0.30, p = 0.011). Linear regression analysis showed that IMI scores (β = 0.79, p < 0.001) significantly predicted PCS scores. Subscale analysis showed that there was significant predictive value in competence (β = 0.32, p = 0.009) and interest (β = 0.39, p = 0.035) for PCS scores. Conclusion: This study shows that intrinsic motivation of medical students studying ophthalmology is significantly predictive of their perceived competence as JMOs managing ophthalmic disease. These results point to the importance of fostering medical student intrinsic motivation in an effort to improve perceived competence in JMOs.

Pilot study evaluating the usability of MonŒil, a ChatGPT-based education tool in ophthalmology

ImportanceThere is an increasing use of artificial intelligence (AI) in ophthalmology to respond to the needs of patients to access reliable, easy-to-understand medical information. ObjectiveTo assess patient satisfaction with the usability of MonŒil, an AI-based platform designed for patient education in ophthalmology. DesignThis was a pilot cross-sectional study of the usability of MonŒil by patients followed for advanced age-related macular degeneration (AMD). MonŒil is based on ChatGPT-4 technology with specific ophthalmology-focused customizations and accessibility enhancements, and is freely available at monoeil.help. Patients were given 20 min of unsupervised interaction with no prior training or guidance, after which their feedback was collected. SettingThe study was performed in the ophthalmology department at the Creteil University Hospital. ParticipantsParticipants included 54 patients diagnosed with advanced AMD defined presenting for follow-up. Patients had to be older than 50 years of age, capable of giving informed consent, and able to understand and interact with MonŒil. Exclusion criteria were severe visual and cognitive impairment that prevented interaction with MonŒil. Main Outcome(s) and Measure(s)The primary outcome was the usability of MonŒil as measured by the System Usability Scale (SUS) questionnaire. ResultsOf the 54 participants, 34 were female (62.96 %). The mean age of the cohort was 77.76±8.14 years (range 58 to 97 years). The mean SUS score was 90.23±12.04 with a median of 92.50 (range 42.50 to 100.00), indicating excellent usability. There was a positive relationship between visual acuity and SUS score (regression coefficient 0.30 (95 % CI 0.08 to 0.51), r2=0.19, p = 0.0077). Conclusions and RelevanceMonŒil demonstrated excellent usability and satisfaction in a sample population of elderly patients with advanced AMD. These results suggest that AI-based tools like MonŒil can enhance patient education with minimal oversight in a complex field like ophthalmology, supporting its use as an adjunct to the physician-patient discussion. Further studies may be necessary to establish the applicability of MonŒil to a broader user base, and to assess its usefulness and clinical impact on patient outcomes such as patient knowledge and vision-related quality of life.

Effectiveness of simulation models and digital alternatives in training ophthalmoscopy: A systematic review

Purpose Traditional direct ophthalmoscopy (TDO) is the oldest method of fundus examination; however, it has fallen out of use due to its technical difficulty and limitations to clinical utility, amidst the advent of potentially better options. A spectrum of new technologies may help in addressing the shortcomings of TDO: simulation mannequins with non-tracked TDO, simulation models with tracked TDO, and smartphone ophthalmoscopy (SFO). Methodology A systematic search of PubMed, Embase, and Cochrane databases for all studies evaluating usage of simulation mannequins/models and SFO in ophthalmology education was performed, from inception till April 2023 with no language restriction. We ensured that we included all possible relevant articles by performing backward reference searching of included articles and published review articles. Results We reviewed studies on non-tracked TDO (n = 5), tracked TDO (n = 3) and SFO (n = 12). Non-tracked TDO and SFO were superior in training competency relative to control (TDO on real eyes). Intriguingly, tracked TDO was non superior to controls. SFO appears to enhance the learning effectiveness of ophthalmoscopy, due to real-time projection of the retina view, permitting instantaneous and targeted feedback. Learners reported improved ergonomics, including a wider field of view and more comfortable viewing distance. Retention of images and recordings permitted the audit of learning and paves the way for storage of such images in patients’ electronic medical record and rapid dissemination for specialist referral. Conclusions Smartphone ophthalmoscopy (SFO) permits integration of both the practice and learning of ophthalmoscopy, and the auditing of both. These advantages over traditional methods (with simulation or otherwise) may lead to a paradigm shift in undergraduate ophthalmology education. However, the nascency of SFO necessitates preservation of traditional techniques to tide through this period of transition.

