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BACKGROUND: Incorporation of the rapid advances in ophthalmologic surgical and diagnostic techniques inherent in the field poses a challenge to residency training programs. This study investigates exposure to new technologies during residency and perception of its impact on practice patterns. METHODS: Ophthalmology residents at various training levels and practicing ophthalmologists who had completed their training were invited to participate in a survey study assessing exposure to various technologies in residency and in practice. Data collection occurred from December 2022 to June 2023. Descriptive statistics were performed. RESULTS: The study received 132 unique responses, including 63 ophthalmology residents and 69 practicing ophthalmologists. 65.2% (n = 45) of practicing ophthalmologists and 47.6% (n = 30) of current residents reported discussion/training on newly developed products on the market (e.g. premium IOLS, MIGS), was minimally discussed but not emphasized or not discussed at all in residency. 55.1% (n = 38) of practicing ophthalmologists reported that exposure to new technologies during residency did influence types of technologies employed during practice. The majority resident physicians reported enjoying being trained on newer technology and feeling more prepared for future changes in the field (95.2%, n = 60) and felt that having industry partnerships in residency enhances education and training (90.5%, n = 57). CONCLUSIONS: Considering how to maximize exposure to newer technologies/devices during residency training is important, and may contribute to training more confident, adaptable surgeons, who are more likely to critically consider new technologies and adopt promising ones into their future clinical practice.

Purpose: Automated machine learning (AutoML) allows clinicians without coding experience to build their own deep learning (DL) models. This study assesses the performance of AutoML in detecting and localizing ocular toxoplasmosis (OT) lesions in fundus images and compares it to expert-designed models. Methods: Ophthalmology trainees without coding experience designed AutoML models using 304 labelled fundus images. We designed a binary model to differentiate OT from normal and an object detection model to visually identify OT lesions. Results: The AutoML model had an area under the precision-recall curve (AuPRC) of 0.945, sensitivity of 100%, specificity of 83% and accuracy of 93.5% (vs. 94%, 86% and 91% for the bespoke models). The AutoML object detection model had an AuPRC of 0.600 with a precision of 93.3% and recall of 56%. Using a diversified external validation dataset, our model correctly labeled 15 normal fundus images (100%) and 15 OT fundus images (100%), with a mean confidence score of 0.965 and 0.963, respectively. Conclusion: AutoML models created by ophthalmologists without coding experience were comparable or better than expert-designed bespoke models trained on the same dataset. By creatively using AutoML to identify OT lesions on fundus images, our approach brings the whole spectrum of DL model design into the hands of clinicians. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusion To validate the performance of autonomous diabetic retinopathy (DR) grading by comparing a human grader and a self‐developed deep‐learning (DL) algorithm with gold‐standard evaluation.We included 500, 6‐field retinal images graded by an expert ophthalmologist (gold standard) according to the International Clinical Diabetic Retinopathy Disease Severity Scale as represented with DR levels 0–4 (97, 100, 100, 103, 100, respectively). Weighted kappa was calculated to measure the DR classification agreement for (1) a certified human grader without, and (2) with assistance from a DL algorithm and (3) the DL operating autonomously. Using any DR (level 0 vs. 1–4) as a cutoff, we calculated sensitivity, specificity, as well as positive and negative predictive values (PPV and NPV). Finally, we assessed lesion discrepancies between Model 3 and the gold standard.As compared to the gold standard, weighted kappa for Models 1–3 was 0.88, 0.89 and 0.72, sensitivities were 95%, 94% and 78% and specificities were 82%, 84% and 81%. Extrapolating to a real‐world DR prevalence of 23.8%, the PPV were 63%, 64% and 57% and the NPV were 98%, 98% and 92%. Discrepancies between the gold standard and Model 3 were mainly incorrect detection of artefacts (n = 49), missed microaneurysms (n = 26) and inconsistencies between the segmentation and classification (n = 51).While the autonomous DL algorithm for DR classification only performed on par with a human grader for some measures in a high‐risk population, extrapolations to a real‐world population demonstrated an excellent 92% NPV, which could make it clinically feasible to use autonomously to identify non‐DR patients. [ABSTRACT FROM AUTHOR]

The year 2024 marks the 170th anniversary of the journal Graefe's Archive for Clinical and Experimental Ophthalmology. The journal is the first printed journal specializing in ophthalmology, founded by Albrecht von Graefe (1828–1870) in 1854. The reason behind creating the journal was to publish useful clinical information and develop discussion and debate among ophthalmologists and vision scientists. Thanks to its diligence and appropriate selection of published content, the journal has become widely read not only among the German scientific community, but also internationally. The aim of this review article is to present the activities of Graefe's Archive for Clinical and Experimental Ophthalmology during the past 170 years. Key messages: What is known Graefe's Archive for Clinical and Experimental Ophthalmology is the oldest worldwide ophthalmology journal that in 2024 celebrates its 170th anniversary. The journal was founded by Albrecht von Graefe, and after his death continued by other giants in ophthalmology, including Ferdinand von Arlt and Franciscus Cornelius Donders. What is new: There were mostly male editors-in-chief, with Antonia Joussen as the first female editor-in-chief in the long journal's history. This article presents for the first time the complete list of all editors-in-chief in the 170 year long history of the journal. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the possibility of distinguishing between IgG4-related ophthalmic disease (IgG4-ROD) and orbital MALT lymphoma using artificial intelligence (AI) and hematoxylin–eosin (HE) images. Methods: After identifying a total of 127 patients from whom we were able to procure tissue blocks with IgG4-ROD and orbital MALT lymphoma, we performed histological and molecular genetic analyses, such as gene rearrangement. Subsequently, pathological HE images were collected from these patients followed by the cutting out of 10 different image patches from the HE image of each patient. A total of 970 image patches from the 97 patients were used to construct nine different models of deep learning, and the 300 image patches from the remaining 30 patients were used to evaluate the diagnostic performance of the models. Area under the curve (AUC) and accuracy (ACC) were used for the performance evaluation of the deep learning models. In addition, four ophthalmologists performed the binary classification between IgG4-ROD and orbital MALT lymphoma. Results: EVA, which is a vision-centric foundation model to explore the limits of visual representation, was the best deep learning model among the nine models. The results of EVA were ACC = 73.3% and AUC = 0.807. The ACC of the four ophthalmologists ranged from 40 to 60%. Conclusions: It was possible to construct an AI software based on deep learning that was able to distinguish between IgG4-ROD and orbital MALT. This AI model may be useful as an initial screening tool to direct further ancillary investigations. [ABSTRACT FROM AUTHOR]

Purpose: The PERSPECTIVE study was a real-world European, non-interventional, multicenter, observational study that evaluated the effectiveness, tolerability, and safety of ciclosporin A (CsA) 0.1% cationic emulsion (CE) in routine clinical practice as a treatment for adults with severe keratitis and dry eye disease (DED) that remained insufficiently controlled with artificial tears. This sub-analysis examined data from ophthalmology clinics in Germany to provide more precise insights into treatment patterns, outcomes, and clinical decision-making related to CsA 0.1% CE. Methods: Study data were collected from adults starting CsA 0.1% CE (one drop in both eyes at bedtime) and followed up at Week 4, 12, and 24, and Month 12. The primary endpoint was mean change from baseline in corneal fluorescein staining (CFS) score (Oxford Grade Scale) at Month 12. Secondary endpoints examined the severity of ocular signs and symptoms, and adverse events (AEs). Results: A total of 236 patients from 20 ophthalmology clinics in Germany participated in the PERSPECTIVE study (69.9% female; mean age 60.8 years). Following treatment with CsA 0.1% CE, patients experienced significant reductions in CFS score from Week 4, which were maintained through to Month 12 (P < 0.0001). From baseline, 81.6% of patients experienced an improvement in CFS score at Month 12. CsA 0.1% CE provided significant reductions in the severity of eyelid and conjunctival erythema at Month 12 compared with baseline (P < 0.001), as well as significant reductions in the severity of subjective ocular symptoms (all P ≤ 0.015). Safety data were consistent with the known safety profile of CsA 0.1% CE. Tolerability was rated as "satisfactory," "good," or "very good" by 97.2% of physicians and 95.7% of patients. Conclusion: Outcomes in Germany were similar to those reported for the overall European study population and are indicative of the treatment results that ophthalmologists may expect to see with CsA 0.1% CE treatment in real-life clinical practice. Treatment with CsA 0.1% CE provided long-term improvements over 12 months and was generally well tolerated. [ABSTRACT FROM AUTHOR]

This article provides an overview of the historical contributions made by the Babylonians, Ancient Egyptians, Medieval Arabs, and Persians to the understanding and treatment of lacrimal drainage disorders. It highlights the Code of Hammurabi, which contains laws related to lacrimal sac abscesses, and the Ebers Papyrus, which documents treatments for lacrimal sac inflammations. The text also discusses the works of physicians like Al-Razi and Ibn-Sina, who made significant contributions to ophthalmology in the Middle Ages. It emphasizes the importance of understanding these ancient descriptions in their historical context and acknowledges that our understanding of lacrimal diseases has evolved over time. The author concludes by stating that there is still much to learn in this field. [Extracted from the article]

Background: The clinical approach to inherited eye diseases has evolved due to advances in genetic testing methods and treatment opportunities. However, no data are available on the current practices of ophthalmologists in countries, such as Turkey, with higher rates of consanguinity and inherited eye diseases. The aim of this study was to evaluate the current practices, knowledge, and needs of ophthalmologists in Turkey regarding inherited eye diseases. Methods: A 29-item self-administered survey with a branching algorithm was developed through Google Forms. The survey link was sent to 2983 ophthalmologists in Turkey. The survey assessed respondents' occupational characteristics, current practices, knowledge about available diagnostic and therapeutic options, and opinions on improving continuing education and healthcare services. Results: Responses from 414 ophthalmologists (20.8%) were analyzed. The responses suggested that ophthalmologists mainly collaborate with medical geneticists in respect of inherited eye diseases. The majority of ophthalmologists reported a lack of knowledge about genetic diagnostic tests, and approximately 90% of the ophthalmologists thought training after residency was inadequate for inherited eye diseases. Conclusion: This is the most extensive survey exploring ophthalmologists' practice patterns and needs in a setting without specialists or specialized centers in ophthalmic genetics. The results emphasize the need for continued education on updated approaches to inherited eye diseases. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this work is to develop a deep learning (DL) system for rapidly and accurately screening for intraocular tumor (IOT), retinal detachment (RD), vitreous hemorrhage (VH), and posterior scleral staphyloma (PSS) using ocular B-scan ultrasound images. Methods: Ultrasound images from five clinically confirmed categories, including vitreous hemorrhage, retinal detachment, intraocular tumor, posterior scleral staphyloma, and normal eyes, were used to develop and evaluate a fine-grained classification system (the Dual-Path Lesion Attention Network, DPLA-Net). Images were derived from five centers scanned by different sonographers and divided into training, validation, and test sets in a ratio of 7:1:2. Two senior ophthalmologists and four junior ophthalmologists were recruited to evaluate the system's performance. Results: This multi-center cross-sectional study was conducted in six hospitals in China. A total of 6054 ultrasound images were collected; 4758 images were used for the training and validation of the system, and 1296 images were used as a testing set. DPLA-Net achieved a mean accuracy of 0.943 in the testing set, and the area under the curve was 0.988 for IOT, 0.997 for RD, 0.994 for PSS, 0.988 for VH, and 0.993 for normal. With the help of DPLA-Net, the accuracy of the four junior ophthalmologists improved from 0.696 (95% confidence interval [CI] 0.684–0.707) to 0.919 (95% CI 0.912–0.926, p < 0.001), and the time used for classifying each image reduced from 16.84 ± 2.34 s to 10.09 ± 1.79 s. Conclusions: The proposed DPLA-Net showed high accuracy for screening and classifying multiple ophthalmic diseases using B-scan ultrasound images across mutiple centers. Moreover, the system can promote the efficiency of classification by ophthalmologists. [ABSTRACT FROM AUTHOR]

Purpose: While progress was made towards the Vision 2020: The Right to Sight goals, Ethiopia, Ghana, and Zambia fell short of the recommended cataract surgical rate (CSR) on a national level. Post-operative cataract surgical outcomes are also lower compared to other regions. This study aimed to describe perceived barriers to cataract surgical uptake, factors related to surgeon surgical productivity, and surgical offerings in each of these countries. Methods: An online survey was sent to ophthalmologists practicing in Ethiopia, Ghana, and Zambia. Responses were collected between June 25, 2021 and January 30, 2022. Results: Responses were received from 122 ophthalmologists from Ethiopia, Ghana, and Zambia. The estimated participation rate was 47% (122/257). Distance to cataract surgical centres, lack of surgical centres, and lack of surgical equipment were among the top 10 most agreed upon barriers by respondents within each country. Many respondents reported that current financial reimbursement does not incentivise maximum productivity in themselves (56%, 68/122) or their staff (61%, 74/122). Surgeons proposed several ways to improve productivity incentives. Private practice was perceived to have the best reimbursement incentives (77%, 94/122), whereas government hospitals were least agreed upon (4%, 5/122). Discrepancies in timely post-operative refraction and eyeglasses disbursement were reported. Conclusions: Overcoming the identified barriers, improving surgeon productivity, and addressing identified deficits in cataract care will likely reduce the backlog of cataract blindness while ensuring increasingly improved patient outcomes. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to design and test a platform of key performance indicators (KPIs) and indices emphasizing achievements and improvement and helping decision-making. Methods: An operations research study was designed to analyze data from the Hospital Management Information System (HMIS) from July 2017 to June 2018 at the Research Institute of Ophthalmology (RIO), Giza, Egypt. The HMIS data were submitted to reform covering parameters in service delivery and corresponding indicators and indices. Data were grouped into four themes: human resources and outpatient, inpatient, and surgical operations. A total of 14 performance indicators were deployed to four specific indices and total performance indices and applied to six teams of ophthalmologists at RIO. The decision matrices were deliberated to demonstrate achievements and provide recommendations for subsequent improvements. Results: Throughout 1 year, six teams of ophthalmologists (n = 222) at RIO provided the following services: outpatient (n = 116,043), inpatient (n = 8,081), and surgical operations (n = 9,174). Teams 2, 1, and 6 were the top teams in the total performance index. Team 4 had plunges in the outpatient index, and Team 5 faced limitations in the inpatient index. Conclusion: The study provided a model for upgrading the performance of the management information system (MIS) in health organizations. The KPIs and indices were used not only for documenting successful models of efficient service delivery but also as examples of limitations for further support and interventions. [ABSTRACT FROM AUTHOR]

Introduction: Training novice ophthalmology residents on the EyeSi® simulator increases cataract surgery safety. However, there is no consensus regarding how much training residents should perform before their first time on patients. We evaluated the French national training program through the analysis of the learning curves of novice residents. Methods: This prospective multicentric pedagogic study was conducted with French novice residents. Each resident completed the recommended four two-hour training sessions and performed a standardized assessment simulating standard cataract surgery before the first session (A0), at the end of the first (A1), second (A2), third (A3) and fourth (A4) sessions. For each surgical step of each attempt, the following data were collected: score, odometer, completion time, posterior capsular rupture and cumulative energy delivered (ultrasounds) during phacoemulsification. A performance threshold was set at a score of 80/100 for each surgical step, 400/500 for the overall procedure. Only descriptive statistics were employed. Results: Sixteen newly nominated ophthalmology residents were included. Median score progressively increased from 95 [IQR 53; 147]) at A0 to 425 [IQR 411; 451] at A4. Despite a significant progression, the "emulsification" step had the lowest A4 scores 86 [IQR 60; 94] without reduction in completion time, odometer or ultrasounds delivered. The rate of posterior capsular rupture decreased linearly from 75% at A0 to 13% at A4 during "emulsification" and from 69 to 0% during "irrigation and aspiration". At A4, only 25% [8; 53] of residents had > 80 at each step and only 75% [47; 92] had > 400/500 overall. Conclusion: A training program consisting of four two-hour sessions on the EyeSi simulator over four consecutive days effectively enhances the surgical skills of novice ophthalmology residents. Undergoing more training sessions may improve scores and decrease the incidence of surgical complications, particularly at the emulsification step of cataract surgery. The learning curves presented here can reassure residents who are progressing normally and help identify those who need a further personalized training program. Trial registration: ClinicalTrials registration number: NCT05722080 (first submitted 22/12/2022, first posted 10/02/2023). [ABSTRACT FROM AUTHOR]

Objective: To determine the rate of Medicare opt-out among optometrists and ophthalmologists and to contrast the differences in the characteristics and geographic distribution of these populations. Design: A retrospective cross-sectional study. Setting: Using a publicly available Centers for Medicare & Medicaid Services (CMS) data set, we collated data for ophthalmologists and optometrists who opted out in each year between 2005 and 2023. We calculated the rate of opt-out annually in each year window and cumulatively from 2005 to 2023. Comparative analysis was used to identify clinician characteristics associated with opt-out. Main outcomes and measures: Both annual and cumulative rate of ophthalmologist and optometrist opt-out from Medicare. Results: The estimated prevalence of Medicare opt-outs was 0.52% (77/14,807) for ophthalmologists and 0.38% (154/40,526) for optometrists. Ophthalmologists opting out were predominantly male (67.5%), had a longer practice duration (average 31.8 years), and were more often located in urban areas (83.1%), compared to optometrists (53.2% male, average 19.6 years in practice, 59.1% in urban areas, p = 0.04, p<0.001, p<0.001 respectively). Approximately 83% of ophthalmologists were either anterior segment or oculoplastics specialties, while the majority (52.1%) of optometrists were in optometry-only practices; >75% of identified clinicians were in private practice. Geographical distribution across the US showed variable opt-out rates, with the top 3 states including Oklahoma (3.4%), Arizona (2.1%), and Kansas (1.6%) for ophthalmology and Idaho (4.3%), Montana (3.1%), and Wyoming (1.4%) for optometry. Conclusions and relevance: Few ophthalmologists and optometrists opt-out of Medicare but this trend has significantly increased since 2012. Of those who disenrolled from Medicare, 83% of ophthalmologists were in urbanized areas while 41% of optometrists were in non-urbanized areas. Because reasons for Medicare opt-out cannot be solely determined by administrative data, further investigation is warranted given the potential impact on healthcare accessibility. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionsTo compare the long-term outcomes of mucosal-sparing mechanical endoscopic dacryocystorhinostomy (MMED) for primary acquired nasolacrimal duct obstruction (PANDO) with or without silicone intubation.An 11-year follow-up study of the Silicone intubation in Endoscopic Dacryocystorhinostomy (SEND) randomized controlled trial (RCT) was conducted at a university-affiliated dacryology clinic from December 2019 to March 2023. Questionnaires on symptoms, anterior segment examination, endoscopic examination with functional endoscopic dye test (FEDT) and FICI grading, and ostial size measurements using Image J software were performed by a masked ophthalmologist. The primary outcome was surgical success, defined by Munk’s score ≤1 and a positive fluorescein endoscopic dye test. Secondary outcomes included risk factors for failure and outcomes of revision surgeries.Fifty-three of the original 118 patients were evaluated at 155 ± 21 (136–218) months postoperatively. Seventy-seven percent (46/60) ostia remained successful, including 70% (19/27) of unstented and 82% (27/33) of stented ostia (p = .3). Stented ostia had larger size (p = .003), but this did not confer higher success (p = .14). Successful ostia had higher FICI scores and better ostial dynamicity (p < .05). Ostium movement was the only parameter associated with surgical success on multivariate analysis (OR 13.1, p = .01). Four (1 stented) underwent revision MMED, intraoperative mitomycin-C, and 12-week intubation. All revision ostia were functional after 141 ± 43 months.Surgical success of MMED after 11-years was 77%, a notable reduction compared to 96% success at 1-year. Statistical advantage of silicone intubation for primary MMED was not demonstrated, though clinically, stented ostia had a higher success (82% vs 70%). The presence of a dynamic internal common opening was highly associated with long-term surgical success. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to identify clinical guidelines that provide recommendations on prescribing refractive error correction in children, evaluate the overall quality of these guidelines using the Appraisal of Guidelines for REsearch and Evaluation II (AGREE II) tool and subsequently gain consensus on the prescribing recommendations from high‐quality guidelines using the modified Delphi technique. Methods: A comprehensive search for prescribing guidelines was conducted using databases and professional websites. The quality appraisal of eligible guidelines was undertaken by scoring the six AGREE II domains. Subsequently, the modified Delphi technique was used by 10 experts (sub‐specialist optometrists, ophthalmologists and orthoptists) to gain consensus on the prescribing recommendation statements extracted from guidelines that had been identified as high quality. Three rounds were conducted in which agreement of these statements were scored using a 9‐point Likert scale with a free‐text option for any additional comments. Results: Five eligible guidelines were identified. The AGREE II tool demonstrated that the guidelines varied substantially in quality, with only one guideline identified as being of high quality. A total of 168 prescribing statements were reviewed in the Delphi procedure. Of these, 95 statements reached expert consensus as being appropriate prescribing recommendations. Conclusion: There is significant scope for improving current guidelines for prescribing refractive error correction in children. We used the modified Delphi technique to find points of agreement on prescribing recommendations to support professionals prescribing refractive error correction in children. We recommend that further work is needed to address gaps in the guidelines. [ABSTRACT FROM AUTHOR]

The use of atropine is currently one of the most effective methods used to prevent myopia progression. The purpose of this study was to investigate atropine adherence in preschool children with myopia, to explain the context of treatment through caregivers, and to identify barriers and facilitators of using atropine. We conducted in-depth interviews with 60 caregivers of children (parents, kindergarten teachers and nurses) in four different areas ranging from large cities to rural areas in Taiwan. Based on the social ecological theory model, the recorded text was systematically analyzed, extracted, edited and indexed by NVivo 12 Plus. After interviewing caregivers, we determined the barriers and facilitators at the four levels of influence (children, parents, school, and hospital and society). Barriers included the side effects, parental neglect, lack of understanding of long-term drug use, lack of conducive environment, and lack of friendly medical services. Facilitators included overcoming side effects, parental responsibility, myopia progression on treatment adherence, teacher support, management by nurses, navigation by ophthalmologists, and model learning. Hence, establishing a social support network, discussing the experience of individualized drug use in preschool children, and establishing a friendly medical intervention strategy can raise awareness among parents regarding myopia, and improve atropine adherence in preschool children. [ABSTRACT FROM AUTHOR]

ChatGPT, a generative artificial intelligence model, can provide useful and reliable responses in the field of ophthalmology, comparable to those of medical professionals. Twelve frequently asked questions from ophthalmology patients were selected, and responses were generated both in the role of an expert user and a non-expert user. The responses were evaluated by ophthalmologists using three scales: Global Quality Score (GQS), Reliability Score (RS), and Usefulness Score (US), and analyzed statistically through descriptive study, association, and comparison. The results indicate that there are no significant differences between the responses of expert and non-expert users, although the responses from the expert user tend to be slightly better rated. ChatGPT's responses proved to be reliable and useful, suggesting its potential as a complementary tool to enhance health literacy and alleviate the informational burden on healthcare professionals. [ABSTRACT FROM AUTHOR]

Objective: Low-vision quality-of-life (LVQOL) questionnaire was recently translated to Persian. Its model fit and construct validity were assessed by exploratory and confirmatory analysis for adults with visual impairment, before. In this study, we aimed to test the reliability of the Persian LVQOL questionnaire based on Rasch analysis. Methods: Overall, 100 low-vision patients and 100 demographic statue-matched control subjects were participated for evaluating reliability aspects. All the participants were asked to complete the Persian LVQOL questionnaire. The low-vision group was asked to fill out the LVQOL 3 months after rehabilitation to determine how rehabilitation changed the quality of life. Rasch analyses of the survey items were conducted using WINSTEPS. Results: All items fitted the Rasch model. Point-measure correlations values varied from.13 to.70, providing a preliminary indication of adequate construct validity. All factor loadings found more than.4. infit values for all other participants were in the acceptable range. All items obtained infit and outfit MSQ values of < 2.0. Patients' abilities relative to the item difficulty were analyzed. Item difficulty was estimated and item characteristic curves were included. Sufficient unidimensionality, hierarchical order, and equal interval scaring were obtained. Conclusion: The Persian LVQOL questionnaire was reliable enough and it will be valuable in both clinical practice and research. [ABSTRACT FROM AUTHOR]

Most of the vision quality assessment questionnaires are in English. None of the low-vision-related quality-of-life questionnaires have been translated or developed in Persian. It will help Persian optometrists and ophthalmologists to assess improvement of visual function and quality of life during their low-vision rehabilitation programs. In this study, we aimed to translate the low-vision quality-of-life (LVQOL) questionnaire in Persian language and apply exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to assess the construct validity and fit model. Translation and cultural adjustment of the English language LVQOL questionnaire to Persian was undertaken. Overall, 100 low-vision patients were participated to validate and model the assessment questionnaire by both EFA and CFA methods. Complementary EFA and CFA results provide detailed information about item and scale performance of the Persian LVQOL. EFA showed Items 15, 16, and 21 which had factor loadings lower than 0.3. The modified model had the comparative fit index (CFI) and root mean square error of approximation (RMSEA) of 0.89 and 0.06, respectively. The translation, adjustment, and fit analysis of the LVQOL questionnaire into Persian were successful and it will be valuable in both clinical practice and research. [ABSTRACT FROM AUTHOR]

Sometimes even with the best efforts by the eye care worker (ECW), patients cannot be stopped from losing vision even in the best of centers anywhere in the world. However, in developing countries, most vision loss happens in rural and suburban areas away from where ECWs are majorly located due to poor facilities, adverse living conditions, and poverty. Once irreversible blindness happens, rehabilitation should follow. However, the numbers of those who are not referred for rehabilitation by far outstrips those who are, for various reasons. To find out why this is so, 150 ECWs with 1:2 M:F ratio were contacted through Google links sent through WhatsApp groups. Glaucoma was statistically the commonest cause of irreversible blindness (χ2 = 66.17, p -value <.0001) mostly from late presentation (n = 146 of 150 responses, 97.7%). When patients go blind, most (n = 132, 87.4%) of the ECW advise them to go to a blind school (81.2%). Only about a quarter of the respondents properly ensure that they go. A third admitted (n = 78, 39%) that knowing the patients personally improved their willingness to refer. Many do not think the government is doing enough to help the blind (n = 118, 78.7%). Even though many ECWs have given sensitization talks on blindness (124 of 164 responses), very few focus on what happens after blindness occurs (42.4% of respondents). A third of the ECW admitted to not doing enough for the blind in their practice (n = 51, 34%). Majority have, however, heard about The Lens Eye Clinic (TLEC) rehab center, one of the foremost rehabilitation centers for the blind in Nigeria (n = 103, 68.7%). ECW should ensure those who live in rural areas have poor socioeconomic background, less educated, female, elderly, or born blind should have regular screening and awareness programs in the areas of practice to catch the condition on time with provision made for early counseling and support services. [ABSTRACT FROM AUTHOR]

Background and Objectives: Pediatric rhegmatogenous retinal detachment (RRD) represents a challenge for ophthalmologists and vitreoretinal surgeons. In this study, we aim to review the clinical features, and surgical and visual outcomes of pediatric RRD in a tertiary referral center. Materials and Methods: This is a retrospective study using the review of charts for all patients who presented to King Abdul-Aziz University Hospital, Riyadh, Saudi Arabia, from 2005 to 2016. This study included patients 18 years old or younger, had undergone surgical repairs for RRD, and were followed up for 1 year or more. Results: Eighty-nine eyes of 70 children who underwent surgical repair for RRD were included in the current retrospective study. A previous history of intraocular surgeries was present in 31.5%. The majority of cases had known ocular disease or syndromes (n = 58, 65.2%). The majority of eyes which had a primary surgical intervention achieved anatomical success (n = 88). Corneal complications accounted for the majority of complications following primary and secondary surgical interventions. Forty-two percent of the eyes had vision better than 20/200, while thirty-five percent had vision of hand motion or worse. Conclusions: In conclusion, despite the variability in causes of RRD in children, successful anatomical outcomes can be achieved with the proper surgical approach. Visual outcomes are less predictable due to other ocular complications. [ABSTRACT FROM AUTHOR]

Purpose: To develop a simple, subjective, and reliable grading scale for isotretinoin-induced meibography changes. Methods: After analyzing meibography images obtained from systemic isotretinoin users, a grading scale was proposed and named “meibography health score.” The score ranged from 1 to 3, with decreasing gland reflectivity and identifiable margins. A total of 11 medical professionals were asked to grade 10 meibography images obtained from isotretinoin users using the proposed scale and were divided into three groups: (A) ophthalmologists with experience with meibography, (B) ophthalmologists with no experience with meibography, and (C) radiologists. The kappa statistic was determined to test interrater reliability. Results: The overall kappa was approximately 0.64. The kappa scores for Groups A, B, and C were 0.78, 0.59, and 0.90, respectively. Grade 2 had the lowest kappa scores (0.62, 0.35, and 0.82 for A, B, and C, respectively) and grade 3 the highest (0.78, 0.90, and 1.0 for A, B and C, respectively). Furthermore, Group C had the highest kappa scores and Group B the lowest. Conclusion: The meibography health score exhibited good interrater reliability, particularly in severe cases. [ABSTRACT FROM AUTHOR]

Background/Objectives: Lentigo maligna (LM) and lentigo maligna melanoma (LMM) are significant subtypes of melanoma, with an annual incidence of 1.37 per 100,000 people in the U.S. These skin tumors, often found in photo-exposed areas such as the face, are frequently misdiagnosed, leading to delayed treatment or unnecessary excisions, especially in the elderly. Facial melanocytic skin tumors (lentigo maligna—LM/lentigo maligna melanoma—LMM) and their simulators (solar lentigo, pigmented actinic keratosis, seborrheic keratosis and lichen planus-like keratosis) often affect the periocular region. Thus, their diagnosis and management can involve different medical figures, mainly dermatologists and ophthalmologists. This study aimed to evaluate the ability of ophthalmologists to diagnose and manage pigmented skin lesions of the periorbital area. Methods: A multicentric, retrospective, cross-sectional study on a dataset of 79 periorbital pigmented skin lesions with both clinical and dermoscopic images was selected. The images were reviewed by six ophthalmologists and two dermatologists. Descriptive statistics were carried out, and the accuracy, sensitivity, and specificity, with their 95% confidence interval (95% CI), were estimated. Results: Ophthalmologists achieved a diagnostic accuracy of 63.50% (95% CI: 58.99–67.85%), while dermatologists achieved 66.50% (95% CI: 58.5–73.8). The sensitivity was lower for ophthalmologists in respect to dermatologists, 33.3% vs. 46.9%, respectively. Concerning the case difficulty rating, ophthalmologists rated as "difficult" 84% of cases, while for dermatologists, it was about 30%. Management was also consistently different, with a "biopsy" decision being suggested in 25.5% of malignant lesions by ophthalmologists compared with 50% of dermatologists. Conclusions: Ophthalmologists revealed a good diagnostic potential in the identification of periorbital LMs/LMMs. Given progressive population ageing and the parallel increase in facial/periorbital skin tumors, the opportunity to train new generations of ophthalmologists in the early diagnosis of these neoformations should be considered in the next future, also taking into account the surgical difficulty/complexity of this peculiar facial area. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionThe objective of this study was to evaluate the relationship between research activity and National Institutes of Health (NIH) funding status of the United States (US) academic ophthalmologists.A retrospective cross-sectional analysis of bibliometric data was conducted. The NIH Research Portfolio Online Reporting Tools Expenditures and Reports (rePORTER) website was utilized to identify ophthalmology departments in the US that received NIH funding. Affiliated faculty from these institutions were then identified using NIH rePORTER and institutional websites. H-index was calculated using the Scopus database, and the NIH iCite tool was used to determine the Relative Citation Ratio (RCR). The h-index and w-RCR quantified research productivity, while m-RCR measured research impact.Data on 2688 faculty members from 66 departments we re identified, of which 21% were NIH-funded. Faculty members who received NIH-funding had significantly greater research productivity and impact as measured by h-index (32.5 vs 16.6; p < .001), m-RCR (2.2 vs 1.6; p < .001), and w-RCR (147.2 vs 70.1; p < .001) than their non-funded peers. When stratified by academic rank, NIH-funded faculty still had significantly higher h-index (16.1 vs 7.9; p < .001), m-RCR (2.2 vs 1.4; p < .001), and w-RCR (63.2 vs 61.8; p < .001) than non-funded peers. A similar trend was observed among non-tenured faculty members.NIH funding is associated with higher research productivity and impact among US academic ophthalmologists as measured by h-index and RCR, which suggests that NIH funding may be a critical factor in enhancing scholarly contributions of ophthalmologists.  These findings underscore the importance of continued investment in NIH funding to foster high-impact research within the field of ophthalmology. [ABSTRACT FROM AUTHOR]

Background: In the current period, competition among the healthcare sector has increased and healthcare providers try to get loyalty and satisfy the patients by establishing different strategies. Purpose: : This current study aims to discover ophthalmology practice-related factors and patient loyalty and to analyze the mediating role of patient satisfaction in private ophthalmology services in various private centers in the Kingdom of Saudi Arabia. Methods: : The nature of the study is quantitative, and data is collected with a questionnaire. We used a pre-tested questionnaire that was divided into different sections assessing ophthalmology practice-related factors, patient satisfaction, and patient loyalty. These were measured using a 5-point Likert scale, focusing on financial aspects, access to facilities, staff services, and ophthalmologist services. Further, the smartPLS technique was used to extract the results by using SmartPLS. Results: : The analysis sample size consisted of 323 participants from Saudi Arabia. The results found that ophthalmologist service has a positive relationship with patient satisfaction (β= 0.369, p = 0.000) as well as patient loyalty (β= 0.234, p = 0.004), but there are some ophthalmology practice-related factors such as financial aspects, access and facilities, and staff service, which showed no relationship with patient loyalty but a positive relationship with patient satisfaction. Further analysis found that patient satisfaction as a mediator has a positive relationship between ophthalmology practice-related factors, namely, ophthalmologist service (β= 0.228, P= 0.000), financial aspects (β= 0.102, p = 0.019), access and facilities (β= 0.109, p =0.000), and staff service (β= 0.188, p = 0.000) with patient loyalty. Conclusion: : The present study findings reveal the importance of focused patient satisfaction improvements in enhancing patient loyalty within ophthalmological clinic settings in Saudi Arabia. Furthermore, we recommend future exploratory prospective research to find the satisfaction and loyalty factors that change over a period of time. [ABSTRACT FROM AUTHOR]

Objectives: Behçet uveitis (BU) is a potentially blinding disorder. The main determinant of visual prognosis is early and appropriate treatment that provides rapid suppression of inflammatory attacks, control of subclinical inflammation, and prevention of new attacks. Our study aimed to determine the Turkish uveitis specialists' approach regarding the treatment choices and management of special situations such as pregnancy, vaccination, and surgical planning in BU patients, and to increase information sharing and raise awareness of issues where knowledge is lacking. Materials and Methods: A web-based survey including 16 questions about the treatment approach in ocular involvement of Behçet's disease was sent via e-mail to uveitis specialists in Türkiye. Based on the answers of 49 ophthalmologists who responded to the survey, we evaluated the approaches of uveitis specialists in our country to initiating treatment, selecting therapeutic agents, monitoring, switching and stopping treatment, and special situations such as surgical planning, vaccination, and pregnancy in BU patients. Results: Uveitis specialists in our country mostly act in accordance with the guidelines in the decision to start treatment, selection of therapeutic agents, and monitoring the safety of treatment in BU. However, there is a lack of information about the therapeutic approach in pregnancy and vaccination practices. It was also observed that there is no consensus on the precautions to be taken before cataract surgery. Conclusion: Our study has shown that there is a need for more detailed and widespread information sharing on treatment in preparation for ocular surgery, safety monitoring, drug use during pregnancy, and vaccination in BU patients. [ABSTRACT FROM AUTHOR]

