Ophthalmology Practice Research Articles

Vision language models in ophthalmology.

Vision Language Models are an emerging paradigm in artificial intelligence that offers the potential to natively analyze both image and textual data simultaneously, within a single model. The fusion of these two modalities is of particular relevance to ophthalmology, which has historically involved specialized imaging techniques such as angiography, optical coherence tomography, and fundus photography, while also interfacing with electronic health records that include free text descriptions. This review then surveys the fast-evolving field of Vision Language Models as they apply to current ophthalmologic research and practice. Although models incorporating both image and text data have a long provenance in ophthalmology, effective multimodal Vision Language Models are a recent development exploiting advances in technologies such as transformer and autoencoder models. Vision Language Models offer the potential to assist and streamline the existing clinical workflow in ophthalmology, whether previsit, during, or post-visit. There are, however, also important challenges to be overcome, particularly regarding patient privacy and explainability of model recommendations.

Research Trends and Hotspots of Big Data in Ophthalmology: A Bibliometric Analysis and Visualization

ABSTRACT Purpose The burst of modern information has significantly promoted the development of global medicine into a new era of big data healthcare. Ophthalmology is one of the most prominent medical specialties driven by big data analytics. This study aimed to describe the development status and research hotspots of big data in ophthalmology. Methods English articles and reviews related to big data in ophthalmology published from January 1, 1999, to April 30, 2024, were retrieved from the Web of Science Core Collection. The relevant information was analyzed and visualized using VOSviewer and CiteSpace software. Results A total of 406 qualified documents were included in the analysis. The annual number of publications on big data in ophthalmology reached a rapidly increasing stage since 2019. The United States (n = 147) led in the number of publications, followed by India (n = 77) and China (n = 69). The L.V. Prasad Eye Institute in India was the most productive institution (n = 50), and Anthony Vipin Das was the most influential author with the most relevant literature (n = 45). The electronic medical records were the primary source of ophthalmic big data, and artificial intelligence served as the principal analytics tool. Diabetic retinopathy, glaucoma, and myopia are currently the main topics of interest in this field. Conclusions The application of big data in ophthalmology has experienced rapid growth in recent years. Big data is expected to play an increasingly significant role in shaping the future of research and clinical practice in ophthalmology.

Adopting Interventional Glaucoma Via Sustained-Release Therapies: The Wide-Ranging Impact of Procedural Pharmaceuticals in Ophthalmology.

Topical medical therapy is the most common approach to the treatment of many ocular conditions. While effective, topical therapy has numerous important limitations. Eye drops can have unpleasant or even dangerous side effects, are often difficult to self-administer, and the application of multiple drops per day, possibly from multiple different bottles, can be burdensome. Perhaps the most important limitation of topical medical therapy is non-adherence, a complex multifactorial behavior that increases the risk of poor outcomes associated with undertreatment. There is growing interest in a class of therapeutics termed "procedural pharmaceuticals" (PPs), which remove the responsibility of self-dosing from patients. An array of PPs are available for the treatment of a variety of ocular conditions, such as those for glaucoma, retina, and cataract surgery; and many more will emerge in coming years. A paradigm shift away from patient-administered therapy toward provider-administered therapy will have important implications for both providers and patients. This paper explores the impact that PPs have had, and will have, on the clinical practice of ophthalmology.

Neuroimaging in Optic Neuropathies

Optic neuropathy is a frequent cause of vision loss encountered during routine ophthalmology practice. While some of the cases can be easily diagnosed due to symptoms and examination findings, a significant group of them require neuroimaging tests for differential diagnosis. Imaging examinations such as magnetic resonance imaging, computed tomography, doppler ultrasonography, magnetic resonance, and computed tomography angiography provide valuable clues in differential diagnosis when used in appropriate clinical scenarios.

Assessing Private Equity Involvement in Ophthalmology: Parallels with the Past, Concerns for the Future

PurposeTo discuss the history and current state of private equity in ophthalmology and explore potential implications for ophthalmology practices, physicians, and patients. DesignPerspective. MethodsReview of selected articles in ophthalmology and non-ophthalmology medical literature and commentary based on the authors’ experiences. ResultsInvestment in ophthalmology appeals to private equity firms because of high procedural volumes, fragmented private practices, opportunities for real estate ownership, and an aging population in need of eye care. As a result, acquisition of private practices by large private equity companies has swelled since 2015. Metropolitan areas and practices that possess ambulatory surgical centers or a high proportion of retina surgeons receive the greatest investment. However, little objective data exists regarding the benefits of this trend. Initial research suggests that private equity ownership may negatively impact patient care through greater costs, shorter appointments, and fewer Medicare/Medicaid patients seen. Skeptics of private equity also highlight concerns that include financial risk falling primarily on the acquired practice itself, a short-term business approach that rewards profit maximization, and the erosion of physician autonomy. Furthermore, young ophthalmologists express reservations about working for private equity firms. 78% of trainees indicated they would not consider employment by a private equity owned practice and 81.4% of vitreoretinal fellows voiced concerns about autonomy and job security. Proposed legislation aimed at limiting private equity acquisitions is currently under review at the statewide level, adding additional uncertainty to the future of private equity involvement in ophthalmology. ConclusionAlthough investment by private equity offers potential financial rewards and operational improvements for practices, it also raises significant concerns reminiscent of those experienced by physician practice management companies in the 1990s. Nonanecdotal data is needed to assess the benefits and future of private equity involvement in ophthalmology.

Reconstruction of deep and perforating corneal defects in dogs-A review (Part II/III): Biomaterials and keratoprosthesis.

The surgical reconstruction of severe corneal ulcers is a common and crucial component of the clinical practice of veterinary ophthalmology. Numerous surgical techniques are used in dogs for corneal reconstruction, and these techniques may be categorized by the material used to repair the corneal lesion. The first part of the present review described procedures that utilize autogenous ocular tissues, homologous donor tissues, and heterologous donor tissues. In this second part of the review, the categories of biomaterials and keratoprosthetics will be summarized. Biomaterials that are reported for use in dogs include amniotic membrane, porcine urinary bladder acellular matrix, porcine small intestinal submucosa, acellular porcine corneal stroma, and other miscellaneous soft tissue and cartilage grafts (e.g., preserved equine renal capsule, autologous omentum, autologous buccal mucosa membrane, bovine pericardium, and homologous peritoneum). Descriptions of keratoprosthesis surgery in dogs are currently limited, but the use of artificial corneal transplants hold promise for dogs with severe, vision-compromising corneal disease that is not amenable to other reconstruction techniques. This review describes the results of experimental studies evaluating these graft materials in dogs, and it will summarize the findings and outcomes of the clinical articles published in each material category. Reporting inconsistencies and areas where additional research is required will be highlighted to help guide future studies in this area. A major aim of this review is to help identify potential subjects that could be evaluated in future investigations and that might lead to refinements in clinical practice.

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.

Reconstruction of deep and perforating corneal defects in dogs-A review (Part III/III): The use of corneal sutures and reporting of ocular discomfort.

The surgical reconstruction of severe corneal disease is a common and crucial component of the clinical practice of veterinary ophthalmology. The first part of the present review described procedures that utilize autogenous ocular tissues, homologous donor tissues, and heterologous donor tissues in dogs, while the second part reviewed the use of biomaterials and keratoprosthetics in this species. This third part is dedicated to the review of the use of corneal sutures including suture type and suture pattern in corneal reconstruction of small animals including dogs and cats. The review also focused on the way studies report postoperative ocular discomfort/pain and how this is treated. Lastly, the author briefly presents the simple but effective techniques available to bury corneal knots for corneal reconstructive surgery in small animal patients, such as the "tugging" and "deep-superficial-superficial-deep" methods for simple interrupted sutures, and the adaptation of the latter for simple continuous sutures.

Ophthalmologic Symptoms and Practice Patterns in Children and Young Adults in the NAPRTCS Cystinosis Registry

Ophthalmologic Symptoms and Practice Patterns in Children and Young Adults in the NAPRTCS Cystinosis Registry

Review of Guideline Recommendations for Optimal Anti-VEGF Therapy in Age-Related Macular Degeneration.

Neovascular age-related macular degeneration is a progressive, blinding macular disease that has become a burden both in healthcare systems and the global economy. The vascular endothelial growth factor (VEGF) is the main agent involved in the pathogenic process of the disease. The main goal of the age-related macular degeneration treatment is to maintain and improve visual acuity by injecting intravitreal anti-VEGF agents in either a reactive or proactive manner. Subretinal and intraretinal fluids are the main biomarkers that should be considered when managing the frequency of the therapy. This review discusses both functional and morphological treatment criteria according to current recommendations as opposed to real-life situations encountered during day-to-day clinical practice and highlights situations in which the benefits of continuing therapy are arguable in terms of improving patients' quality of life. Optimizing the treatment regimen represents an important aim of current clinical ophthalmological practice, as age-related macular degeneration patients usually have a long follow-up period.

Sturge-Weber Syndrome: a case report

Sturge-Weber syndrome is a rare congenital, non-familial sporadic condition also known as encephalotrigeminal angiomatosis, is a phakomatoses consisting of neurological, skin and ocular manifestations. Symptoms reported varies in severity and age of onset but it is commonly detected in infancy. The Ophthalmic feature of this disease consists of glaucoma and is also associated with vascular manifestation of the conjunctiva, epi-sclera, choroid and retina. In the present case, a 19-year-old male presented with a port wine stain on the right side of the face, leptomeningeal angioma, ocular hypertension, temporal hemianopia of the left eye and choroidal hemangioma with macular scar of the right eye, seizure and weakness of the left side of the body. The purpose of presenting the case is to illustrate both the characteristic presentation and to underline the importance of its diagnosis in the clinical ophthalmological practice. BIRDEM Med J 2024; 14(3): 166-169

Application of Artificial Intelligence in Ophthalmology: An Updated Comprehensive Review.

Artificial intelligence (AI) holds immense promise for transforming ophthalmic care through automated screening, precision diagnostics, and optimized treatment planning. This paper reviews recent advances and challenges in applying AI techniques such as machine learning and deep learning to major eye diseases. In diabetic retinopathy, AI algorithms analyze retinal images to accurately identify lesions, which helps clinicians in ophthalmology practice. Systems like IDx-DR (IDx Technologies Inc, USA) are FDA-approved for autonomous detection of referable diabetic retinopathy. For glaucoma, deep learning models assess optic nerve head morphology in fundus photographs to detect damage. In age-related macular degeneration, AI can quantify drusen and diagnose disease severity from both color fundus and optical coherence tomography images. AI has also been used in screening for retinopathy of prematurity, keratoconus, and dry eye disease. Beyond screening, AI can aid treatment decisions by forecasting disease progression and anti-VEGF response. However, potential limitations such as the quality and diversity of training data, lack of rigorous clinical validation, and challenges in regulatory approval and clinician trust must be addressed for the widespread adoption of AI. Two other significant hurdles include the integration of AI into existing clinical workflows and ensuring transparency in AI decision-making processes. With continued research to address these limitations, AI promises to enable earlier diagnosis, optimized resource allocation, personalized treatment, and improved patient outcomes. Besides, synergistic human-AI systems could set a new standard for evidence-based, precise ophthalmic care.

Commercial Versus Compounded Preparations in Pediatric Ophthalmology.

Many conditions managed by pediatric ophthalmologists are rare diseases, and even if pharmacological treatments are available, these have often not been evaluated in children. Off-label prescribing is a common practice in pediatric ophthalmology. In addition, there is often no commercial case for the production of a medicine that may only be used for a small number of patients worldwide. Compounded preparations prepared locally are therefore still in frequent use, although it is known that production may not meet stringent quality assurance standards. For several indications, commercial preparations, evaluated in rigorous clinical trials with children, are now available. Myopia management is joining the list of these indications, with low-concentration atropine formulations derived from recent clinical trials in Australia, USA, and Europe now entering the market. This short article gives an overview of the background and recent developments of compounded and commercial preparations for use in pediatric ophthalmology.

Systematic Literature Reviews Comparing the Long-Term Safety Outcomes for the Port Delivery System with Ranibizumab (PDS) Versus Other Ocular Implants.

