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Indian Journal of Ophthalmology Nov 2019
Topics: Clinical Competence; Delivery of Health Care; Education, Medical, Graduate; Eye Diseases; Humans; Ophthalmologists; Ophthalmology; Point-of-Care Systems
PubMed: 31638034
DOI: 10.4103/ijo.IJO_1922_19 -
Indian Journal of Ophthalmology Sep 2018
Topics: Burnout, Professional; Humans; Ophthalmologists; Ophthalmology; Surveys and Questionnaires
PubMed: 30127181
DOI: 10.4103/ijo.IJO_979_18 -
JAMA Network Open Aug 2023Large language models (LLMs) like ChatGPT appear capable of performing a variety of tasks, including answering patient eye care questions, but have not yet been...
IMPORTANCE
Large language models (LLMs) like ChatGPT appear capable of performing a variety of tasks, including answering patient eye care questions, but have not yet been evaluated in direct comparison with ophthalmologists. It remains unclear whether LLM-generated advice is accurate, appropriate, and safe for eye patients.
OBJECTIVE
To evaluate the quality of ophthalmology advice generated by an LLM chatbot in comparison with ophthalmologist-written advice.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study used deidentified data from an online medical forum, in which patient questions received responses written by American Academy of Ophthalmology (AAO)-affiliated ophthalmologists. A masked panel of 8 board-certified ophthalmologists were asked to distinguish between answers generated by the ChatGPT chatbot and human answers. Posts were dated between 2007 and 2016; data were accessed January 2023 and analysis was performed between March and May 2023.
MAIN OUTCOMES AND MEASURES
Identification of chatbot and human answers on a 4-point scale (likely or definitely artificial intelligence [AI] vs likely or definitely human) and evaluation of responses for presence of incorrect information, alignment with perceived consensus in the medical community, likelihood to cause harm, and extent of harm.
RESULTS
A total of 200 pairs of user questions and answers by AAO-affiliated ophthalmologists were evaluated. The mean (SD) accuracy for distinguishing between AI and human responses was 61.3% (9.7%). Of 800 evaluations of chatbot-written answers, 168 answers (21.0%) were marked as human-written, while 517 of 800 human-written answers (64.6%) were marked as AI-written. Compared with human answers, chatbot answers were more frequently rated as probably or definitely written by AI (prevalence ratio [PR], 1.72; 95% CI, 1.52-1.93). The likelihood of chatbot answers containing incorrect or inappropriate material was comparable with human answers (PR, 0.92; 95% CI, 0.77-1.10), and did not differ from human answers in terms of likelihood of harm (PR, 0.84; 95% CI, 0.67-1.07) nor extent of harm (PR, 0.99; 95% CI, 0.80-1.22).
CONCLUSIONS AND RELEVANCE
In this cross-sectional study of human-written and AI-generated responses to 200 eye care questions from an online advice forum, a chatbot appeared capable of responding to long user-written eye health posts and largely generated appropriate responses that did not differ significantly from ophthalmologist-written responses in terms of incorrect information, likelihood of harm, extent of harm, or deviation from ophthalmologist community standards. Additional research is needed to assess patient attitudes toward LLM-augmented ophthalmologists vs fully autonomous AI content generation, to evaluate clarity and acceptability of LLM-generated answers from the patient perspective, to test the performance of LLMs in a greater variety of clinical contexts, and to determine an optimal manner of utilizing LLMs that is ethical and minimizes harm.
Topics: Humans; Artificial Intelligence; Ophthalmologists; Cross-Sectional Studies; Software; Language
PubMed: 37606922
DOI: 10.1001/jamanetworkopen.2023.30320 -
Ceska a Slovenska Oftalmologie :... 2020Carotid-cavernous fistula (CCF) is an abnormal communication - vascular connection between arteries and veins in the cavernous sinus. Classification according to... (Review)
Review
Carotid-cavernous fistula (CCF) is an abnormal communication - vascular connection between arteries and veins in the cavernous sinus. Classification according to etiology is traumatic vs spontaneous. According to blood flow rate per high flow vs low flow fistula. According to anatomy of direct vs indirect: Direct (direct) CCF arises through direct communication between the internal carotid artery (ICA) and the cavernous sinus. Indirect CCF originates through indirect communication through the meningeal branches of ICA, external carotid artery and cavernous sinus (not directly with ICA) and Barrow type A, B, C, D division. Patients subjective complaints depend on the type of CCF. Most often it is pulsating tinnitus, synchronous with blood pulse. Typical findings include protrusion and pulsation of the eyeball, corkscrew vessels - arterialization of conjunctival and episleral vessels, increased intraocular pressure, not responding to local antiglaucomatous therapy, keratopathy a lagophthalmo, corneal ulcers. In the later untreated stages of CCF, secondary, venous stasis or central retinal vein occlusion can occur. Diagnostic procedures include B-scan and color Doppler ultrasonography, digital ophthamodynamometry, computer tomography, nuclear magnetic resonance and digital subtraction angiography. CCF can simulate orbitopathy, conjunctivitis symptoms, carotid occlusion, scleritis or cavernous sinus thrombosis. The ophthalmologist should recognize and indicate the necessary examinations in a timely manner. The therapy is ophthalmological, neuroradiological, sterotactic, surgical and conservative.