Background: Dupilumab has been shown to be an effective treatment in moderate‐to‐severe atopic dermatitis (AD) and severe asthma (SA). However, comparative real‐world analyses of adverse events (AE), particularly dupilumab‐associated ocular surface disease (DAOSD), are lacking. Objective: This is the first real‐world study to provide insight into the prevalence of AEs associated with dupilumab in AD compared with SA. Secondary objectives were to assess the prevalence, onset and therapeutic strategies of DAOSD and evaluate dupilumab discontinuation rates. Methods: Data from two daily practice registries including AD and SA patients receiving dupilumab treatment were analyzed. Adverse events, including DAOSD, were evaluated. Results: In total, 322 AD and 148 SA patients were included. Headaches (23.6%), injection site reactions (10.1%), and influenza‐like symptoms (13.5%) were more prevalent in SA patients. Interestingly, ocular AEs were significantly more prevalent in AD patients (62.1%, p < 0.001), including conjunctivitis (17.1%, p = 0.004). 88% AD and 47% SA patients with ocular AEs received one or more ophthalmic treatment(s). Additionally, 20% of AD and 17.6% of SA patients discontinued dupilumab treatment due to ocular AEs, while only 65% of these AD and none of these SA patients were referred to an ophthalmologist. Conclusion: The higher incidence of DAOSD in AD patients compared with SA patients in this real‐world study highlights the importance of physician awareness, especially when prescribing dupilumab to AD patients. Conversely, the findings of this study help alleviate potential concerns about ocular AEs in patients with SA who do not have comorbid AD. Furthermore, the effective management of most ocular AEs with ophthalmic treatments suggests favorable tolerability of dupilumab in daily practice, and multidisciplinary collaboration is essential to proactively manage ocular AEs before discontinuing dupilumab. [ABSTRACT FROM AUTHOR]

Background: Gender disparities in the field of ophthalmology have been increasingly recognized. Although mentorship has been proposed as a contributing factor, there are limited data on the differences in mentorship experiences by gender among ophthalmologists. Objective: The purpose of this study was to evaluate gender disparities in mentorship experiences among ophthalmologists, and the impact of mentorship disparities on career outcomes. Design: Prospective, cross-sectional study. Setting: Web-based survey distributed through ophthalmology listservs. Participants: Ophthalmologists and ophthalmologists-in-training who completed the survey. Exposure: Training and practicing in the field of ophthalmology. Main Outcome Measures: Mentorship score based on 10 items from a previously published scale of mentorship quality and self-reported career outcomes (income, job satisfaction, achievement of career goals, and support to achieve future career goals). Results: We received survey responses from 202 male and 245 female ophthalmologists. Female ophthalmologists reported significantly lower mentorship satisfaction and worse quality of mentorship (p < 0.03). Female ophthalmologists also reported significantly lower income, worse job satisfaction, and lower rates of goal achievement and support to achieve future goals; all of these career outcomes, except income level, were partly mediated by mentorship score (mediation effect ranged from 29% to 68%, p < 0.014). Conclusions and Relevance: Gender-based inequities in achievement of career goals and job satisfaction are partly mediated by disparities in mentorship. Therefore, focused mentorship of women in ophthalmology at all career stages is imperative to reduce these inequities. [ABSTRACT FROM AUTHOR]

To study geographic patterns in ophthalmologist supply and patient demand for services in the United States. Google Trends data for the keywords "ophthalmology" and "ophthalmologist" between 2004 and 2019 were queried and normalized to determine relative search volumes (RSV) for each United States state. Ophthalmologist density was calculated by dividing the number of practicing ophthalmologists by the State Census Bureau population estimates. RSV values were divided by ophthalmologist density and normalized to calculate the relative demand index (RDI) for each state. The number of accredited ophthalmology programs per state was acquired through the Accreditation Council for Graduate Medical Education. Ophthalmologist concentration was highly heterogeneous across the country. The states with the highest concentration of ophthalmologist per 10,000 people were Washington, DC (1.42), Maryland (0.94), Massachusetts (0.87), and New York (0.86), while the lowest were Wyoming (0.19), Idaho (0.36), New Mexico (0.38), and Nevada (0.39). RSVs ranged from 36 (Alaska and North Dakota) to 100 (Michigan). The highest RDI was found in South Dakota (100), Delaware (84), Michigan (66), and Arizona (56). The lowest RDI was in Washington, DC (0), Hawaii (7), Oregon (8), and Montana (14). The highest number of ophthalmology residency programs were in New York (18), Texas (9), and California (9), whereas 12 states lacked residency programs altogether. In this study, we found a wide range in the geographic distribution of ophthalmologists and residency programs in the United States. States with the highest relative demand index may represent areas most at risk of unmet medical needs. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion To evaluate current practice patterns of Immediate Sequential Bilateral Cataract Surgery (ISBCS) by ophthalmologists in Singapore and assess their attitudes towards performing ISBCS in future cataract care.An anonymised electronic survey, modified to local context from a similar study conducted in the United Kingdom, was distributed to members of the College of Ophthalmologists, Academy of Medicine, Singapore, from 20 June to 1 September 2023. An initial screening question on prior experience with ISBCS directed the rest of the survey. Questions explored ophthalmologists' current ISBCS practice patterns and the importance of factors affecting their willingness to perform ISBCS. Results were descriptively analysed.Results collated 2 months upon survey dissemination saw a total of 58 respondents from 235 eligible members (24.7% response rate). Of these, 16 (27.6%) were currently performing ISBCS, 37 (63.8%) had never performed, and 5 (8.6%) had stopped performing. In considering ISBCS, patient convenience (n = 11, 68.8%) and reduced hospital visits (n = 8, 50.0%) were the most important factors nominated. The most important barriers to performing ISBCS were medico‐legal issues (n = 31, 83.8%) and risk of endophthalmitis (n = 27, 73.0%), followed by perceived lack of evidence for its effectiveness (n = 19, 51.4%).This is one of the first studies evaluating ophthalmologists' sentiments towards performing ISBCS in an Asian country. It highlights some of the most pertinent barriers and concerns that ophthalmologists face in performing and offering ISBCS. This study provides a better understanding of the potential role and prospects of ISBCS in future cataract care in Singapore. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the effects of an eye care protocol (ECP) on patients in the intensive care unit (ICU). Methods: This study utilized a randomized controlled design. Participants were patients who met the inclusion criteria and were admitted to the ICU (36 in the experimental group and 38 in the control group). The experimental group received an ECP, while the control group received standard eye care, starting the day after admission, for a duration of 10 days. The ECP classifies the degree of eyelid obstruction into three stages based on the degree of exposure to the lower eyelid conjunctiva and cornea. The protocol included cleansing with normal saline gauze, administering eye drops, applying silicone and polyurethane films, and recommending consultation with an ophthalmologist if necessary. The effectiveness of ECP was assessed by analyzing tear volume, hyperemia, chemosis, and eye discharge. Data analysis was conducted using SPSS 27.0, employing the Mann-Whitney U-test and generalized estimating equations. Results: On day 5, the experimental group demonstrated a significant increase in tear volume in both eyes compared with the control group. However, no statistically significant differences were observed in the incidence of hyperemia, chemosis, and eye discharge on days 5 and 10 of the intervention. Conclusion: The application of the ECP in this study increased tear volume in ICU patients, thereby reducing discomfort caused by dry eyes. It has the potential to prevent complications such as damage to the surface of the eyeball resulting from decreased tear volume. [ABSTRACT FROM AUTHOR]

Cataract surgery is the most commonly performed eye surgical procedure. Many ophthalmologists choose phacoemulsification as a cataract surgery procedure. The phacoemulsification technique has many advantages for both the operator and the patient. The main advantages are the smaller incision size, which minimizes tissue damage, lacks inflammation and postoperative pain, and provides faster refractive stabilization with minimal astigmatism due to surgery. The presence of smaller incised wounds in this phacoemulsification technique allows for faster wound healing. The aim of this study was to determine and obtain an overview of wound healing in clear cornea incisions for cataract patients after phacoemulsification surgery on control days 1, 3, and 7 at Hasanuddin University Makassar State University Hospital in February 2021. This study used a prospective cohort research design by collecting patient data on days 1, 3, and 7 after the phacoemulsification procedure. The sample consisted of six men and four women, with an average age of 48.9 years. The patient's vision is typically at the counting finger level, i.e. 70%, with the remaining 30% at the hand movement level. On day 7, a wound healing image of a clear corneal incision in a patient after phacoemulsification surgery shows significant changes in the anterior segment OCT image. [ABSTRACT FROM AUTHOR]

This document contains summaries of various research studies and case reports in the field of veterinary ophthalmology. The studies cover a range of topics, including the prevalence of vision and hearing impairments in companion dogs, genetic investigations of retinal diseases in specific dog breeds, the use of deep learning to classify bovine retinal images, and the outcomes of different treatments for glaucoma in animals. The case reports discuss various eye conditions and their management in different animal species. These summaries provide valuable insights into ophthalmic diseases and treatment options in animals, making them useful for researchers and veterinarians interested in this field. [Extracted from the article]

Background: As global aging intensifies, the prevalence of ocular fundus diseases continues to rise. In China, the tense doctor-patient ratio poses numerous challenges for the early diagnosis and treatment of ocular fundus diseases. To reduce the high risk of missed or misdiagnosed cases, avoid irreversible visual impairment for patients, and ensure good visual prognosis for patients with ocular fundus diseases, it is particularly important to enhance the growth and diagnostic capabilities of junior doctors. This study aims to leverage the value of electronic medical record data to developing a diagnostic intelligent decision support platform. This platform aims to assist junior doctors in diagnosing ocular fundus diseases quickly and accurately, expedite their professional growth, and prevent delays in patient treatment. An empirical evaluation will assess the platform's effectiveness in enhancing doctors' diagnostic efficiency and accuracy. Methods: In this study, eight Chinese Named Entity Recognition (NER) models were compared, and the SoftLexicon-Glove-Word2vec model, achieving a high F1 score of 93.02%, was selected as the optimal recognition tool. This model was then used to extract key information from electronic medical records (EMRs) and generate feature variables based on diagnostic rule templates. Subsequently, an XGBoost algorithm was employed to construct an intelligent decision support platform for diagnosing ocular fundus diseases. The effectiveness of the platform in improving diagnostic efficiency and accuracy was evaluated through a controlled experiment comparing experienced and junior doctors. Results: The use of the diagnostic intelligent decision support platform resulted in significant improvements in both diagnostic efficiency and accuracy for both experienced and junior doctors (P < 0.05). Notably, the gap in diagnostic speed and precision between junior doctors and experienced doctors narrowed considerably when the platform was used. Although the platform also provided some benefits to experienced doctors, the improvement was less pronounced compared to junior doctors. Conclusion: The diagnostic intelligent decision support platform established in this study, based on the XGBoost algorithm and NER, effectively enhances the diagnostic efficiency and accuracy of junior doctors in ocular fundus diseases. This has significant implications for optimizing clinical diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Purpose: To develop a machine learning based diabetic retinopathy screening system to help ophthalmologists for initial level screening. Study Design: Diagnostic accuracy study. Place and Duration of Study: Haldwani in a private hospital from January 2023 to June, 2023. Methods: A total of 229 fundus images (people suffering from diabetic retinopathy)were used which had micro aneurysms, soft exudates, hard exudates and hemorrhages. We classified these images and pre-processed them by scaling, orienting, and color adjustments. With the help of various pre-processing techniques, we decreased the size of our dataset so that it can be handled efficiently by our model with optimal resources. Visual Geometry Group (VGG) is a type of pre-trained deep convolutional neural network (CNN). The term “deep” refers to the number of layers; the VGG-16 uses 16 and VGG-19 uses 19 convolutional layers respectively. The model was tested on fresh retinal dataset. Results: Our research has demonstrated promising results, achieving a high accuracy rate of 90% on a human dataset by utilizing VGG16 for feature extraction and a Logistic Regression classifier for classification. Conclusion: Ophthalmologists can utilize this machine learning based screening system for diabetic retinopathy screening. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to assess quality of surgical training videos for management of open globe injury (OGI) on online platforms. Material and Methods: Twenty-three websites with surgical training videos were queried using the search keyword "open globe repair." Video content characteristics and quality assessment scores using Sandvik score, Health on the Net Foundation Code of Conduct (HON code), mDISCERN scoring, and global quality score (GQS) were recorded. To evaluate the relevance of the surgical videos to the surgical procedure, steps were analyzed as per the Ophthalmology Surgical Competency Assessment Rubric (OSCAR) for Open Globe Surgical Management. Results: One hundred and twenty-three videos were evaluated, and 63 analyzed. Majority videos were uploaded by solitary ophthalmologists (53/63; 84.13%). Mean video quality score (VQS) and GIS scores were 6.55 ± 1.59 and 7.95 ± 1.39, respectively. Mean mDISCERN, GQS, HON Code and Sandvik scores for all the videos were 2.87 ± 1.07, 3.77 ± 1.08, 5.14 ± 1.67, 12.06 ± 1.84, respectively. Videos with background audio and descriptive subtitles had significantly better quality (p < 0.05). All Quality assessment scores showed a statistically significant (p < 0.000) positive correlation with each other. On linear regression analysis, number of video likes, comments and views had a significant (p < 0.05) positive relation with quality of video, whereas video length showed a negative relation with different scores. Conclusion: Nearly two-thirds of surgical videos showing OGI repair had good quality assessment scores. Consensus guidelines should be developed to guide uploaders as regards the essential features required for good quality surgical videos using a standardized rubric. [ABSTRACT FROM AUTHOR]

The integration of artificial intelligence (AI) in ophthalmology has promoted the development of the discipline, offering opportunities for enhancing diagnostic accuracy, patient care, and treatment outcomes. This paper aims to provide a foundational understanding of AI applications in ophthalmology, with a focus on interpreting studies related to AI-driven diagnostics. The core of our discussion is to explore various AI methods, including deep learning (DL) frameworks for detecting and quantifying ophthalmic features in imaging data, as well as using transfer learning for effective model training in limited datasets. The paper highlights the importance of high-quality, diverse datasets for training AI models and the need for transparent reporting of methodologies to ensure reproducibility and reliability in AI studies. Furthermore, we address the clinical implications of AI diagnostics, emphasizing the balance between minimizing false negatives to avoid missed diagnoses and reducing false positives to prevent unnecessary interventions. The paper also discusses the ethical considerations and potential biases in AI models, underscoring the importance of continuous monitoring and improvement of AI systems in clinical settings. In conclusion, this paper serves as a primer for ophthalmologists seeking to understand the basics of AI in their field, guiding them through the critical aspects of interpreting AI studies and the practical considerations for integrating AI into clinical practice. [ABSTRACT FROM AUTHOR]