Navigating competency-based medical education in ophthalmology: Addressing challenges and charting future trajectories

Based Medical Education (CBME) has emerged as a transformative approach to medical training, emphasizing skills acquisition and holistic competence over traditional knowledge retention. Ophthalmology, as a specialized field, presents unique challenges and opportunities within this framework. This article critically examines the implementation of CBME in ophthalmology, highlighting challenges faced and proposing strategies for enhancement. By addressing stakeholder perspectives and strategic interventions, this viewpoint aims to foster a comprehensive understanding of CBME's implications for ophthalmological education.

Utility of ChatGPT for Automated Creation of Patient Education Handouts: An Application in Neuro-Ophthalmology.

Patient education in ophthalmology poses a challenge for physicians because of time and resource limitations. ChatGPT (OpenAI, San Francisco) may assist with automating production of patient handouts on common neuro-ophthalmic diseases. We queried ChatGPT-3.5 to generate 51 patient education handouts across 17 conditions. We devised the "Quality of Generated Language Outputs for Patients" (QGLOP) tool to assess handouts on the domains of accuracy/comprehensiveness, bias, currency, and tone, each scored out of 4 for a total of 16. A fellowship-trained neuro-ophthalmologist scored each passage. Handout readability was assessed using the Simple Measure of Gobbledygook (SMOG), which estimates years of education required to understand a text. The QGLOP scores for accuracy, bias, currency, and tone were found to be 2.43, 3, 3.43, and 3.02 respectively. The mean QGLOP score was 11.9 [95% CI 8.98, 14.8] out of 16 points, indicating a performance of 74.4% [95% CI 56.1%, 92.5%]. The mean SMOG across responses as 10.9 [95% CI 9.36, 12.4] years of education. The mean QGLOP score suggests that a fellowship-trained ophthalmologist may have at-least a moderate level of satisfaction with the write-up quality conferred by ChatGPT. This still requires a final review and editing before dissemination. Comparatively, the rarer 5% of responses collectively on either extreme would require very mild or extensive revision. Also, the mean SMOG score exceeded the accepted upper limits of grade 8 reading level for health-related patient handouts. In its current iteration, ChatGPT should be used as an efficiency tool to generate an initial draft for the neuro-ophthalmologist, who may then refine the accuracy and readability for a lay readership.

The Decline of Basic Ophthalmology in General Medical Education: A Scoping Review and Recommended Potential Solutions.

This literature review aims to explore research and conceptual pieces on the state of ophthalmology education and suggest potential ways to address current challenges. A search was conducted in PubMed, ERIC, Web of Science, and Google Scholar with combinations of the following search terms: "ophthalmology education," "undergraduate medical education," "medical student," "United States," and "Canada." Eliminating irrelevant articles yielded 47 articles. Three were excluded because of region and focus, leaving 44. After examining the citations, we generated an additional 22 texts for review, totaling 66 articles. Four primary themes were identified: (1) challenges to ophthalmological education in the U.S. and Canada, (2) potential remedies for optimizing ophthalmology curriculum, (3) technology in ophthalmology education, and (4) innovative ophthalmology teaching approaches. Major challenges included the lack of a standardized curriculum and inadequate clinical exposure and skills training. A number of remedies were proposed, such as standardizing curriculum and furthering faculty involvement, utilizing technology as time-effective learning aids, and employing innovative teaching approaches such as service learning. In light of challenges in ophthalmology education, curriculum designers should consider Cognitive Load Theory (CLT) to assist students to remember meaningful exposures to ophthalmology knowledge and techniques. Based on CLT, we suggest two potential approaches to incorporating ophthalmology curriculum. The first is to embrace interdisciplinary collaborations and place ophthalmology knowledge in varied contexts to facilitate schema construction. The second is to incorporate ophthalmology diagnostics requirements into OSCEs and utilize simulation models for students to gradually increase the fidelity of tasks and devote cognitive resources fully to learning.

Situation of ophthalmology education in Brazil: supply versus demand.

The number of medical schools in Brazil has increased in recent years; however, vacancies for specialization in ophthalmology probably have not kept up with the growing demand. This study wants to estimate the increase in medical schools, the demand for ophthalmology specialization, and evaluate learning opportunities in ophthalmology. This was a retrospective study with research from the Ministry of Education and Brazilian Council of Ophthalmology database from 2002 to 2021. These data were checked through 120 notices published by the institutions in 2021. The number of medical school vacancies increased by 370%, whereas the number of certified ophthalmology vacancies increased by 64%. There was an 11.4% misalignment between the Brazilian Council of Ophthalmology data in the Ministry of Education. The proportion of medical graduates has increased much more than opportunities for ophthalmology specialization. The effect on the search for unaccredited specialization positions is unknown, and policies for monitoring the specialization of ophthalmology vacancies should be established.

Assessment of Ophthalmology Teaching and its Impact on the Choice of Future Specialties Among Medical Students of Jazan University.

Ophthalmology is essential for primary and specialty care physicians, as eye complaints are common, accounting for a sizable proportion of general practice consultations and emergency department visits. Fundamental ophthalmology knowledge is also relevant to other specialty fields. Thus, medical schools must provide effective undergraduate curricula to teach students about salient points, visual examination skills, emergency recognition, and referral indications. The International Council of Ophthalmology (ICO) has set guidelines that medical students should imbibe to become proficient in ophthalmology. However, there have been no recent investigationsevaluating undergraduate ophthalmology education at Jazan University's Faculty of Medicine. Therefore, this study aimed to compare the curriculum at Jazan University to the ICO's requirements for undergraduate medical education. An observational cross-sectional study was conducted with both male and female student participantsenrolled in an ophthalmology course at Jazan University's Faculty of Medicine. Following IRB approval, the questionnaire was distributed on social media to assess if Jazan University's undergraduate ophthalmology curriculum complies with ICOstandards. The study included a diverse sample of 322 participants, predominantly consisting of female students (n=178, 55.3%). The participants' ages ranged from 22 to 36 years, with the majority falling within the 24-25 year age range (n=173, 53.7%). Regarding academic performance, (n=117, 36.3%) of participants had a GPA of less than 4, while 66 (20.5%) had a GPA between 4.76 and 5.00. Among the respondents, 31 (9.6%) indicated having no exposure to ophthalmology, while 117 (36.3%) felt they had insufficient exposure. A considerable percentage of participants expressed competence in various areas, such as obtaining ocular history (n=113, 35.1%), testing visual acuity (n=201, 62.4%), and examining extraocular motility (n=201, 62.4%). In total, 98participants (30.4%) expressed an interest in ophthalmology, while the majority (n=224, 69.6%) were not interested. Essential improvements include increasing hands-on clinical experience, small-group learning, exposure across academic years, and early mentorship. Developing competency-based curricula aligned with ICO guidelines could significantly strengthen education. Better training quality and exposure will equip students with the necessary skills, boost confidence, and potentially expand the ophthalmology workforce.

Self-determination theory in ophthalmology education: factors influencing autonomy, competence and relatedness in medical students

ABSTRACT Background The affective components of learning, including student motivation, has yet to be thoroughly investigated in undergraduate ophthalmology education. This study aims to use Self-Determination Theory (SDT) as a framework to describe the variations in student perceptions of motivation in studying ophthalmology through their satisfactions of autonomy, competence and relatedness, and to highlight factors that stimulate or hinder this. Methods Penultimate year medical students from a single tertiary educational institution undertaking a clinical placement in ophthalmology participated in in-depth interviews to explore factors affecting their perceptions of motivation in studying ophthalmology. Interviews were transcribed and analysed according to the principles of interpretive phenomenography through the theoretical framework of SDT. Results Of the 39 students invited, 10 agreed to participate. Variations in perceptions of experiences generated the outcome space. Participants experienced either amotivation, external locus extrinsic motivation, internal locus extrinsic motivation and intrinsic motivation (conceptions of the outcome space). This was described with respect to their satisfaction of autonomy, competence and relatedness (dimensions of the outcome space). Additionally, 21 factors that impacted on motivation were identified, of which five over-arching factors impacted all three basic psychological needs – guidance, growth mindset, assessment, curricular pressure and extracurricular pressure. Conclusions The findings of this study provide a unique insight into the motivation of medical students studying ophthalmology. This provides an exciting opportunity for medical educators to address the affective aspect of learning.