To determine whether the types and rates of post-surgical complications associated with the Port Delivery System with ranibizumab (PDS) are comparable with those reported for other ocular implants that cross the sclera. Systematic literature reviews were conducted to determine the long-term (≥ 18-month) safety of ocular implants that cross the sclera in clinical trials and real-world studies. Complication types and rates were compared with those reported for the PDS in phase III clinical trials (Archway, Pagoda, and Pavilion). Sixteen clinical trials (24 publications) and 43 real-world studies were identified reporting 30 complications in eyes with 15 implant types and 8 ocular diseases. Implants were associated with an acceptable, well-characterized safety profile, with most complications resolving spontaneously or with treatment. Device-related complications were reported in 0.7% (0.0-5.0%) of study eyes in clinical trials and 1.3% (0.0-14.5%) of eyes in real-world studies. Rates of conjunctival complications were 2.1% (0.0-22.8%) and 2.2% (0.9-4.6%), respectively. The overall types and rates of adverse events of special interest reported for the PDS in phase III trials (cataract, conjunctival bleb, vitreous hemorrhage, conjunctival erosion, conjunctival retraction, endophthalmitis, implant dislocation, retinal detachment, and hyphema) were within the ranges reported for other ocular implants. The rates of complications reported in phase III clinical trials for the PDS were within the ranges reported for other ocular implants that cross the sclera. This suggests that the long-term safety of the PDS is consistent with other ocular devices established in ophthalmology clinical practice. PROSPERO international prospective register of systematic reviews: CRD5202234129, CRD42022343129.

Objective Refraction Status before and after Cycloplegia: From Childhood to Young Adulthood.

This study aimed to evaluate the clinical information revealed after cycloplegia and assess how age and non-cycloplegic refractive status influence the classification of types of refractive error, as well as the relationship between age and cycloplegia-induced changes in the power of refractive errors. We analysed the records of 472 non-population-based ophthalmology practice patients aged 3-28 years (mean ± SD: 9.1 ± 4.6). Cycloplegia was induced with one drop of cyclopentolate 1% in each eye, and eye refraction was measured 30 ± 5 min later using an objective autorefractometer. Cycloplegia induced a clinically significant (≥0.50 D) hyperopic shift in the spherical equivalent of 60.2% of participants and a myopic shift in 1%, resulting in a 34.1% increase in the frequency of participants with hyperopia, while the frequency of those with myopia and emmetropia decreased by 5.5% and 23.3%, respectively. The average spherical equivalent difference (mean ± SD) induced by cycloplegia was 0.72 ± 0.73 D, with the highest difference observed in the 3-5 years age group (1.18 ± 0.85 D). The differences in astigmatism power (p = 0.84) and astigmatism axis (p = 0.97) between non-cycloplegic and cycloplegic conditions were not statistically significant.

Role of optical coherence tomography angiography in retinal tumors: A narrative review.

Intraocular tumors constitute a small subset of cases in ophthalmologic practice. Proper diagnosis of intraocular tumors is crucial because some pose threat to vision and life, while others may indicate underlying systemic disorders. Intraocular tumors comprise benign and malignant lesions affecting the retina, choroid, optic disc, iris, and ciliary body. Retinal tumors can be classified as vascular, neural, glial, and retinal pigment epithelial tumors. Optical coherence tomography angiography (OCTA) is a noninvasive imaging modality employed in diagnosis and management of retinal and choroidal vascular diseases, and has enhanced our knowledge in better understanding of the vascular physiology and pathology. Multiple case reports and small series evaluating the role of OCTA in retinal tumors are published in literature. OCTA helps in better understanding of the vascularity of intraocular tumors. In addition to this, OCTA has its role in clinical practice. It helps in identification of small retinal capillary hemangioblastoma (RCH), assessment of treatment response, and identification of tumor recurrence in RCH. It aids in identification of retinal astrocytic hamartoma missed on clinical examination and differentiating retinal astrocytic hamartoma and presumed solitary circumscribed retinal astrocytic proliferation. It helps in assessment of risk of tumor recurrence in retinoblastoma. It helps in differentiating tumors of retinal pigment epithelium (RPE) origin from pigmented tumors of the choroid. It also helps in detection of choroidal neovascular membrane in combined hamartoma of the retina and RPE.

Response to "Telemedicine at a University Ophthalmology Practice During the Beginning of the COVID-19 Pandemic" [Letter

Response to "Telemedicine at a University Ophthalmology Practice During the Beginning of the COVID-19 Pandemic" [Letter

Telemedicine at a University Ophthalmology Practice During the Beginning of the COVID-19 Pandemic.

The aim of the research was to evaluate the use of teleophthalmology at a university practice during the COVID-19 pandemic, specifically examining precision, effectiveness, and patient satisfaction. Telemedicine visits were offered to new and established patients requesting appointments with the Stony Brook University Department of Ophthalmology between March 30 and June 2, 2020. Records from these visits were reviewed for chief complaint, past medical and ocular history, diagnoses, treatment/management, and providers' sub-specialty. Precision was determined by comparing agreement between diagnoses of the telemedicine visit with those of the subsequent in-person visit. The decision to follow up in person was made by the physician and patient. Diagnostic precision as well as progression, improvement, or stability of patients' symptoms were determined by the physician's assessment at follow-up visits. Post-telemedicine visit satisfaction surveys were sent to all patients. Telemedicine visits were offered to 783 patients, 520 (66.4%) of whom accepted. Of these 520 patients, 409 (78.7%) were established and 105 (20.2%) had in-person, follow-up visits. Overall, the diagnostic precision of the follow-up visits was 89.5%. Precision differed significantly across ophthalmologic subspecialties. Of the patients who had in-person follow-up visits, 56.8% remained stable, 32.4% improved, and 10.8% worsened. Established patients presented with more extensive ocular histories/procedures and experienced a higher percentage of worsening symptoms/disease stage compared to new patients. Oculoplastics/orbit was the most prevalent diagnostic subspecialty that worsened. Surveys were sent to all patients completing telemedicine visits, 15.0% of whom responded. Overall satisfaction was 91.9%, although only 23.0% of respondents preferred telemedicine to an in-office visit. Telehealth provides high levels of precision and patient satisfaction for a wide range of ophthalmologic visits, although most patients still prefer in-office examinations. Employing teleophthalmology for follow-up and emergency care may provide patients with an effective alternative during pandemic situations and beyond.

Epidemiology of Field of Vision Disorders (eFOVID) study, Western Australia, 1988-2022. Report 1: Data collection and aggregation protocol.

Computerised static visual field testing using dedicated machines such as the Humphrey Field Analyzer (HFA) can assess and track changes in visual field sensitivity. The use of retrospective visual field databases is a novel undertaking, with no studies published utilising large scale population-level data. This study phase developed a method to extract HFA data into a large standardised population-based database including point sensitivity data with additional derived variables. Retrospective, longitudinal, population study of visual field data from people who attended an ophthalmology service and had a HFA field test, in Western Australia, between 1988 and 2022. Raw test data included patient demographic fields, sensitivity readings and test parameters. Calculated fields included reliability scores, and a novel combined reliability score. There were 606 230 tests for 92 215 study individuals, from 22 ophthalmology practices in metropolitan Perth and three public hospital eye clinics, representing around 85% of the field tests performed by ophthalmologists each year. Raw sensitivity values were available for all tests, and additional descriptors were available for most tests (97.5%-100% of tests) with the exception of data variables retired by the manufacturer. Visual field data from 606 230 tests were collated into a single dataset, which is highly representative over a long period of time, for a defined population. This dataset has been linked to other administrative datasets to allow for epidemiological investigation of field of vision disorders.

The carbon footprint of French hospital ophthalmology consultations.

France carbon footprint, with 604 million tons of CO2 equivalent (CO2eq) annual emissions, far exceeds the worldwide scientific specifications to not exceed 2 °C of warming in 2100. The healthcare sector is one of the biggest contributors to greenhouse gas emissions. The aim of this study is to quantify and evaluate the carbon footprint of the consultation activity of an ophthalmology department at a single institution in France. The perimeter of the investigation included consultations and excluded the surgeries and the hospitalisation. We calculated the carbon footprint of a single day of practice in our scope of investigation. We included consumption of energy, patient travel, staff travel, pharmaceutics and medical devices purchases, computer hardware, biomedical equipment/exam materials, and waste. We used the official French public database of emission factors: Base Empreinte® of the Environmental and Energy Management Agency of France. The carbon footprint of a single day of our department was estimated at 1 688.65 kgCO2eq. It represents an average of 9.28 kgCO2eq per patient. Energy consumption contributed for 114.80 kgCO2eq (6.8%), travel for 1324.76 kgCO2eq (78.4%), pharmaceutics and medical devices for 208.33 kgCO2eq (12.3%), equipment for 14.38 kgCO2eq (0.9%) and waste for 26.38 kgCO2eq (1.6%). This study highlights the importance of patient travels, and possibly pharmaceutics, in the carbon footprint of hospital ophthalmology practice in France. More studies are needed to establish it at the national or international scale, as well as more carbon footprint analyses on products, especially those of high prices, to increase the accuracy of these studies.