Assessment of a Large Language Model's Responses to Questions and Cases About Glaucoma and Retina Management.

Importance: Large language models (LLMs) are revolutionizing medical diagnosis and treatment, offering unprecedented accuracy and ease surpassing conventional search engines. Their integration into medical assistance programs will become pivotal for ophthalmologists as an adjunct for practicing evidence-based medicine. Therefore, the diagnostic and treatment accuracy of LLM-generated responses compared with fellowship-trained ophthalmologists can help assess their accuracy and validate their potential utility in ophthalmic subspecialties. Objective: To compare the diagnostic accuracy and comprehensiveness of responses from an LLM chatbot with those of fellowship-trained glaucoma and retina specialists on ophthalmological questions and real patient case management. Design, Setting, and Participants: This comparative cross-sectional study recruited 15 participants aged 31 to 67 years, including 12 attending physicians and 3 senior trainees, from eye clinics affiliated with the Department of Ophthalmology at Icahn School of Medicine at Mount Sinai, New York, New York. Glaucoma and retina questions (10 of each type) were randomly selected from the American Academy of Ophthalmology's commonly asked questions Ask an Ophthalmologist. Deidentified glaucoma and retinal cases (10 of each type) were randomly selected from ophthalmology patients seen at Icahn School of Medicine at Mount Sinai-affiliated clinics. The LLM used was GPT-4 (version dated May 12, 2023). Data were collected from June to August 2023. Main Outcomes and Measures: Responses were assessed via a Likert scale for medical accuracy and completeness. Statistical analysis involved the Mann-Whitney U test and the Kruskal-Wallis test, followed by pairwise comparison. Results: The combined question-case mean rank for accuracy was 506.2 for the LLM chatbot and 403.4 for glaucoma specialists (n = 831; Mann-Whitney U = 27976.5; P < .001), and the mean rank for completeness was 528.3 and 398.7, respectively (n = 828; Mann-Whitney U = 25218.5; P < .001). The mean rank for accuracy was 235.3 for the LLM chatbot and 216.1 for retina specialists (n = 440; Mann-Whitney U = 15518.0; P = .17), and the mean rank for completeness was 258.3 and 208.7, respectively (n = 439; Mann-Whitney U = 13123.5; P = .005). The Dunn test revealed a significant difference between all pairwise comparisons, except specialist vs trainee in rating chatbot completeness. The overall pairwise comparisons showed that both trainees and specialists rated the chatbot's accuracy and completeness more favorably than those of their specialist counterparts, with specialists noting a significant difference in the chatbot's accuracy (z = 3.23; P = .007) and completeness (z = 5.86; P < .001). Conclusions and Relevance: This study accentuates the comparative proficiency of LLM chatbots in diagnostic accuracy and completeness compared with fellowship-trained ophthalmologists in various clinical scenarios. The LLM chatbot outperformed glaucoma specialists and matched retina specialists in diagnostic and treatment accuracy, substantiating its role as a promising diagnostic adjunct in ophthalmology.

Outcome Measures to Assess Dry Eye Severity: A Review.

Outcome measures used to assess efficacy of dry eye therapeutics have not been consistently applied in clinical settings, nor have they been shown to correlate with functional outcomes. We propose that corneal staining, a clinically meaningful dry eye parameter, should be used as a standard objective outcome measure across all clinical trials evaluating dry eye treatments. We justify this based on evidence regarding its relationship to vision and vision related quality-of-life. In addition, corneal staining has been shown to correlate with ocular surface inflammation, a well elucidated aspect of dry eye pathophysiology and an active area in therapeutics research. No one outcome measure explored herein correlates perfectly to this heterogenous disease. However, there is mounting evidence showing the correlation between corneal staining and functional visual indices. We hope that future clinical trials will standardize corneal staining as a measure to determine the efficacy of interventions and justify their clinical utility.

The Efficacy of the After-visit Summary in Medication Recall Among Glaucoma Patients.

PRéCIS:: To assess the after-visit summary (AVS) as a tool for glaucoma medication recall. Medication recall was associated with level of education and complexity of medication regimen. Receiving an AVS was not associated with better medication recall. PURPOSE: The purpose of this study was to determine whether patients given the AVS have better or worse glaucoma medication recall. MATERIALS AND METHODS: Observational clinical study. Adults on ≥1 glaucoma medications examined between June 30, 2017 and August 2, 2017. DATA COLLECTION: in-person questionnaire and retrospective chart review. Self-reported glaucoma medications compared with prescribed glaucoma medication regimen verified by electronic medical record. Medication recall assessed using 3-point scoring: 1 point each for; (1) name or color of bottle or cap; (2) treatment eye(s); and (3) dosing regimen. DATA ANALYSIS: 2-sample Welch t test, 2-proportion z-test, analysis of variance, univariate, and multivariate regression. RESULTS: A total of 118 patients enrolled: age 69.7±12.9 years (mean±SD), 55.9% of patients had received an AVS at the previous visit. Of these, 33.3% reported receiving an AVS, 51.2% reported not receiving one (15.1% did not recall or respond). Patients who had received AVSs had lower medication recall scores than those who did not (2.4±1.0 vs. 2.7±0.6, P=0.04). Receipt of an AVS was associated with having Nisha Chadha as their provider (P=0.01), fewer days since prior visit (P=0.0001), and medication regimen change at prior visit (P<0.0001). Multivariate analysis revealed completion of associate's degree or higher and fewer prescribed medications to be independent predictors of higher recall score (P=0.0002 and 0.002). CONCLUSIONS: AVSs were conceived to enhance patient care. This study indicates this goal is not achieved consistently. Less education and more complex medication regimens were identified as barriers to medication recall. Additional investigations should explore if modifying this document and enhanced explanation of its use will impact medication recall and health outcomes.

Lamellar Macular Hole: Two Distinct Clinical Entities?

PURPOSE: To investigate whether lamellar macular holes can be divided into different subgroups. DESIGN: Retrospective observational case series. METHODS: In this institutional study, clinical charts and spectral-domain optical coherence tomography (OCT) images of 102 eyes of 90 consecutive patients diagnosed with lamellar macular hole were reviewed. In OCT imaging, the presence of lamellar macular hole was defined according to the following findings: presence of irregular foveal contour, separation of the layers of the neurosensory retina, and the absence of full-thickness macular defect. Mean outcome was the morphologic and functional characterization of different subtypes of macular hole. RESULTS: Two different subtypes of lamellar macular hole were identified: tractional and degenerative. The first type, tractional, was diagnosed in 43 eyes, and was characterized by the schitic separation of neurosensory retina between outer plexiform and outer nuclear layers. It often presented with an intact ellipsoid layer and was associated with tractional epiretinal membranes and/or vitreomacular traction. The second type, degenerative, was diagnosed in 48 eyes, and its distinctive traits included the presence of intraretinal cavitation that could affect all retinal layers. It was often associated with nontractional epiretinal proliferation and a retinal "bump." Moreover, it often presented with early ellipsoidal zone defect and its pathogenesis, although chronic and progressive, remains poorly understood. Eleven eyes shared common features with both tractional and degenerative lamellar macular holes and were classified as mixed lesions. CONCLUSIONS: Degenerative and tractional lamellar macular holes may be 2 distinct clinical entities. A revision of the current concept of lamellar macular holes is needed.

Corals and their potential applications to integrative medicine.

Over the last few years, we have pursued the use and exploitation of invertebrate immune systems, most notably their humoral products, to determine what effects their complex molecules might exert on humans, specifically their potential for therapeutic applications. This endeavor, called "bioprospecting," is an emerging necessity for biomedical research. In order to treat the currently "untreatable," or to discover more efficient treatment modalities, all options and potential sources must be exhausted so that we can provide the best care to patients, that is, proceed from forest and ocean ecosystems through the laboratory to the bedside. Here, we review current research findings that have yielded therapeutic benefits, particularly as derived from soft and hard corals. Several applications have already been demonstrated, including anti-inflammatory properties, anticancer properties, bone repair, and neurological benefits.

Origin of innate immune responses: revelation of food and medicinal applications.

Much is known about the strong ecological impact that earthworms ( Qiu Yǐn; Pheretima) have on soil in terms of fertility, nutrient production, and tilling. Even more interesting though is the impact they have had on our understanding of innate immunity, and from this discovery, there has been a simultaneous recognition of their potential through their historical use as food and their use in treatment of certain chronic health problems that often afflict humans. This bifurcating growing knowledge base has stemmed from centuries of honing and practicing traditional and complementary forms of medicine such as Ayurveda (India) Traditional Chinese Medicine (China), Kampo (Japan), and Traditional Korean Medicine (Korea). Earthworms (Dilong) have also been credited as a model for research concerning the nervous and endocrine systems. One of the reasons behind the earthworm's tremendous impact on research into these biomedical endeavors is partly due to its lack of ethical restrictions, like those imposed on vertebrate models. