Tracking Online Interest in Artificial Intelligence in Ophthalmology Using Google Trends

PURPOSE

To examine trends in internet search queries related to artificial intelligence (AI) in ophthalmology and determine the correlation between online interest in AI, capital investment in AI, and peer-reviewed indexed publications regarding AI and ophthalmology.

METHODS

Online search trends for "AI retina", "AI eye", and "AI healthcare" were obtained via Google Trends from 2016 to 2022 on a relative interest scale in 1-week intervals. Global venture financing of AI- and machine learning (ML)-focused companies in healthcare was tracked from 2010 to 2019 from the consulting company, Klynveld Peat Marwick Goerdeler (KPMG), and the technology market intelligence company, CB Insights. Citation count from pubmed.gov was determined using the search query "artificial intelligence retina" from 2012 to 2021.

RESULTS

An increasingly linear growth in online search trends for "AI retina", "AI eye", and "AI healthcare" keyword searches was observed between 2016 and 2022. Global venture financing of AI and ML companies in healthcare also increased exponentially over the same time frame. There was an exponential increase in citations with nearly a 10-fold increase as reported by PubMed from 2015 onwards for the "artificial intelligence retina" search query. There was a significant and positive correlation between online search trends and investment trends (correlation coefficients of 0.98-0.99 and p-values <0.05) and between online search trends and citation count trends (correlation coefficients of 0.98-0.99 and p-values <0.05).

CONCLUSIONS

These results demonstrate that the applications of AI and ML in ophthalmology are increasingly being investigated, financed, and formally researched, suggesting a prominent role for AI-derived tools in ophthalmology clinical practice in the near future.

Managing a Pigmented Corneal Ulcer in a 58-Year-Old Patient

We report on a case study involving a 58-year-old male with a pigmented corneal ulcer. The patient presented with a two-month history of an unresolved corneal ulcer in the oculus sinister (OS), accompanied by increasing ocular discomfort. His best corrected visual acuity (BCVA) was 20/20 oculus dexter and hand motion OS. Examination of OS revealed mild conjunctival injection, diffuse corneal edema, and the presence of a central pigmented lesion. Microbiological analysis via culture identified the causative agent as Ochroconis fungi, belonging to the dematiaceous species. Subsequently, the patient's condition was managed through a comprehensive regimen that included multiple topical antifungal agents, a topical antibiotic, and povidone-iodine drops. After two months of treatment, the patient exhibited improvement in his condition. His BCVA improved to counting fingers at a distance of two feet OS.

Examining Global Crises: Extracting Insights From the COVID-19 Pandemic and Natural Disasters to Develop a Robust Emergency Diabetic Retinopathy Strategy for Puerto Rico

In this critical analysis, we investigate the profound impact of natural disasters and pandemics on the care and adherence to treating diabetic retinopathy, a severe complication of diabetes requiring continuous monitoring and treatment to prevent vision loss. Our study also sheds light on the social and economic context of Puerto Rico, emphasizing recent emergency events that have exacerbated existing public health challenges. Through a comprehensive review of relevant literature from PubMed, Google Scholar, and the George Washington University Himmelfarb Health Sciences Library database, we identified 31 pertinent articles out of 45 evaluated, focusing on the effects of these crises on healthcare delivery, diabetic retinopathy screening, and treatment. The evidence strongly indicates that during such emergencies, barriers to healthcare escalate, leading to significant treatment delays and a reduction in diabetic retinopathy screening and diagnosis, ultimately resulting in deteriorated visual outcomes. Thus, our review underscores the urgent need for the development of effective emergency plans tailored specifically to diabetic retinopathy, particularly in Puerto Rico, where diabetes prevalence and its complications are notably higher. Such plans should not only incorporate established emergency measures but also harness emerging technological advances in the field of ophthalmology to ensure optimal preparedness for future pandemics and natural disasters.

Consequences of Purtscher-Like Retinopathy in a Patient With Systemic Lupus Erythematosus: A Case Report

We report on a case of Purtscher-like retinopathy (PLR) secondary to systemic lupus erythematosus, which caused retinal ischemia, retinal neovascularization, vitreous hemorrhage, and, ultimately, a combined tractional and rhegmatogenous retinal detachment. A 23-year-old male presented with decreased visual acuity in the left eye (OS). He had a recent history of systemic lupus erythematosus and was being treated with systemic corticosteroids. At presentation, his visual acuity was counting fingers in the OS; a fundus examination of the OS revealed the presence of macular edema associated with flame hemorrhages, diffuse cotton-wool spots surrounding the macula, and vascular sheathing with the retina attached, all of which were consistent with PLR. Five months later, his fundus examination (OS) showed severe retinal ischemia and active neovascularization. The patient was scheduled for pan-retinal photocoagulation (PRP) laser therapy, but he was lost to follow-up. Subsequently, he returned two months later with progressive damage and was treated with PRP in the OS. An additional two months after PRP treatment, an examination revealed combined tractional and rhegmatogenous retinal detachment. Ultimately, the patient required a pars plana vitrectomy.

Proliferative diabetic retinopathy as the initial presenting feature of type 1 diabetes

Summary

Type 1 diabetes mellitus (T1DM) is an autoimmune disorder caused by the destruction of the pancreatic beta cells, which produce insulin. Individuals with T1DM usually require at least 3-5 years to develop microvascular complications in comparison to people with type 2 diabetes (T2DM), who may develop complications even before the diagnosis of diabetes. We discuss a patient who presented with proliferative diabetic retinopathy subsequently diagnosed with T1DM and diabetic neuropathy following investigations. Diabetic retinopathy or other microvascular complications as the presenting feature of T1DM is rarely known or reported in the literature. A 33-year-old healthcare worker had been seen by the opticians due to 1-week history of blurred vision. The ophthalmology assessment had confirmed proliferative retinopathy in the right eye and severe non-proliferative retinopathy in the left eye with bilateral clinically significant macular oedema. His BMI was 24.9 kg/m2. The nervous system examination revealed bilateral stocking type peripheral neuropathy. The random venous glucose was 24.9 mmol/L. Plasma ketones were 0.7 mmol/L and HbA1c was 137 mmol/mol. On further evaluation, the anti-glutamic acid decarboxylase (GAD) antibody was positive, confirming the diagnosis of T1DM. He was started on aflibercept injections in both eyes, followed by panretinal photocoagulation. Subsequent nerve conduction studies confirmed the presence of symmetrical polyneuropathy. The pathogenesis of the development of microvascular complications in T1DM is multifactorial. Usually, the development of complications is seen at least a few years following the diagnosis. The occurrence of microvascular complications at presentation is rare. This makes the management challenging and extremely important in preventing the progression of the disease.

Learning points

The pathogenesis of the development of microvascular complications in type 1 diabetes mellitus is multifactorial. The development of complications is seen at least a few years following the diagnosis. Occurrence of microvascular complications at presentation is rare. This makes the management challenging and extremely important to prevent the progression of the disease.

Neurosyphilis Mimicking Connective Tissue Disease

A male in his 60s developed a pruritic, maculopapular rash on his torso and arms, sparing his palms and soles. He tested positive for ANA and an initial skin biopsy identified "bullous lupus," supporting the diagnosis of a connective tissue disease. Additional symptoms included headaches, facial nerve palsy and hearing loss, which partially responded to oral corticosteroids. He subsequently developed a steroid-dependent left eye scotoma, neuroretinitis and optic nerve papillitis. Mycophenolate mofetil was added but an attempted oral steroid taper led to a worsening rash, progressive retinitis and papillitis. Neurosyphilis was confirmed by serum positive rapid plasma reagin test, reactive treponema pallidum antibodies, positive cerebrospinal fluid venereal disease research laboratory and positive spirochete immunostain of skin biopsy of lesional (rash) tissue. Treatment with intravenous ceftriaxone resolved his rash and visual symptoms. It is important to consider syphilis as a mimicker of connective tissue diseases.

Guidelines on clinical research evaluation of artificial intelligence in ophthalmology (2023)

With the upsurge of artificial intelligence (AI) technology in the medical field, its application in ophthalmology has become a cutting-edge research field. Notably, machine learning techniques have shown remarkable achievements in diagnosing, intervening, and predicting ophthalmic diseases. To meet the requirements of clinical research and fit the actual progress of clinical diagnosis and treatment of ophthalmic AI, the Ophthalmic Imaging and Intelligent Medicine Branch and the Intelligent Medicine Committee of Chinese Medicine Education Association organized experts to integrate recent evaluation reports of clinical AI research at home and abroad and formed a guideline on clinical research evaluation of AI in ophthalmology after several rounds of discussion and modification. The main content includes the background and method of developing this guideline, an introduction to international guidelines on the clinical research evaluation of AI, and the evaluation methods of clinical ophthalmic AI models. This guideline introduces general evaluation methods of clinical ophthalmic AI research, evaluation methods of clinical ophthalmic AI models, and commonly-used indices and formulae for clinical ophthalmic AI model evaluation in detail, and amply elaborates the evaluation methods of clinical ophthalmic AI trials. This guideline aims to provide guidance and norms for clinical researchers of ophthalmic AI, promote the development of regularization and standardization, and further improve the overall level of clinical ophthalmic AI research evaluations.

Evaluating the Diagnostic Accuracy and Management Recommendations of ChatGPT in Uveitis

INTRODUCTION

Accurate diagnosis and timely management are vital for favorable uveitis outcomes. Artificial Intelligence (AI) holds promise in medical decision-making, particularly in ophthalmology. Yet, the diagnostic precision and management advice from AI-based uveitis chatbots lack assessment.

METHODS

We appraised diagnostic accuracy and management suggestions of an AI-based chatbot, ChatGPT, versus five uveitis-trained ophthalmologists, using 25 standard cases aligned with new Uveitis Nomenclature guidelines. Participants predicted likely diagnoses, two differentials, and next management steps. Comparative success rates were computed.

RESULTS

Ophthalmologists excelled (60-92%) in likely diagnosis, exceeding AI (60%). Considering fully and partially accurate diagnoses, ophthalmologists achieved 76-100% success; AI attained 72%. Despite an 8% AI improvement, its overall performance lagged. Ophthalmologists and AI agreed on diagnosis in 48% cases, with 91.6% exhibiting concurrence in management plans.

CONCLUSIONS

The study underscores AI chatbots' potential in uveitis diagnosis and management, indicating their value in reducing diagnostic errors. Further research is essential to enhance AI chatbot precision in diagnosis and recommendations.

Clinical Research on the Leading Causes of Severe Sight Impairment in the UK General and Working Populations

Purpose

Clinical research brings the potential of improved diagnostics, sight-saving treatments, and more accessible services to those suffering with severe sight impairment (SSI). This report investigates whether registered ophthalmology clinical studies address the leading causes of SSI in the general and working populations of the United Kingdom (UK).

Methods

The latest statistics on the leading causes of SSI in the UK general and working populations were identified by searching PubMed, Cochrane Library, and TRIP databases. Clinical study registries were searched to identify registered clinical studies (on or prior to 1st December 2022) on the leading causes of SSI. The relationship between the number of clinical studies on leading causes of SSI and the percentage of SSI certifications they account for was analyzed.

Results

In the UK general population, the number of registered clinical studies on the leading causes of SSI is statistically significantly correlated (Spearman's rho = 0.86, p < 0.01) with the percentage of SSI certifications they account for. However, there is no correlation between the two in the UK working population (aged 16-64) (Spearman's rho = 0.15, p = 0.70). Eye conditions accounting for the most SSI certifications in individuals of working age have significantly less clinical research activity than those that cause the most SSI certifications in the general population. Out of the leading causes of SSI certifications studied, disorders of the visual cortex and congenital anomalies of the eye have the least clinical research activity.

Conclusion

Clinical research into the leading causes of SSI in the general population is essential. However, it is important to consider eye conditions that cause the most severe visual impairment in individuals of working age due to the significant health and socioeconomic implications of sight loss in this population.

Disparities in Eye Care Access and Utilization: A Narrative Review

This narrative review summarizes the literature on factors related to eye care access and utilization in the United States. Using the Healthy People 2030 framework, this review investigates social determinants of health associated with general and follow-up engagement, screenings, diagnostic visits, treatment, technology, and teleophthalmology. We provide hypotheses for these documented eye care disparities, featuring qualitative, patient-centered research. Lastly, we provide recommendations in the hopes of appropriately eliminating these disparities and reimagining eye care.

Development of an AAV-CRISPR-Cas9-based treatment for dominant cone-rod dystrophy 6

Cone-rod dystrophy 6 (CORD6) is caused by gain-of-function mutations in the GUCY2D gene, which encodes retinal guanylate cyclase-1 (RetGC1). There are currently no treatments available for this autosomal dominant disease, which is characterized by severe, early-onset visual impairment. The purpose of our study was to develop an adeno-associated virus (AAV)-CRISPR-Cas9-based approach referred to as "ablate and replace" and evaluate its therapeutic potential in mouse models of CORD6. This two-vector system delivers (1) CRISPR-Cas9 targeted to the early coding sequence of the wild-type and mutant GUCY2D alleles and (2) a CRISPR-Cas9-resistant cDNA copy of GUCY2D ("hardened" GUCY2D). Together, these vectors knock out ("ablate") expression of endogenous RetGC1 in photoreceptors and supplement ("replace") a healthy copy of exogenous GUCY2D. First, we confirmed that ablation of mutant R838S GUCY2D was therapeutic in a transgenic mouse model of CORD6. Next, we established a proof of concept for "ablate and replace" and optimized vector doses in Gucy2e+/-:Gucy2f-/- and Gucy2f-/- mice, respectively. Finally, we confirmed that the "ablate and replace" approach stably preserved retinal structure and function in a novel knockin mouse model of CORD6, the RetGC1 (hR838S, hWT) mouse. Taken together, our results support further development of the "ablate and replace" approach for treatment of CORD6.

Ozonated Oil in Liposome Eyedrops Reduces the Formation of Biofilm, Selection of Antibiotic-Resistant Bacteria, and Adhesion of Bacteria to Human Corneal Cells

The recent attention to the risk of potential permanent eye damage triggered by ocular infections has been leading to a deeper investigation of the current antimicrobials. An antimicrobial agent used in ophthalmology should possess the following characteristics: a broad antimicrobial spectrum, prompt action even in the presence of organic matter, and nontoxicity. The objective of this study is to compare the antimicrobial efficacy of widely used ophthalmic antiseptics containing povidone-iodine, chlorhexidine, and liposomes containing ozonated sunflower oil. We determined the minimum inhibitory concentration (MIC) on various microbial strains: Staphylococcus aureus (ATCC 6538), methicillin-resistant Staphylococcus aureus (ATCC 33591), Staphylococcus epidermidis (ATCC 12228), Pseudomonas aeruginosa (ATCC 9027), and Escherichia coli (ATCC 873). Furthermore, we assessed its efficacy in controlling antibiotic resistance, biofilm formation, and bacterial adhesion. All three antiseptic ophthalmic preparations showed significant anti-microbicidal and anti-biofilm activity, with the liposomes containing ozonated sunflower oil with the highest ability to control antibiotic resistance and bacteria adhesion to human corneal cells.

Contact lens-related complications in austere conditions among military personnel: a systematic review

INTRODUCTION

Military service personnel are required to deploy to austere environments where they are exposed to harsh conditions. Many service personnel continue to wear contact lenses when deployed as they are an effective alternative to spectacles by affording superior ergonomic functionality, although they are associated with significant complications. We aimed to explore the prevalence and type of contact lens-related complications among deployed service personnel worldwide.

METHODS

A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. PubMed, Medline, CINAHL and EMBASE databases were searched for relevant articles published between 1950 and 2023. The keywords 'contact lens' and 'military' or 'army' or 'navy' or 'air force' and 'austere' or 'deployed' or 'adverse' were used.

RESULTS

Five eligible articles were included. Excluded articles reported contact lens wear in the firm base, were not related to military personnel or did not involve the deployed setting. Major complications associated with contact lens wear included microbial keratitis and contact lens-related discomfort. Excluding case reports, the overall incidence of contact lens-related complications ranged from 0.35% to 25.4%. The three case reports included in this systematic review described Acanthamoeba keratitis, Nocardia keratitis and contact lens-related discomfort as significant complications. These case reports also detailed time to initial presentation and type of contact lens worn when complications were encountered. Types of deployed conditions service personnel were exposed to included desert, temperate and underwater environments.

CONCLUSIONS

We highlight a scarcity of recent data regarding contact lens-related complications in the deployed setting. While contact lens-wearing service personnel are at risk of infectious keratitis and contact lens-related discomfort, we recommend good-quality data collection on contact lens wearing schedules and complication rates to steer guidance on contact lens wear in service personnel.

Discriminative-Region Multi-Label Classification of Ultra-Widefield Fundus Images

Ultra-widefield fundus image (UFI) has become a crucial tool for ophthalmologists in diagnosing ocular diseases because of its ability to capture a wide field of the retina. Nevertheless, detecting and classifying multiple diseases within this imaging modality continues to pose a significant challenge for ophthalmologists. An automated disease classification system for UFI can support ophthalmologists in making faster and more precise diagnoses. However, existing works for UFI classification often focus on a single disease or assume each image only contains one disease when tackling multi-disease issues. Furthermore, the distinctive characteristics of each disease are typically not utilized to improve the performance of the classification systems. To address these limitations, we propose a novel approach that leverages disease-specific regions of interest for the multi-label classification of UFI. Our method uses three regions, including the optic disc area, the macula area, and the entire UFI, which serve as the most informative regions for diagnosing one or multiple ocular diseases. Experimental results on a dataset comprising 5930 UFIs with six common ocular diseases showcase that our proposed approach attains exceptional performance, with the area under the receiver operating characteristic curve scores for each class spanning from 95.07% to 99.14%. These results not only surpass existing state-of-the-art methods but also exhibit significant enhancements, with improvements of up to 5.29%. These results demonstrate the potential of our method to provide ophthalmologists with valuable information for early and accurate diagnosis of ocular diseases, ultimately leading to improved patient outcomes.

Technological Advances in a Therapy of Primary Open-Angle Glaucoma: Insights into Current Nanotechnologies

Glaucoma is a leading cause of irreversible blindness and is characterized by increased intraocular pressure (IOP) and progressive optic nerve damage. The current therapeutic approaches for glaucoma management, such as eye drops and oral medications, face challenges including poor bioavailability, low patient compliance, and limited efficacy. In recent years, nanotechnology has emerged as a promising approach to overcome these limitations and revolutionize glaucoma treatment. In this narrative review, we present an overview of the novel nanotechnologies employed in the treatment of primary open-angle glaucoma. Various nanosystems, including liposomes, niosomes, nanoparticles, and other nanostructured carriers, have been developed to enhance the delivery and bioavailability of antiglaucoma drugs. They offer advantages such as a high drug loading capacity, sustained release, improved corneal permeability, and targeted drug delivery to the ocular tissues. The application of nanotechnologies in glaucoma treatment represents a transformative approach that addresses the limitations of conventional therapies. However, further research is needed to optimize the formulations, evaluate long-term safety, and implement these nanotechnologies into clinical practice. With continued advancements in nanotechnology, the future holds great potential for improving the management and outcomes of glaucoma, ultimately preserving vision and improving the lives of millions affected by this debilitating disease.

First report of molecular confirmation and phylogenetic analysis of ocular seteriasis in buffalo in India using 12S rRNA

An adult Indian buffalo (Bubalus bubalis) presented with corneal opacity, irritation, and excessive lacrimation from the left eye in the Referral Veterinary Polyclinic-Teaching Veterinary Clinical Complex (RVC-TVCC), Indian Veterinary Research Institute, Izatnagar. Clinical examination revealed a whitish thread-like worm in the left eye's anterior chamber. The worm was surgically removed from the eye with supportive nerve blocks. Light microscopy was used for parasite morphological identification, which provided insight into the worm as female Setaria sp. Genomic DNA was isolated, and polymerase chain reaction amplification of 12S rRNA was conducted for molecular confirmation of the parasite. The amplicon was sequenced and analysed by bioinformatics software. Sequence data showed an amplicon size of 243 bp. Phylogenetic analysis with reference data from the NCBI Genbank database revealed the worm was S. digitata, with a similarity of 99.17%. The common predilection site of S. digitata is in the peritoneal cavity of natural hosts like cattle and buffalo and is mostly non-pathogenic. The aberrant migration of the parasite larva to the brain and eye commonly occurs in goats, sheep, and horses, causing clinical conditions like cerebrospinal nematodiasis (lumbar paralysis) and ocular setariasis, respectively. Nevertheless, until now, there have been no reports of ocular setariasis in buffalo. This report is the first unusual occurrence of ocular setariasis in buffalo and its molecular confirmation and phylogenetic analysis using 12S rRNA.

NPHP1-Related ciliopathies: A new case and major review of the ophthalmic manifestations of 147 reported cases

Our case report and review contribute to the understanding of ocular manifestations in NPHP1 ciliopathies by reinforcing the relationship between pathogenic genetic variants and a wide array of ophthalmic abnormalities.

Birefringence analysis of collagen supraorganization in cat corneas with tropical keratopathy

OBJECTIVE

To evaluate the birefringent properties of the cornea and examine the supraorganizational aspects of collagen fibers in cats with tropical keratopathy.

PROCEDURE

In this study, 10-micrometer-thick sections of corneal tissue from cats with tropical keratopathy were examined, both in the opaque and transparent areas of the anterior stroma. Control samples were obtained from healthy cat corneas. Polarized light microscopy was employed to evaluate the birefringent properties using two distinct methods. The first method involved measuring the optical retardation associated with corneal birefringence, while the second method assessed the alignment/waviness of the birefringent collagen fibers. Differences were significant when p < .05.

RESULTS

Tropical keratopathy resulted in a significant rise (p < .05) in optical retardation in both opaque and transparent regions of the cat cornea. In the anterior stroma, both the opaque zones and transparent tissue exhibited a higher degree of collagen fiber packing than the control corneas. However, no significant differences (p > .05) in alignment were observed between the transparent tissue of the diseased cornea and the healthy corneas.

CONCLUSION

Supraorganizational changes in collagen fiber packing are not restricted to lesion zones in cat corneas affected by tropical keratopathy. Such alterations also occur in the corneal tissue of the anterior stroma adjoining the lesions. Therefore, it is plausible that the transparent tissue of the anterior stroma in corneas affected by the disease may have functional abnormalities, despite its macroscopic healthy appearance. Additional investigations are required to clarify the implications of these potential defects and their conceivable contribution to tropical keratopathy.

Evaluating the Artificial Intelligence Performance Growth in Ophthalmic Knowledge

OBJECTIVE

We aim to compare the capabilities of Chat Generative Pre-Trained Transformer (ChatGPT)-3.5 and ChatGPT-4.0 (OpenAI, San Francisco, CA, USA) in addressing multiple-choice ophthalmic case challenges.

METHODS AND ANALYSIS

Both models' accuracy was compared across different ophthalmology subspecialties using multiple-choice ophthalmic clinical cases provided by the American Academy of Ophthalmology (AAO) "Diagnosis This" questions. Additional analysis was based on image content, question difficulty, character length of models' responses, and model's alignment with responses from human respondents. χ2 test, Fisher's exact test, Student's t-test, and one-way analysis of variance (ANOVA) were conducted where appropriate, with p<0.05 considered significant.

RESULTS

GPT-4.0 significantly outperformed GPT-3.5 (75% versus 46%, p<0.01), with the most noticeable improvement in neuro-ophthalmology (100% versus 38%, p=0.03). While both models struggled with uveitis and refractive questions, GPT-4.0 excelled in other areas, such as pediatric questions (82%). In image-related questions, GPT-4.0 also displayed superior accuracy that trended toward significance (73% versus 46%, p=0.07). GPT-4.0 performed better with easier questions (93.8% (least difficult) versus 76.2% (middle) versus 53.3% (most), p=0.03) and generated more concise answers than GPT-3.5 (651.7±342.9 versus 1,112.9±328.8 characters, p<0.01). Moreover, GPT-4.0's answers were more in line with those of AAO respondents (57.3% versus 41.4%, p<0.01), showing a strong correlation between its accuracy and the proportion of AAO respondents who selected GPT-4.0's answer (ρ=0.713, p<0.01).

CONCLUSION AND RELEVANCE

Our study demonstrated that GPT-4.0 significantly outperforms GPT-3.5 in addressing ophthalmic case challenges, especially in neuro-ophthalmology, with improved accuracy even in image-related questions. These findings underscore the potential of advancing artificial intelligence (AI) models in enhancing ophthalmic diagnostics and medical education.

Ophthalmology at the Forefront of Big Data Integration in Medicine: Insights from the IRIS Registry Database

Ophthalmology stands at the vanguard of incorporating big data into medicine, as exemplified by the integration of The Intelligent Research in Sight (IRIS) Registry. This synergy cultivates patient-centered care, demonstrates real world efficacy and safety data for new therapies, and facilitates comprehensive population health insights. By evaluating the creation and utilization of the world's largest specialty clinical data registry, we underscore the transformative capacity of data-driven medical paradigms, current shortcomings, and future directions. We aim to provide a scaffold for other specialties to adopt big data integration into medicine.

The Influence of Gender on Choosing Ophthalmology as a Career Among Medical Students and Interns in Madinah, Saudi Arabia

Introduction The field of ophthalmology has become increasingly popular among medical students and interns in recent years. However, there may be gender-based differences in the factors influencing the choice of ophthalmology as a career path. This study aimed to investigate the influence of gender on the decision to pursue ophthalmology as a career among medical students and interns in Madinah, Saudi Arabia. Methods This cross-sectional study involved medical students and interns in Madinah, Saudi Arabia. A self-administered questionnaire was used to collect data from the participants at two medical colleges from March to May 2023. The questionnaire examined potential factors that would influence the students to choose or eliminate ophthalmology as a future career and whether there is a gender difference. Result A total of 449 medical students were included. Two hundred eighteen were males, and 231 were females. The mean age was 22; around (30%) of the participants were in the fourth year of medical school, and most respondents (63%) had no prior exposure to ophthalmology. Fewer working hours was the driving factor among the males to choose ophthalmology as a speciality (58%); in contrast to females, interest in eye anatomy and physiology was the main factor (60%). Being already passionate about other specialties was the main factor that deterred the students from choosing ophthalmology as a career among both males and females, with a p-value of 0.033. Conclusion Our study has shown that gender plays no significant role in influencing medical students' choice to pursue ophthalmology as a future career. Teaching students in early medical years about ophthalmology as an option may lead to significant contributions to understanding and determining their future path.

Is Artificial Intelligence the Cost-Saving Lens to Diabetic Retinopathy Screening in Low- and Middle-Income Countries?

Diabetes is a rapidly growing global health crisis disproportionately affecting low- and middle-income countries (LMICs). The emergence of diabetes as a global pandemic is one of the major challenges to human health, as long-term microvascular complications such as diabetic retinopathy (DR) can lead to irreversible blindness. Leveraging artificial intelligence (AI) technology may improve the diagnostic accuracy, efficiency, and accessibility of DR screenings across LMICs. However, there is a gap between the potential of AI technology and its implementation in clinical practice. The main objective of this systematic review is to summarize the currently available literature on the health economic assessments of AI implementation for DR screening in LMICs. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We conducted an extensive systematic search of PubMed/MEDLINE, Scopus, and the Web of Science on July 15, 2023. Our review included full-text English-language articles from any publication year. The Joanna Briggs Institute's (JBI) critical appraisal checklist for economic evaluations was used to rate the quality and rigor of the selected articles. The initial search generated 1,423 records and was narrowed to five full-text articles through comprehensive inclusion and exclusion criteria. Of the five articles included in our systematic review, two used a cost-effectiveness analysis, two used a cost-utility analysis, and one used both a cost-effectiveness analysis and a cost-utility analysis. Across the five articles, LMICs such as China, Thailand, and Brazil were represented in the economic evaluations and models. Overall, three out of the five articles concluded that AI-based DR screening was more cost-effective in comparison to standard-of-care screening methods. Our systematic review highlights the need for more primary health economic analyses that carefully evaluate the economic implications of adopting AI technology for DR screening in LMICs. We hope this systematic review will offer valuable guidance to healthcare providers, scientists, and legislators to support appropriate decision-making regarding the implementation of AI algorithms for DR screening in healthcare workflows.

Suprachoroidal Injection: A Novel Approach for Targeted Drug Delivery

Treating posterior segment and retinal diseases poses challenges due to the complex structures in the eye that act as robust barriers, limiting medication delivery and bioavailability. This necessitates frequent dosing, typically via eye drops or intravitreal injections, to manage diseases, often leading to side effects with long-term use. Suprachoroidal injection is a novel approach for targeted drug delivery to the posterior segment. The suprachoroidal space is the region between the sclera and the choroid and provides a potential route for minimally invasive medication delivery. Through a more targeted delivery to the posterior segment, this method offers advantages over other routes of administration, such as higher drug concentrations, increased bioavailability, and prolonged duration of action. Additionally, this approach minimizes the risk of corticosteroid-related adverse events such as cataracts and intraocular pressure elevation via compartmentalization. This review focuses on preclinical and clinical studies published between 2019 and 2023, highlighting the potential of suprachoroidal injection in treating a variety of posterior segment diseases. However, to fully harness its potential, more research is needed to address current challenges and limitations, such as the need for technological advancements, refinement of injection techniques, and consideration of cost and accessibility factors. Future studies exploring its use in conjunction with biotech products, gene therapies, and cell-based therapies can lead to personalized treatments that can revolutionize the field of ophthalmology.

Prescribing patterns for paediatric hyperopia among paediatric eye care providers

PURPOSE

To survey paediatric eye care providers to identify current patterns of prescribing for hyperopia.

METHODS

Paediatric eye care providers were invited, via email, to participate in a survey to evaluate current age-based refractive error prescribing practices. Questions were designed to determine which factors may influence the survey participant's prescribing pattern (e.g., patient's age, magnitude of hyperopia, patient's symptoms, heterophoria and stereopsis) and if the providers were to prescribe, how much hyperopic correction would they prescribe (e.g., full or partial prescription). The response distributions by profession (optometry and ophthalmology) were compared using the Kolmogorov-Smirnov cumulative distribution function test.

RESULTS

Responses were submitted by 738 participants regarding how they prescribe for their hyperopic patients. Most providers within each profession considered similar clinical factors when prescribing. The percentages of optometrists and ophthalmologists who reported considering the factor often differed significantly. Factors considered similarly by both optometrists and ophthalmologists were the presence of symptoms (98.0%, p = 0.14), presence of astigmatism and/or anisometropia (97.5%, p = 0.06) and the possibility of teasing (8.3%, p = 0.49). A wide range of prescribing was observed within each profession, with some providers reporting that they would prescribe for low levels of hyperopia while others reported that they would never prescribe. When prescribing for bilateral hyperopia in children with age-normal visual acuity and no manifest deviation or symptoms, the threshold for prescribing decreased with age for both professions, with ophthalmologists typically prescribing 1.5-2 D less than optometrists. The threshold for prescribing also decreased for both optometrists and ophthalmologists when children had associated clinical factors (e.g., esophoria or reduced near visual function). Optometrists and ophthalmologists most commonly prescribed based on cycloplegic refraction, although optometrists most commonly prescribed based on both the manifest and cycloplegic refraction for children ≥7 years.

CONCLUSION

Prescribing patterns for paediatric hyperopia vary significantly among eye care providers.

Availability of Physical Activity Tracking Data from Wearable Devices for Glaucoma Patients

Physical activity has been found to potentially modulate glaucoma risk, but the evidence remains inconclusive. The increasing use of wearable physical activity trackers may provide longitudinal and granular data suitable to address this issue, but little is known regarding the characteristics and availability of these data sources. We performed a scoping review and query of data sources on the availability of wearable physical activity data for glaucoma patients. Literature databases (PubMed and MEDLINE) were reviewed with search terms consisting of those related to physical activity trackers and those related to glaucoma, and we evaluated results at the intersection of these two groups. Biomedical databases were also reviewed, for which we completed database queries. We identified eight data sources containing physical activity tracking data for glaucoma, with two being large national databases (UK BioBank and All of Us) and six from individual journal articles providing participant-level information. The number of glaucoma patients with physical activity tracking data available, types of glaucoma-related data, fitness devices utilized, and diversity of participants varied across all sources. Overall, there were limited analyses of these data, suggesting the need for additional research to further investigate how physical activity may alter glaucoma risk.