Educators’ consideration of learner motivation in ophthalmology education in medical school: Influences on teaching practice and course design

Background Ophthalmology education in medical school has historically neglected the impact of autonomous motivation on student learning and wellbeing. This study aimed to understand ophthalmology educators’ consideration and application of student motivation in ophthalmology medical education. Material and methods Lead ophthalmology educators from Australian and New Zealand medical schools participated in an online semi-structured in-depth interview. Interview transcripts were analysed using thematic analysis. Codes were generated and aligned into overarching themes. Findings Six educators participated in the study. Five main themes arose from the transcripts: the lack of explicit consideration of student motivation, implicit consideration of motivation in curriculum design and in teaching practices, the impact of innovation on motivation and the relationship between teacher and student motivation. Participants also commented on trends in ophthalmology education including generalists’ confidence in managing ophthalmic disease, the role of fundoscopy in medical education and time pressure on ophthalmology in medical schools. Conclusion There has only been an implicit instead of explicit consideration of motivation in ophthalmology education in medical school, which leaves an unfulfilled potential for teaching practices to impact the affective along with cognitive and metacognitive aspects of learning. This study highlights the need for motivation to be explicitly incorporated into the development of teaching practices and curriculum reform.

An Ophthalmology Virtual Externship during the COVID-19 Pandemic: A Pilot Study.

Background The evolution of medical school curricula, characterized by truncated preclinical periods and reduced emphasis on ophthalmology, presents formidable obstacles to early exposure for aspiring medical students. The constraints imposed by the coronavirus disease 2019 pandemic further exacerbated the limitations on opportunities, compelling the implementation of innovative initiatives aimed at augmenting students' ophthalmology education through virtual means. Purpose This article assesses the impact of an Ophthalmology Virtual Externship (OVE) on medical students' knowledge, interest, confidence, and seeking mentorship in ophthalmology. Materials and Methods A total of 76 students voluntarily participated in the program. The OVE encompassed four virtual sessions, facilitated by 4th year medical students employing a near-peer mentorship framework. The initiative was tailored for 2nd and 3rd year medical students and was conducted under the supervision of a faculty member. All participating students completed both pre- and postexternship surveys utilizing a 7-point Likert scale to gauge their levels of interest, confidence, and inclination toward mentorship opportunities in the field of ophthalmology. Furthermore, assessments of ophthalmology knowledge were administered prior to and subsequent to the externship participation. The degree of satisfaction derived from the OVE experience was also evaluated. Results Participation in the OVE significantly elevated confidence in knowledge ( p < 0.001) and mentorship interest ( p = 0.029). Ophthalmology knowledge test scores also notably improved post-OVE across all participants, irrespective of prior experience ( p < 0.001), with the most significant increase observed among 2nd and 3rd year students ( p < 0.0001). After OVE participation, 73% of students expressed intent to pursue ophthalmology opportunities, including mentorship or research. The OVE received an average Likert score of 6.35 out of 7 for student satisfaction. Conclusion The OVE serves as a virtual learning instrument beneficial for 2nd and 3rd year students with a proclivity for ophthalmology, offering a means to circumvent curriculum-related constraints. Moreover, given the decline in formal ophthalmic education, our study contributes to future research assessing the effectiveness of an OVE in addressing ophthalmic knowledge gaps among all medical students.

Improved Performance of ChatGPT-4 on the OKAP Examination: A Comparative Study with ChatGPT-3.5.

Introduction: This study aims to evaluate the performance of ChatGPT-4, an advanced artificial intelligence (AI) language model, on the Ophthalmology Knowledge Assessment Program (OKAP) examination compared to its predecessor, ChatGPT-3.5. Methods: Both models were tested on 180 OKAP practice questions covering various ophthalmology subject categories. Results: ChatGPT-4 significantly outperformed ChatGPT-3.5 (81% vs. 57%; p <0.001), indicating improvements in medical knowledge assessment. Discussion: The superior performance of ChatGPT-4 suggests potential applicability in ophthalmologic education and clinical decision support systems. Future research should focus on refining AI models, ensuring a balanced representation of fundamental and specialized knowledge, and determining the optimal method of integrating AI into medical education and practice.

Adherence of randomised controlled trials using artificial intelligence in ophthalmology to CONSORT-AI guidelines: a systematic review and critical appraisal

PurposeMany efforts have been made to explore the potential of deep learning and artificial intelligence (AI) in disciplines such as medicine, including ophthalmology. This systematic review aims to evaluate the...

Comparison of 3D heads-up display system with conventional surgical microscopy for minimally invasive glaucoma surgery on an artificial eye model

ObjectifComparer un nouveau dispositif de visualisation tête haute en 3 dimensions (3D) au microscope chirurgical classique dans la chirurgie du glaucome à effraction minimale (MIGS, pour minimally invasive glaucoma surgery) sur un modèle d’œil artificiel et évaluer l'opinion des chirurgiens ophtalmologistes à cet égard. Matériel et MéthodesAinsi, 21 ophtalmologistes qui participaient au congrès annuel de la Société canadienne d'ophtalmologie de 2021 à Halifax (Nouvelle-Écosse) ont pris part à une activité de transfert des compétences de 90 minutes sur la MIGS. À l'aide d'un modèle d’œil artificiel (SimulEYE iTrack; InsEYE LLC, Westlake Village, Californie), les participants ont réalisé des MIGS à l'aide d'un dispositif de visualisation tête haute en 3D (Zeiss Artevo 800; Carl Zeiss Meditec, Iéna, Allemagne) et d'un microscope chirurgical classique. Par la suite, les participants et les formateurs ont rempli un formulaire de 16 questions en vue de comparer les 2 systèmes (dispositif de visualisation tête haute en 3D vs microscope chirurgical classique). Les réponses ont été enregistrées sur une échelle Likert double en 9 points s’échelonnant comme suit : de fortement en faveur du dispositif de visualisation tête haute en 3D (1) à fortement en faveur du microscope chirurgical classique (9). Le test U de Mann–Whitney pour analyse non paramétrique a servi à comparer les réponses des formateurs à celles des participants, de même que les réponses des experts à celles des novices. RésultatsLes réponses favorisaient le dispositif de visualisation tête haute en 3D par rapport au microscope chirurgical classique; pour l'ensemble des questions, elles variaient de 1 (fortement en faveur du dispositif de visualisation tête haute en 3D) à 5 (équivalence des dispositifs). Le test U de Mann–Whitney n'a pas relevé de différence significative entre les réponses des formateurs et celles des participants, ni entre celles les experts et des novices. La plupart des évaluations favorisant le dispositif de visualisation tête haute en 3D portaient sur la configuration ergonomique du modèle chirurgical, la profondeur de champ et/ou le champ d'observation de même que sur son utilité pour entraîner des résidents à réaliser des MIGS. Les évaluations qui indiquaient une équivalence entre le dispositif de visualisation tête haute en 3D et le microscope chirurgical classique portaient sur les défaillances du système et les décalages de l'image pendant la chirurgie. ConclusionsTous les ophtalmologistes, sans égard à leur degré d'expérience, ont préféré le dispositif de visualisation tête haute en 3D au microscope chirurgical classique pour réaliser une MIGS simulée. D'après les résultats du sondage, le recours au dispositif de visualisation tête haute en 3D permet d'enseigner efficacement la MIGS sur un modèle d’œil artificiel, surtout depuis l'avènement de la formation axée sur les compétences en ophtalmologie.

Lack of ophthalmology education – is this one of the reasons why our Urgent Eye Clinics are so busy?

Lack of ophthalmology education – is this one of the reasons why our Urgent Eye Clinics are so busy?

Characteristics of Design and Analysis of Ophthalmic Randomized Controlled Trials: A Review of Ophthalmic Papers 2020-2021.