Background: Color vision deficiency (CVD) is an often-overlooked issue within the medical community, and its consequences remain insufficiently explored. We aim to evaluate how CVD affects diagnostic accuracy and distinguish between malignant choroidal melanoma and benign choroidal nevus among ophthalmologists. Methods: In this cross-sectional study, we engaged ophthalmologists through a web-based survey distributed via the professional ophthalmology society's social media channels. The survey encompassed a series of three fundus images representing normal fundus, choroidal nevus, and choroidal melanoma. Each image underwent simulation for the three primary types of CVD—protanopia, deuteranopia, and tritanopia—alongside a non-simulated version. Results: The study included 41 participants, averaging 40 years of age (±9.2), comprising 28 (68%) men and 13 (32%) women. Significantly lower rates of identifying orange pigments were observed in simulated protanopia images compared to non-simulated ones (p = 0.038). In simulated deutranopia images, the recognition of melanotic lesions was notably reduced compared to non-simulated images (p = 0.048). No such limitation was observed for tritanopia. However, participants retained their ability to identify subretinal fluid and estimate tumor thickness in simulated and non-simulated images. Concerning simulated images of choroidal nevi, participants misdiagnosed nevi as choroidal melanoma in 37% of cases in simulated protanopia nevi images and 41% in simulated deutranopia nevi images. This resulted in unnecessary referrals of benign lesions as malignant, emphasizing the potential for mistaken diagnoses. Nevertheless, almost all simulated images of malignant melanoma were correctly referred for specialized oncological treatment. Conclusions: The simulated CVD conditions of protanopia and deuteranopia affected the accuracy of identifying the melanotic nature of the choroidal tumor and the presence of orange pigments. This limitation led to challenges in correctly diagnosing choroidal melanoma and choroidal nevus, resulting in extra referrals for nevus cases. However, participants were safe and could still determine the possible risk of eyes with choroidal melanoma, so most referred melanoma cases to specialized oncologists as needed. [ABSTRACT FROM AUTHOR]

Featured Application: This study assesses the diagnostic accuracy of non-mydriatic FP vs. OCT in posterior pole screenings; it determines the level of agreement between optometrist and ophthalmologist in the assessment of retinal abnormalities. It aims to prevent avoidable cases of blindness or low vision in the relevant population by achieving the better and wider detection of pathologies of the posterior pole. (1) Background: This study aimed to determine the diagnostic accuracy that optical coherence tomography (OCT) can add to fundus photography (FP) in assessing the condition of the retinal posterior pole. (2) Methods: We conducted two blocks of analysis: First, the posterior pole of each eye was examined using an FP non-mydriatic imaging device. Second, OCT was used in addition to FP. After consolidating the specific diagnostic criteria, the assessments were evaluated using two blinded independent investigation groups (by optometrists, and by ophthalmologists who were considered the gold standard). (3) Results: We calculated the diagnostic accuracy of FP compared to OCT and found that they had similar sensitivity. FP had a slightly higher specificity (p-value: 0.01), and OCT had a higher kappa coefficient with 0.50 (95% CI: 0.46–0.55) vs. 0.39 (95% CI: 0.34–0.45) for FP. (4) Conclusions: On the basis that the role of the optometrist in Spain is not to diagnose but to detect lesions and refer patients to an ophthalmologist, the results of this study support the use of OCT, which provided gradable images in almost all examined eyes (97.5%), compared to FP (73.5%). However, optometrists need a detailed and standardized guide in order to conduct evaluations according to the ophthalmologist's criteria. [ABSTRACT FROM AUTHOR]

Unexpected anesthesia-related complications are among the most feared outcomes of ambulatory surgery. One potential culprit is pseudocholinesterase deficiency, which most commonly presents with protracted apnea, necessitating prolonged mechanical ventilation. We report the first case of pseudocholinesterase deficiency in a Bengali person and the first systematic review of pseudocholinesterase deficiency in ophthalmology. This review analyzed the epidemiology, etiologies, presentation, evaluation, and treatment of pseudocholinesterase deficiency. Searches were conducted in PubMed, Embase, and Medline through August of 2022 for publications related to pseudocholinesterase deficiency in ophthalmology. In total, 689 studies were screened by two independent reviewers with 26 full-text articles examined for inclusion eligibility. Nineteen studies were eligible and included in the final analysis. Of the 16 identified cases of pseudocholinesterase deficiency, nine (56%) were drug-induced, four (25%) were inherited deficiencies, and in one (6%) of the cases, the cause could not be determined. In two (13%) cases, pseudocholinesterase deficiency could not be confirmed or ruled out. The duration of post-operative apnea ranged from 10 minutes to 14 hours. Continued ventilatory support was the main treatment for all cases and all patients made a full recovery. Pseudocholinesterase deficiency is a rare, but potentially fatal, anesthetic complication that results in prolonged apnea, respiratory distress, and dependency on ventilators. Ophthalmologists should remain aware of this condition, especially when planning outpatient procedures, as ambulatory centers may have limited resources for managing prolonged post-operative complications. [ABSTRACT FROM AUTHOR]

Background: Large language models (LLMs) are becoming increasingly important as they are being used more frequently for providing medical information. Our aim is to evaluate the effectiveness of electronic artificial intelligence (AI) large language models (LLMs), such as ChatGPT-4, BingAI, and Gemini in responding to patient inquiries about retinopathy of prematurity (ROP). Methods: The answers of LLMs for fifty real-life patient inquiries were assessed using a 5-point Likert scale by three ophthalmologists. The models' responses were also evaluated for reliability with the DISCERN instrument and the EQIP framework, and for readability using the Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), and Coleman-Liau Index. Results: ChatGPT-4 outperformed BingAI and Gemini, scoring the highest with 5 points in 90% (45 out of 50) and achieving ratings of "agreed" or "strongly agreed" in 98% (49 out of 50) of responses. It led in accuracy and reliability with DISCERN and EQIP scores of 63 and 72.2, respectively. BingAI followed with scores of 53 and 61.1, while Gemini was noted for the best readability (FRE score of 39.1) but lower reliability scores. Statistically significant performance differences were observed particularly in the screening, diagnosis, and treatment categories. Conclusion: ChatGPT-4 excelled in providing detailed and reliable responses to ROP-related queries, although its texts were more complex. All models delivered generally accurate information as per DISCERN and EQIP assessments. [ABSTRACT FROM AUTHOR]

In this study, we propose a generative data augmentation technique to overcome the challenges of severely limited data when designing a deep learning-based automated strabismus diagnosis system. We implement a generative model based on the StyleGAN2-ADA model for system design and assess strabismus classification performance using two classifiers. We evaluate the capability of our proposed method against traditional data augmentation techniques and confirm a substantial enhancement in performance. Furthermore, we conduct experiments to explore the relationship between the diagnosis agreement among ophthalmologists and the generation performance of the generative model. Beyond FID, we validate the generative samples on the classifier to establish their practicality. Through these experiments, we demonstrate that the generative model-based data augmentation improves overall quantitative performance in scenarios of extreme data scarcity and effectively mitigates overfitting issues during deep learning model training. [ABSTRACT FROM AUTHOR]