Considerations of COVID-19 in Ophthalmology

Since its emergence in early 2020, the SARS-CoV-2 infection has had a significant impact on the entire eye care system. Ophthalmologists have been categorized as a high-risk group for contracting the virus due to the belief that the eye may be a site of inoculation and transmission of the SARS-CoV-2 infection. As a result, clinical ophthalmologists, optometrists, and eyecare professionals have had to familiarize themselves with the ocular manifestations of COVID-19, as well as its treatments and vaccines. The implementation of measures to prevent the transmission of the virus, such as restrictions, lockdowns, telemedicine, and artificial intelligence (AI), have led to substantial and potentially irreversible changes in routine clinical practice, education, and research. This has resulted in the emergence of a new mode of managing patients in a routine clinical setting. This brief review aims to provide an overview of various aspects of COVID-19 in ophthalmology, including the ocular manifestations related to the disease, the modes of transmission of SARS-CoV-2 infection, precautions taken in ophthalmic practice to prevent the spread of the virus, drugs, and vaccines used in the treatment of COVID-19, the impact of the pandemic on patients, clinicians, and the eye care system as a whole, and the future of ophthalmology conditioned by this global pandemic experience.

Central vein stenosis: a rare cause of orbital congestion in a haemodialysis patient

We report a rare, potentially sight-threatening ocular complication due to central venous stenosis related to a previous site of haemodialysis catheter. A dialysis-dependent woman in her 60s presented with left eye redness for 1 month followed by a remarkably prominent vessel on the left upper eyelid for 2 weeks. Examinations found left eyelid oedema with prominent venous dilatation on the upper eyelid as well as left eye mild proptosis, conjunctiva injection with corkscrew vessels, raised intraocular pressure, and dilated and tortuous retina vessels. Central thoracic venogram showed total occlusion on the left brachiocephalic vein with retrograde reflux to the jugular vein. An endovascular percutaneous transluminal balloon angioplasty was performed for the left brachiocephalic vein stenosis, which resolved the orbital, facial and neck venous congestion. The patient remained asymptomatic after 1 year.

Retinopathy as an initial sign of hereditary immunological diseases: report of six families and challenges in eye clinic

Introduction

Retinal degenerative or inflammatory changes may occur with hereditary immunological disorders (HID) due to variants in approximately 20 genes. This study aimed to investigate if such retinopathy may present as an initial sign of immunological disorders in eye clinic.

Methods

The variants in the 20 genes were selected from in-house exome sequencing data from 10,530 individuals with different eye conditions. Potential pathogenic variants were assessed by multistep bioinformatic analysis. Pathogenic variants were defined according to the ACMG/AMP criteria and confirmed by Sanger sequencing, co-segregation analysis, and consistency with related phenotypes. Ocular clinical data were thoroughly reviewed, especially fundus changes.

Results

A total of seven pathogenic variants in four of the 20 genes were detected in six probands from six families, including three with hemizygous nonsense variants p.(Q308*), p.(Q416*), and p.(R550*) in MSN, one with homozygous nonsense variants p.(R257*) in AIRE, one with compound heterozygous nonsense variants p.(R176*) and p.(T902*) in LAMB2, and one with a known c.1222T>C (p.W408R) heterozygous variant in CBL. Ocular presentation, as the initial signs of the diseases, was mainly retinopathy mimicking other forms of hereditary retinal degeneration, including exudative vitreoretinopathy in the three patients with MSN variants or tapetoretinal degeneration in the other three patients. Neither extraocular symptoms nor extraocular manifestations were recorded at the time of visit to our eye clinic. However, of the 19 families in the literature with retinopathy caused by variants in these four genes, only one family with an AIRE homozygous variant had retinopathy as an initial symptom, while the other 18 families had systemic abnormalities that preceded retinopathy.

Discussion

This study, for the first time, identified six unrelated patients with retinopathy as their initial and only presenting sign of HID, contrary to the previous reports where retinopathy was the accompanying sign of systemic HID. Recognizing such phenotype of HID may facilitate the clinical care of these patients. Follow-up visits to such patients and additional studies are expected to validate and confirm our findings.

Prevalence, correlates, and network analysis of depression and its associated quality of life among ophthalmology nurses during the COVID-19 pandemic

Background

Nurses in Ophthalmology Department (OD) had a high risk of infection during the novel coronavirus disease 2019 (COVID-19) pandemic. This study examined the prevalence, correlates, and network structure of depression, and explored its association with quality of life (QOL) in Chinese OD nurses.

Methods

Based on a cross-sectional survey, demographic and clinical data were collected. Depression was measured with the 9-item Self-reported Patient Health Questionnaire (PHQ-9), and QOL was measured using the World Health Organization Quality of Life Questionnaire-brief version (WHOQOL-BREF). Univariate analyses, multivariate logistic regression analyses, and network analyses were performed.

Results

Altogether, 2,155 OD nurses were included. The overall prevalence of depression among OD nurses was 32.71% (95%CI: 30.73-34.70%). Multiple logistic regression analysis revealed that having family or friends or colleagues who were infected (OR = 1.760, p = 0.003) was significantly associated with higher risk of depression. After controlling for covariates, nurses with depression reported lower QOL (F(1, 2,155) = 596.784, p < 0.001) than those without depression. Network analyses revealed that 'Sad Mood', 'Energy Loss' and 'Worthlessness' were the key central symptoms.

Conclusion

Depression was common among OD nurses during the COVID-19 pandemic. Considering the negative impact of depression on QOL and daily life, regular screening for depression, timely counselling service, and psychiatric treatment should be provided for OD nurses, especially those who had infected family/friends or colleagues. Central symptoms identified in network analysis should be targeted in the treatment of depression.

Sir Benjamin William Rycroft OBE (1902-1967): British ophthalmologist and pioneer in corneal surgery

An unsung hero of British ophthalmology is the largely forgotten Sir Benjamin Rycroft (1902-1967). This paper will discuss and analyse the undervalued career of this great man. Upon graduating from medical school, Rycroft became a General Practitioner. Rycroft then decided to train to become an ophthalmologist. Rycroft began his ophthalmology career in 1930s London focusing on the new ground-breaking surgery of keratoplasty (corneal grafting) before serving with distinction in the medical corps during the Second World War. He is chiefly remembered for his work after the war at the Queen Victoria Hospital in East Grinstead, Sussex, where he worked with renowned plastics surgeon Archibald McIndoe. During his time, there Rycroft became globally recognised for his skill in keratoplasty and started a campaign which radically changed the legal framework behind organ donation in the UK. Despite few knowing of him today, Rycroft is undoubtedly one of the most influential British ophthalmologists of the past century. He was for decades seen as one of the world's leading practitioners of keratoplasty and established a unit which restored sight to wounded veterans. His greatest achievement lies in his organ donation reform, which started the process of allowing organ donation to be carried out on a nationwide scale for the first time.

Needle-Stick Injuries in Ophthalmic Practice

Purpose

Needle-stick injuries (NSI) are a prominent route by which blood-borne infections are transmitted. The unique microsurgical nature of ophthalmic practice constitutes an additional risk to sustain injury. This study aimed to identify the epidemiological profile of needle-stick injuries in a tertiary eye center and to evaluate the implemented safety policy in preventing sharp injuries.

Methods

This was a retrospective cross-sectional study of all sharp injuries that occurred at King Khalid Eye Specialist Hospital (KKESH). Data on all reported sharp injury incidents from 2013 to 2021 were collected. The mechanisms of injury, context, location, and type of prick were collected and analyzed. Also, this study involved an institution-based survey for all ophthalmic staff.

Results

Two hundred and one sharp injury incidents were reported over 9 years. Physicians sustained 46.8% (n=94) of injuries, followed by nurses and ophthalmic technicians, 40.8% (n=82) and 7% (14); respectively. Operating and treatment rooms were the locations of 60.7% of incidents, whereas outpatient clinics and emergency rooms accounted for 19.4% and 13.4% of injuries, respectively.

Conclusion

The current findings add to the growing body of literature on the importance of NSI prevention and reporting strategies. In the present study, sharp injuries were most commonly encountered by ophthalmic staff in the operating rooms. Continuous staff education on handling sharp instruments, encouraging anonymous reporting, and up-to-date revisions of guidelines and policies are of paramount importance to lessen the burden of sharp injuries.

Associations between vision impairment and vision-related interventions on crash risk and driving cessation: systematic review and meta-analysis

OBJECTIVES

To systematically investigate the associations between vision impairment and risk of motor vehicle crash (MVC) involvement, and evaluate vision-related interventions to reduce MVCs.

DESIGN

Medline (Ovid), EMBASE and Global Health electronic databases were systematically searched from inception to March 2022 for observational and interventional English-language studies. Screening, data extraction and appraisals using the Joanna Briggs Institute appraisal tools were completed by two reviewers independently. Where appropriate, measures of association were converted into risk ratios (RRs) or ORs for meta-analysis.

PARTICIPANTS

Drivers of four-wheeled vehicles of all ages with no cognitive declines.

PRIMARY AND SECONDARY OUTCOMES

MVC involvement (primary) and driving cessation (secondary).

RESULTS

101 studies (n=778 052) were included after full-text review. 57 studies only involved older drivers (≥65 years) and 85 were in high-income settings. Heterogeneity in the data meant that most meta-analyses were underpowered as only 25 studies, further split into different groups of eye diseases and measures of vision, could be meta-analysed. The limited evidence from the meta-analyses suggests that visual field defects (four studies; RR 1.51 (95% CI 1.23, 1.85); p<0.001; I2=46.79%), and contrast sensitivity (two studies; RR 1.40 (95% CI 1.08, 1.80); p=0.01, I2=0.11%) and visual acuity loss (five studies; RR 1.21 (95% CI 1.02, 1.43); p=0.03, I2=28.49%) may increase crash risk. The results are more inconclusive for available evidence for associations of glaucoma (five studies, RR 1.27 (95% CI 0.67, 2.42); p=0.47; I2=93.48%) and cataract (two studies RR 1.15 (95% CI 0.97, 1.36); p=0.11; I2=3.96%) with crashes. Driving cessation may also be linked with glaucoma (two studies; RR 1.62 (95% CI 1.20, 2.19); p<0.001, I2=22.45%), age-related macular degeneration (AMD) (three studies; RR 2.21 (95% CI 1.47, 3.31); p<0.001, I2=75.11%) and reduced contrast sensitivity (three studies; RR 1.30 (95% CI 1.05, 1.61); p=0.02; I2=63.19%). Cataract surgery halved MVC risk (three studies; RR 0.55 (95% CI 0.34, 0.92); p=0.02; I2=97.10). Ranibizumab injections (four randomised controlled trials) prolonged driving in persons with AMD.

CONCLUSION

Impaired vision identified through a variety of measures is associated with both increased MVC involvement and cessation. Cataract surgery can reduce MVC risk. Despite literature being highly heterogeneous, this review shows that detection of vision problems and appropriate treatment are critical to road safety.

PROSPERO REGISTRATION NUMBER

CRD42020172153.

School performances in children with cataract: results from a population-based cohort study

OBJECTIVES

Childhood cataract is a chronic condition that may interfere with the child's learning capacities. We aimed to investigate whether childhood cataract influences academic development by comparing school performance in reading and mathematics in children with cataract to a matched control group.

DESIGN

Nationwide registry-based cohort study.

SETTINGS

Two surgical centres that perform all treatments for childhood cataract in Denmark.

PARTICIPANTS

Children born between 2000 and 2009 diagnosed with cataract before 10 years of age (n=275) and an age-matched and sex-matched control group (n=2473).

MAIN OUTCOME MEASURES

School performance was assessed as test scores in national tests performed at regular intervals from grade 2 to grade 8 in reading and mathematics. Analyses were corrected for birth origin, child somatic and mental disorder and parental socioeconomic status and mental disorders.

RESULTS

Of 275 children, 85 (30.9%) were operated for bilateral cataract, 79 (28.7%) unilateral cataract and 111 (40,4%) were not operated. We found that children with cataract have lower participation rate in the tests (62.5%) compared with the control cohort (77.2%) (p value=0.0001). After adjusting the pooled analyses for birth origin, somatic and mental disease in the child and parental socioeconomic status and mental disorders, we found that the children with cataract scored significantly lower in mathematics compared with those without cataract (mean difference=-4.78, 95% CI: -8.18 to -1.38, p value=0.006), whereas no difference was found regarding scores in reading (p=0.576). The lower score in mathematics was driven by children who had been operated for bilateral cataract (p-value=0.004).

CONCLUSION

Children with cataract without somatic or neurodevelopmental comorbidities or psychosocial adversities seem to do well in school, whereas children operated for bilateral cataract have higher frequencies of difficulties in mathematical tasks.

Discovery of Aptamers and the Acceleration of the Development of Targeting Research in Ophthalmology

Aptamers are widely applied to diagnosis and therapy because of their targeting. However, the current progress of research into aptamers for the treatment of eye disorders has not been well-documented. The current literature on aptamers was reviewed in this study. Aptamer-related drugs and biochemical sensors have been evaluated for several eye disorders within the past decade; S58 targeting TGF-β receptor II and pegaptanib targeting vascular endothelial growth factor (VEGF) are used to prevent fibrosis after glaucoma filtration surgery. Anti-brain-derived neurotrophic factor aptamer has been used to diagnose glaucoma. The first approved aptamer drug (pegaptanib) has been used to inhibit angiogenesis in age-related macular degeneration (AMD) and diabetic retinopathy (DR), and its efficacy and safety have been demonstrated in clinical trials. Aptamers, including E10030, RBM-007, AS1411, and avacincaptad pegol, targeting other angiogenesis-related biomarkers have also been discovered and subjected to clinical trials. Aptamers, such as C promoter binding factor 1, CD44, and advanced end products in AMD and DR, targeting other signal pathway proteins have also been discovered for therapy, and biochemical sensors for early diagnosis have been developed based on aptamers targeting VEGF, connective tissue growth factor, and lipocalin 1. Aptamers used for early detection and treatment of ocular tumors were derived from other disease biomarkers, such as CD71, nucleolin, and high mobility group A. In this review, the development and application of aptamers in eye disorders in recent years are systematically discussed, which may inspire a new link between aptamers and eye disorders. The aptamer development trajectory also facilitates the discovery of the pathogenesis and therapeutic strategies for various eye disorders.

Tape-splint tarsorrhaphy technique to manage exposure keratopathy in a patient refusing surgical intervention

This case report describes the benefits of a unique tape-splinting technique to serve as a nonsurgical tarsorrhaphy in the management of exposure keratopathy in a patient who refuses surgical intervention.

The enigma of Sir William Robert Wills Wilde (1815-1876)

William Wilde, father of Oscar Wilde, made a significant contribution to ophthalmology and otology. Qualified as a surgeon. educated in statistics and showing sympathy for the Irish population, Wilde was appointed a Commissioner for the 1851 Census, which covered the time of the Irish Famine (1845-1852). Wilde, steeped in Irish mythology, used his knowledge to develop a close rapport with the Irish peasantry. However, his life was a paradox; he supported the British Government's approach to the Famine and at the same time he showed humanity to the Irish peasantry. In his personal life he was implicated in an abortive libel case involving a young female patient who had accused him of rape. Wilde lived as though he had two separate lives: on the one hand the successful surgeon, famine Commissioner and cataloguer of Irish antiquities, and the other a countryman and disciple of Irish mythology. Wilde was highly preceptive especially in his views on the recording of medical data and outcomes in clinical practice. We argue that Wilde was probably unmatched in the variety of his talents but was also perplexing in the various actions he took during his life and that indeed Wilde was an enigma.

Analysis of Publication Productivity and Academic Rank of Ophthalmology Residency Program Directors in the United States

PURPOSE

Female ophthalmologists are underrepresented in the field of ophthalmology. This study aimed to analyze the gender differences among ophthalmology residency program directors (PDs) in the United States with respect to academic rank, number of publications, and h-index.

METHODS

This cross-sectional study evaluated 120 ophthalmology residency PDs from 120 ophthalmology residency programs during the 2022 San Francisco Match. The gender information was collected from institutional websites. The information regarding the state of each institute, academic rank, degree (MD or DO), age, and publication productivity was also recorded.

RESULTS

From the 120 residency programs, 120 ophthalmology residency PDs were identified. Most PDs had an MD degree (118 out of 120, 98.3%), while only a few had a DO degree (2 out of 120, 1.7%). Only 31 (25.8%) out of 120 residency PDs were female. There was a statistically significant difference between female residency PDs and male residency PDs (p<0.0001). Male PDs had a higher h-index (15.2 ± 1.2) compared to their female counterparts (11.9 ± 0.97) (p=0.003). Regarding academic rank, male PD number was higher in each category, including assistant professor, associate professor, and full professor.

CONCLUSIONS

United States ophthalmology residency programs have a smaller portion of females compared to male PDs. Furthermore, full professors are more likely to be male, and males have higher publication productivity in terms of h-index. To promote equality among ophthalmologists, future initiatives should focus on addressing the gender disparities in ophthalmology residency programs and the selection of residency PDs.

Ophthalmic Self-Medication Practices and Associated Factors of Using Steroid Eye Drops Among Adult Ophthalmic Patients

BACKGROUND

Self-medication is defined as the selection of medicines by individuals to treat self-diagnosed ophthalmic symptoms without consultation of healthcare professionals. Topical steroids can produce severe eye-threatening complications, including the elevation of intraocular pressure (IOP) with possible development of glaucoma and infrequent optic nerve damage. In recent times, many over-the-counter (OTC) ophthalmic preparations are possible without a prescription. There are a lot of concerns about the safety of long-term use of nonprescription ophthalmic drugs, which may lead to a variety of serious ocular complications.

OBJECTIVE

To determine the prevalence of self-medication ocular topical steroid practices and associated factors among adult ophthalmic patients attending ophthalmology clinics at King Saud Medical City (KSMC) in Riyadh.

METHODS

A cross-sectional study targeted adults aged 18 or older who had used topical steroids eye drops. The data were collected through interviews, and an online questionnaire was distributed among patients who attended ophthalmology clinics between December 2022 and February 2023.

RESULT

From a total of 308 responses, 92 (29.8%) were using ocular topical, 58 (18.8%) with a prescription, five (1.6%) without a prescription, and 29 (9.4%) with and without a prescription, while 216 (70.1%) did not use it. The frequency of using ocular topical steroids without a prescription among participants was 11 (12%) once and 33 (35%) many times. Additionally, 26 (28.3%) were having complications, mostly eye infections (11, 12.4%), glaucoma (8, 9%), and cataracts (6, 6.7%). The reasons for practicing self-medication of steroid eye drops among participants were 14 (15.2%) repeated symptoms, 11 (15.2%) had heard advice from friends, and 11 (15.2%) think they had enough knowledge.

CONCLUSION

The study reported the use of self-medication with steroids in ophthalmology clinics at KSMC, even though detecting a high level of perception and acceptable practices among participants. This practice is mainly due to participants having repeated symptoms and thinking they have enough knowledge. Educating the patients would help in reducing the incidence of self-medication steroid eye drops and its associated complications.

Eyes for Ears: Usage and Efficacy of a Podcast for Ophthalmic Education

Purpose

To characterize listenership and perceived educational impact of the ophthalmic podcast "Eyes for Ears".

Methods

A cross-sectional, internet-distributed, 9-question Qualtrics survey was made available to podcast listeners. Listenership metrics were analyzed from the podcast host platform.

Results

From January 10, 2019 to September 2, 2021, the podcast was downloaded over 422,000 times, averaging about 4442 downloads per episode. 209 Qualtrics survey responses were analyzed from podcast listeners with backgrounds in eye care including medical students, residents, fellows, clinicians and technicians. The majority were residents (60.3%), representative of the target audience of the podcast. Listeners reported using the podcast while commuting (81.3%), felt it increased the time they could spend on self-care (63.2%), and thought it improved their fund of knowledge (99.0%). Respondents recalled feeling better prepared for the OKAP or written boards after using this podcast (before median = 50/100 on Likert Scale, IQR 30-65 vs median = 70/100, IQR 56-81, p <0.001). Respondents identified question banks as the most helpful for OKAP studying, followed by podcasts. Podcasts were preferred over articles and lectures in terms of helpfulness (p < 0.001).

Conclusion

The Eyes for Ears podcast has achieved a robust international audience. The surveyed audience felt the podcast was useful for their education and well-being.

Micropulse Laser Therapy as an Integral Part of Eye Disease Management

Ocular diseases can significantly impact vision and quality of life through pathophysiological alterations to the structure of the eye. The management of these conditions often involves a combination of pharmaceutical interventions, surgical procedures, and laser therapy. Laser technology has revolutionized many medical fields, including ophthalmology, offering precise and targeted treatment options that solve some of the unmet needs of other therapeutic strategies. Conventional laser techniques, while effective, can generate excessive thermal energy, leading to collateral tissue damage and potential side effects. Compared to conventional laser techniques, micropulse laser therapy delivers laser energy in a pulsed manner, minimizing collateral damage while effectively treating target tissues. The present paper highlights the advantages of micropulse laser therapy over conventional laser treatments, presents the implications of applying these strategies to some of the most prevalent ocular diseases, and highlights several types and mechanisms of micropulse lasers. Although micropulse laser therapy shows great potential in the management of ocular diseases, further research is needed to optimize treatment protocols, evaluate long-term efficacy, and explore its role in combination therapies.

The Link Between Gastrointestinal Microbiome and Ocular Disorders

The gut-eye axis has been hypothesized to be a factor in many eye pathologies. This review examines papers from PubMed about this topic. Bacterial commensals could either be protective by regulating the immune system or prove to be damaging to the gut mucosal wall and incite an inflammatory process. The balance between the two appears to be crucial in maintaining eye health. Imbalances have been implicated in ophthalmologic conditions. The use of probiotics, dietary modifications, antibiotics, and faecal microbiota transplant in mice with pathologies such as those encountered in our practice appears to reverse disease course or at least prevent its progression. Clinical trials are currently underway to investigate their clinical significance in diseased patients.

Comparison of antivascular endothelial growth factor treatment for myopia choroidal neovascularisation: a systematic review and meta-analysis of randomised controlled trials

OBJECTIVES

To evaluate the efficacy and safety of anti-vascular endothelial growth factor (anti-VEGF) therapy for myopia choroidal neovascularisation (CNV), and to compare the efficacy of two different anti-VEGF retreatment criteria.

DATA SOURCES

PubMed, EMBASE, the Cochrane Library and ClinicalTrials.gov were searched from inception to 31 July 2022.

STUDY SELECTION

Randomised controlled trials (RCTs) comparing anti-VEGF with sham, photodynamic therapy (PDT) or PDT combination therapy in patients with myopia CNV were reviewed and selected. RCTs comparing visual acuity (VA) stabilisation or disease activity as anti-VEGF retreatment criteria were also included in the study.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently conducted data extraction and quality assessment. We used a random-effects model for all analyses. Primary outcomes included best-corrected visual acuity (BCVA) and central foveal thickness. Secondary outcomes included number of patients who gained more than three lines in BCVA, number of anti-VEGF injections and ocular adverse event (AE).

RESULTS

Seven RCTs involving 1007 patients were included. Compared with sham and PDT therapy, anti-VEGF therapy achieved better BCVA gains of -0.28 logMAR (95% CI -0.36 to -0.20, p<0.00001) and -0.14 logMAR (95% CI -0.17 to -0.10, p<0.00001), respectively. Both ranibizumab and bevacizumab improved patients' vision better than PDT therapy and no definitive increased risk of ocular AE was observed. Analysis of two small RCTs showed that PDT combination therapy had similar visual improvement and needed fewer anti-VEGF injections compared with anti-VEGF monotherapy (weighted mean difference (WMD)=1.30; 95% CI 1.24 to 1.37, p<0.00001). Anti-VEGF retreatment guided by disease activity criteria resulted in comparable visual improvement and reduced anti-VEGF injections compared with retreatment guided by VA stabilisation (WMD=0.83; 95% CI 0.42 to 1.25, p<0.0001).