Topics: Carotid-Cavernous Sinus Fistula; Cavernous Sinus; Fistula; Humans; Magnetic Resonance Imaging; Ophthalmologists
PubMed: 33086846
DOI: 10.31348/2020/8 -
Survey of Ophthalmology 2022Vision loss with clinical findings that are incompatible with the symptoms and recognized neurological or ophthalmic conditions is a common presentation of patients to... (Review)
Review
Vision loss with clinical findings that are incompatible with the symptoms and recognized neurological or ophthalmic conditions is a common presentation of patients to neurologists, ophthalmologists, and neuro-ophthalmologists. The accepted terminology to describe such patients has evolved over time, including functional visual disorder (FVD), non-organic vision loss, non-physiologic vision loss, functional vision loss, psychogenic, psychosomatic, and medically unexplained visual loss. Likewise, attitudes and recommended management options have changed over the years in the fields of psychiatry and neurology. FVD is a diagnosis of inclusion, and it is critical that the diagnosis be made and delivered efficiently and effectively to reduce patient and physician duress. We review the current Diagnostic and Statistical Manual (DSM V) terminology and the prior literature on FVD and describe how the approaches to diagnosis and management have changed. We provide recommendations on the appropriate techniques and diagnostic approach for patients with FVD. We also propose a protocol for consistent and standardized discussion with the patient of the diagnosis of FVD. We believe that the adoption of FVD as both a paradigm and nomenclature shift in ophthalmology will improve patient care.
Topics: Adult; Humans; Ophthalmologists; Ophthalmology; Vision Disorders
PubMed: 33737039
DOI: 10.1016/j.survophthal.2021.03.002 -
Trends in Molecular Medicine Jun 2020The current coronavirus disease 2019 (COVID-19) pandemic is rapidly spreading around the world. The first doctor to report this new disease was an ophthalmologist: this... (Review)
Review
The current coronavirus disease 2019 (COVID-19) pandemic is rapidly spreading around the world. The first doctor to report this new disease was an ophthalmologist: this exemplifies the role of ophthalmologists in an infectious disease pandemic. Here we review how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) affects the eye and discuss implications for ophthalmologists.
Topics: Betacoronavirus; COVID-19; Conjunctiva; Conjunctivitis, Viral; Coronavirus Infections; Eye; Humans; Ophthalmologists; Ophthalmology; Pandemics; Pneumonia, Viral; SARS-CoV-2
PubMed: 32470381
DOI: 10.1016/j.molmed.2020.03.008 -
Ceska a Slovenska Oftalmologie :... 2022In December 2019, a novel coronavirus (CoV) epidemic, caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) emerged from China. Coronaviruses belong... (Review)
Review
In December 2019, a novel coronavirus (CoV) epidemic, caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) emerged from China. Coronaviruses belong to enveloped ssRNA viruses and are classified into four genera: Alpha coronavirus, Beta coronavirus, Gamma coronavirus and Delta coronavirus. It is assumed that SARS-CoV-2 is spread primarily during a personal contact via bigger respiratory droplets. These droplets with viruses can be directly inhaled by other people or can lend on the surfaces with the possibility of further spreading. The ocular surface has been suggested as one of possible infection entries. Human eye has its own renin-angiotensin system with present ACE2 receptors, which bind the virus through spike protein. The most common symptoms of the SARS-CoV-2 infection are fever, cough and dyspnoea. Several clinical entities, such as conjunctivitis, anterior uveitis, retinitis, and optic neuritis have been associated with this infection. The most common ophthalmologic symptom associated with COVID-19 disease is conjunctivitis. Some studies indicate that eye symptoms are commonly present in patients with severe COVID-19 pneumonia and that it is possible to detect viral RNA from the conjunctival sac of these patients. In ophthalmologic praxis, we manage not only the therapy of the eye structures` inflammation in relation with this infection, but also the overall management of the visits and the supervision of the patients who are at risk and positive for coronavirus. Ophthalmologists could potentially have a higher risk of SARS-CoV-2 infection due to personal communication with the patients, frequent exposure to tears and eye secrets and the use of devices. We would like to provide an ophthalmologist`s perspective on this topic.