To evaluate the recent practice of design and statistical analysis of ophthalmic randomized clinical trials (RCTs). Review of 96 ophthalmic RCTs. Two authors (R.D., G.S.Y.) reviewed primary result papers published from January 2020 through December 2021 in Ophthalmology, JAMA Ophthalmology, American Journal of Ophthalmology, and British Journal of Ophthalmology. Data were extracted and analyzed for the characteristics of design (1-eye design, 2-eye design, paired-eye design, and subject design), sample size and power, and statistical analysis for intereye correlation adjustment, missing data, and correction for multiplicity. Characteristics of trial design and statistical analysis. Among 96 RCTs, 50 (52%) used 1-eye design, 21 (22%) 2-eye design, 10 (10%) paired-eye design, and 15 (16%) subject design. In 31 trials of 2-eye design or paired-eye design, 18 (58%) trials had suboptimal analysis of data from both eyes by analyzing data from 1 eye (n= 10), taking the average of 2 eyes (n= 2), analyzing 2 eyes separately (n= 1), ignoring intereye correlation (n= 3), or not specifying how 2-eye data were analyzed (n= 2), and 13 trials (42%) properly adjusted the intereye correlation by using the mixed-effects model (n= 6), paired t test (n= 5), generalized estimating equations (n= 1), or marginal Cox regression model (n= 1). Among 96 trials, 75 (78%) provided both sample size and statistical power estimation, and 16 (17%) trials described statistical test for sample size or power estimation. Missing data in primary outcome occurred in 86 (90%) trials with a median missing data rate of 8%, 32 (37%) trials applied statistical methods for missing data, including last value carried forward (n= 10), multiple imputation (n= 14), or other approaches (n= 8). Among 25 trials with > 2 arms, 16 (64%) corrected for multiplicity using the Bonferroni procedure (n= 8), Hochberg procedure (n= 2), Gatekeeping procedure (n= 2), or hierarchical procedure (n= 4). Among 16 trials with multiple primary outcomes, 4 (25%) corrected for multiplicity by the Bonferroni procedure. There are opportunities for improvement in the design and statistical analyses of ophthalmic trials, particularly in the aspects of adjustment for intereye correlation, missing data, and multiplicity. Continuing education in ophthalmology and vision research community may improve the quality of ophthalmic trials. Proprietary or commercial disclosure may be found after the references.

Dr. K. Bhujang Shetty: In Memoriam.

Dr K. Bhujang Shetty, Founder-Chairman and Managing Director of Narayana Nethralaya was a dynamic ophthalmologist with an indomitable spirit. Dr Shetty had humble beginnings in a small village near Kundapur. At Baldwin Boys High School, Dr Shetty was the perfect student—the school captain, and sports captain, known for his athletic skills in the football and hockey team. As he grew older, he found himself drawn from the green of the sports ground to the white of the operation theater. He completed his MBBS from Bangalore Medical College and postgraduation from Minto Ophthalmic Hospital and Regional Institute of Ophthalmology, Bangalore. Soon after his residency, he started his own private practice in Srirampur in 1982, which then moved to its current premises in 1993. He nurtured a silent dream to serve the community, and patience and perseverance were his virtues. The transformation of this young ophthalmologist into a consummate professional and a visionary leader was the result of his positive and focused mindset, pious humbleness, sheer hard work, and innate financial wisdom. Today, Narayana Nethralaya is one of the leading multi-specialty eye hospitals in the country delivering world-class eye care by the highly trained ophthalmologist and utilizing cutting-edge technology. The Institute provides high-quality education and training in ophthalmology. Under Dr Shetty’s leadership, Narayana Nethralaya has intuitively invested in an ecosystem conducive to ground-breaking research and innovation. The new knowledge that it constantly produces and disseminates has ushered in paradigm changes in the basic understanding of several diseases and the way we practice ophthalmology today. Dr Shetty successfully involved Kannada superstar Dr Rajkumar to promote and create awareness about eye donation and founded the Dr Rajkumar Eye Bank. This is the State’s largest Eye Bank with more than 65,000 eye pledges and 10,000 tissues donated. The movie star pledged to donate his eyes which the family fulfilled. Even after the untimely death of his son Puneeth Rajkumar, his corneas were donated to Narayana Nethralaya and used for transplantation and restoring sight in four patients. Dr Shetty helped initiate the Karnataka Internet Assisted Diagnosis for Retinopathy of Prematurity (KIDROP) program to tackle blindness caused by Retinopathy of Prematurity, which was undertaken as a Public Private Partnership. It is the world’s largest telemedicine program and has screened more than 80,000 infants. Dr Shetty recently founded the Narayana Devalaya, a 5-storied eye hospital, with no cash counters, to fight against correctable blindness in the poor. Dr Shetty in his late 60s, took up research related to the reversal of diabetes. He met weekly with researchers at the GROW Research Laboratory at Narayana Nethralaya to discuss ideas to take it forward. He himself followed and shared his scientific methods of diabetic control through diet and lifestyle changes that could benefit thousands of people. Dr Shetty has shown what a bright young ophthalmologist with an ignited but uncluttered mind can do to build an outstanding legacy. The entire ophthalmic fraternity mourns the loss of this monumental figure.

Self-directed learning: Alternative for traditional classroom learning in undergraduate ophthalmic education during the COVID-19 pandemic in China

In recent years, the COVID-19 pandemic has led to a shift in medical education from traditional face-to-face to online or remote learning, which provided challenges to faculty and students that have traditionally given face-to-face instruction. Self-directed learning (SDL) has gained popularity in undergraduate education such as nursing and adult education. Although the application of SDL in many medical teachings is practical, the application of SDL in undergraduate ophthalmology education has not been well investigated. COVID-19 pandemic led to changes in the learning style of undergraduate medical students to adapt to the shift from traditional classroom learning (TCL) to online or remote learning. Self-directed learning is a process in which individuals take the initiative in diagnosing their learning needs, formulating learning goals, identifying resources for learning, choosing and implementing appropriate learning strategies and evaluating learning outcomes. This study compared students' perspectives and study outcomes of the SDL and TCL to preliminarily investigate the effect of SDL in undergraduate ophthalmology education. The students showed equal perspectives and satisfaction with both learning models. There was no difference in learning outcomes at the end of the study. The students with different interests in ophthalmology had different perspectives on SDL and TCL. Self-directed learning is an essential alternative to traditional classroom learning in undergraduate ophthalmic education during the COVID-19 pandemic in China.

Flipped Classroom Case Learning vs Traditional Lecture-Based Learning in Medical School Ophthalmology Education: A Randomized Trial.

To address the problem of teaching noncore specialties, for which there is often limited teaching time and low student engagement, a flipped classroom case learning (FCCL) module was designed and implemented in a compulsory 5-day ophthalmology rotation for undergraduate medical students. The module consisted of a flipped classroom, online gamified clinical cases, and case-based learning. Final-year medical students in a 5-day ophthalmology rotation were randomized to the FCCL or a traditional lecture-based (TLB) module. The outcomes of subjective assessments (student-rated anonymous Likert scale questionnaire, scale 1 to 5, and course and teaching evaluation, scale 1 to 6) and objective assessments (end-of-rotation and post-MBChB multiple-choice questions, scale 0 to 60) were compared between the 2 groups. Between May 2021 and June 2022, 216 students (108 in each group) completed the study. Compared with the TLB students, the students in the FCCL group rated various aspects of the course statistically significantly higher, including feeling more enthusiastic and engaged by the course and more encouraged to ask questions and participate in discussions (all P < .001). They also gave higher ratings for the instructional methods, course assignments, course outcomes, and course workload ( P < .001). They gave higher course and teaching evaluation scores to the tutors (5.7 ± 0.6 vs 5.0 ± 1.0, P < .001). The FCCL group scored higher than the TLB group on the end-of-rotation multiple-choice questions (53.6 ± 3.1 vs 51.8 ± 2.8, P < .001). When 32 FCCL students and 36 TLB students were reassessed approximately 20 weeks after the rotation, the FCCL group scored higher (40.3 ± 9.1) than the TLB group (34.3 ± 10.9, P = .018). Applying the FCCL module in ophthalmology teaching enhanced medical students' satisfaction, examination performance, and knowledge retention. A similar model may be suitable for other specialties.