CONCLUSIONS

Anti-VEGF therapy is effective and well-tolerated for myopia CNV patients. Anti-VEGF retreatment guided by disease activity criteria can achieve comparable efficacy and potentially reduce anti-VEGF injections.

PROSPERO REGISTRATION NUMBER

CRD42021292806.

Highly cited publication performance in the ophthalmology category in the Web of Science database: a bibliometric analysis

AIM

To determine and evaluate the features of highly cited articles (HCAs) in the ophthalmology category in the Science Citation Index Expanded (SCI-EXPANDED) from 1991 to 2020.

METHODS

The Web of Science Core Collection documents with at least 100 citations from their publication year until December 31, 2020, were evaluated as highly cited. The examined features were the distribution of yearly output and its average number of per publication, HCAs, authors, institutions, journals, and nations. The publication performance of nations and organizations was assessed using six publication indicators. The Y-index was employed to compare the research outputs of various authors.

RESULTS

Publications that had cited the most references were highly published in high-impact factor journals. The United States of America came out on top across all six publication indicators, and it was home to eight of the top 10 most productive institutions. The articles written by Breivik et al (2006) and Farrar et al (2001) were highly cited and had a significant impact in 2020. The authors had a higher number of highly cited articles published as corresponding authors than as first authors.

CONCLUSION

The findings of the present study highlight the current scope of global research in ophthalmology. The findings can help policy-makers and advisory groups of research centers to develop future policies. In addition, the findings can guide researchers in this field.

Impact of the COVID-19 Pandemic on Mental Health among Patients with Chronic Ocular Conditions

The COVID-19 pandemic had significant impacts on the mental and visual health of patients. This cross-sectional, survey-based, multicentric study evaluates the state of mental and visual health among patients with chronic ocular diseases such as glaucoma, neovascular age-related macular degeneration, diabetic retinopathy, or chronic uveitis during the lockdown period of the COVID-19 pandemic. Mental health was assessed using three questionnaires: the Patient Health Questionnaire-9 (PHQ-9), the Impact of Event Scale-Revised (IES-R), and the National Eye Institute Visual Function Questionnaire-25 (VFQ-25). A total of 145 patients completed the questionnaires. The PHQ-9 showed that most respondents (n = 89, 61%) had none or minimal depressive symptoms, while 31 (21%) had mild depressive symptoms, 19 (13%) had moderate depressive symptoms, 5 (3%) had moderately severe depressive symptoms, and 1 (1%) had severe depressive symptoms. Regarding stress surrounding the pandemic, the median IES-R showed mild distress in 16 (11%), moderate distress in 7 (5%), and severe distress in 4 (3%). The COVID-19 pandemic lockdowns had a negative impact on patients' mental health with close to 20% of the patients reporting at least moderately depressive symptoms and 19% reporting at least mildly distressful symptoms.

Role of optical coherence tomography in depression detection: a protocol of systematic review and meta-analysis

INTRODUCTION

Optical coherence tomography (OCT) is a non-invasive approach for detecting changes in the retinal layers, which may also reflect changes in brain structure and function. As one of the leading causes of disability worldwide, depression has been associated with alteration of brain neuroplasticity. However, the role of OCT measurements in detecting depression remains unknown. This study aims to employ a systematic review and meta-analysis approach to explore ocular biomarkers measured by OCT for detecting depression.

METHODS AND ANALYSIS

We will search studies describing the relationship between OCT and depression across seven electronic databases, and retrieve articles published from database inception to date. We will also manually search grey literature and reference lists included in the retrieved studies. Two independent reviewers will screen studies, extract data and assess risk of bias. Target outcomes will include peripapillary retinal nerve fibre layer thickness, macular ganglion cell complex thickness and macular volume, as well as other related indicators. Next, we will conduct subgroup analysis and meta-regression to explore study heterogeneity, then perform sensitivity analysis to investigate the robustness of the synthesised results. Meta-analysis will be performed using Review Manager (V.5.4.1) and STATA (V.12.0), and the certainty of evidence will be graded according to the Grading of Recommendations Assessment, Development and Evaluation system.

ETHICS AND DISSEMINATION

Ethics approval is not necessary because the data used in this systematic review and meta-analysis will be extracted from published studies. Study results will be disseminated by publishing our findings in a peer-reviewed journal.

A cross-sectional study of the impact of the COVID-19 pandemic on an ophthalmology consult service in four Michigan community hospitals

Purpose

During the coronavirus disease 2019 (COVID-19) pandemic, private practice, inpatient consult services, and academic residency programs in ophthalmology saw a decrease in patient encounters. This study elucidates how community hospital ophthalmology consult (OC) services were affected during the pandemic. We aim to determine whether there was a change in resident OC volume in a community-based ophthalmology program consult service during the COVID-19 pandemic. Secondary objectives included analyzing the change in the types of diagnoses and the number of patients seen for diabetic retinopathy over the same time.

Methods

A retrospective cross-sectional study was conducted reviewing the electronic health record (EHR) charts from OCs for the period 2017-2021. Records were categorized by referral source and the nature of OCs (trauma, acute, or chronic); OCs were further grouped by year and weak of referral. An intermonth analysis of weekly OC counts in each category was performed for the average number of consults in February-April 2017-2019 and for February-April 2020. A one-tailed t-test was performed. All t-tests assumed equal variances.

Results

Weekly OCs in 2020 revealed no statistically significant differences in overall cases or in acute or chronic cases when the volume before the COVID-19 pandemic was compared to the volume after the onset of the pandemic. However, a statistically significant increase in the average weekly trauma cases was noted when 2020 (an average of 2.7 cases per week) was compared to the weekly average for the same weeks of years 2017- 2019 (0.4; P = 0.016). This statistically significant increase in trauma in 2020 disappeared when comparing weeks 11-17 in 2020 (2.2 cases per week) and the average of 2017-2019 (1.1).

Conclusion

This report outlines no significant change in OCs before and after the onset of the pandemic compared to three previous years. There was, however, an increase in trauma consults during the pandemic and an increase in the number (though not the proportion) of diabetic retinopathy (DR+) patients seen by residents. This report uniquely describes no significant changes in the resident volume of patients seen during the COVID-19 global pandemic.

Joint keypoint detection and description network for color fundus image registration

Background

Retinal imaging is widely used to diagnose many diseases, both systemic and eye-specific. In these cases, image registration, which is the process of aligning images taken from different viewpoints or moments in time, is fundamental to compare different images and to assess changes in their appearance, commonly caused by disease progression. Currently, the field of color fundus registration is dominated by classical methods, as deep learning alternatives have not shown sufficient improvement over classic methods to justify the added computational cost. However, deep learning registration methods are still considered beneficial as they can be easily adapted to different modalities and devices following a data-driven learning approach.

Methods

In this work, we propose a novel methodology to register color fundus images using deep learning for the joint detection and description of keypoints. In particular, we use an unsupervised neural network trained to obtain repeatable keypoints and reliable descriptors. These keypoints and descriptors allow to produce an accurate registration using RANdom SAmple Consensus (RANSAC). We train the method using the Messidor dataset and test it with the Fundus Image Registration Dataset (FIRE) dataset, both of which are publicly accessible.

Results

Our work demonstrates a color fundus registration method that is robust to changes in imaging devices and capture conditions. Moreover, we conduct multiple experiments exploring several of the method's parameters to assess their impact on the registration performance. The method obtained an overall Registration Score of 0.695 for the whole FIRE dataset (0.925 for category S, 0.352 for P, and 0.726 for A).

Conclusions

Our proposal improves the results of previous deep learning methods in every category and surpasses the performance of classical approaches in category A which has disease progression and thus represents the most relevant scenario for clinical practice as registration is commonly used in patients with diseases for disease monitoring purposes.