Topics: COVID-19; Humans; Ophthalmologists; Pandemics; SARS-CoV-2
PubMed: 35105149
DOI: 10.31348/2022/1 -
Journal Francais D'ophtalmologie Feb 2023The current monkeypox virus (MPXV) outbreak, raging since May 2022, is the largest ever observed on a world-wide scale. Despite previously being endemic in west and... (Review)
Review
The current monkeypox virus (MPXV) outbreak, raging since May 2022, is the largest ever observed on a world-wide scale. Despite previously being endemic in west and central Africa with a mortality rate of up to 10%, it remained a neglected tropical disease. Along with other recent pandemics gaining much attention, this MPXV outbreak has provided an opportunity to improve our understanding of its physiopathology and better define management strategies, particularly in patients with more serious disease. From the ophthalmologist's perspective, eyelid involvement and conjunctivitis or keratoconjunctivitis are frequently observed and may precede systemic signs or even remain the major site of involvement. While the course of MPXV keratoconjunctivitis is most often favorable, severe cases pose a functional threat, in particular for immunocompromised patients. This review provides an overview of MPXV pathophysiology, diagnosis and treatment, as well as considerations for prevention of transmission. During such an epidemic, the ophthalmologist can be the first to diagnose MPXV, treat the ocular involvement, and set up adequate preventative measures in collaboration with infectious disease specialists.
Topics: Humans; Mpox (monkeypox); Ophthalmologists; Monkeypox virus
PubMed: 36639339
DOI: 10.1016/j.jfo.2022.11.002 -
Ophthalmology May 2020
Topics: Betacoronavirus; COVID-19; Coronavirus Infections; Humans; Infection Control; Infectious Disease Transmission, Patient-to-Professional; Ophthalmologists; Ophthalmology; Pandemics; Pneumonia, Viral; SARS-CoV-2
PubMed: 32327128
DOI: 10.1016/j.ophtha.2020.03.037 -
Eye (London, England) Aug 2021In the absence of pre-admission testing for colour blindness, many of the currently practicing ophthalmologists are colour blind, accordingly their accuracy of...
PURPOSE
In the absence of pre-admission testing for colour blindness, many of the currently practicing ophthalmologists are colour blind, accordingly their accuracy of distinguishing fine diabetic retinopathy (DR) changes is still unknown. This study aims to assess the accuracy of diagnosing and staging diabetic retinopathy and macular oedema among protonopic, deutronopic and tritanopic ophthalmologists.
METHODS
Cross-sectional assessment of fundus images that were prepared to simulate the appearance in cases of colour blindness. We assessed the accuracy of staging diabetic retinopathy and macular oedema by a retina specialist on colour-blind simulated images. We used randomiser.org to randomly select images to be simulated by the previously validated Vischeck colour blindness simulator.
RESULTS
A total of 150 simulated images were reviewed, 50 images for each of simulated protanopia, deuteranopia and tritanopia. We found that the accuracy for staging DR and macular oedema for protanope grader were 50% and 60%, respectively. Accuracy within one stage difference for DR and macular oedema were 88% and 90%, respectively. For deuteranopes, 56% and 64% accuracy for DR and macular oedema, respectively. Accuracy within one stage difference for DR and macular oedema were 86% and 90%, respectively. For Tritanope, 62% and 84% accuracy for DR and macular oedema, respectively.
CONCLUSION
Colour vision is important for distinguishing fine details during retina assessment in diabetic retinopathy patients. Colour blindness is associated with low accuracy in staging diabetic retinopathy and macular oedema, particularly among protonopic graders, and to a lesser extent in tritanopic graders.
Topics: Color; Color Vision Defects; Cross-Sectional Studies; Diabetes Mellitus; Diabetic Retinopathy; Humans; Ophthalmologists
PubMed: 33106610
DOI: 10.1038/s41433-020-01232-z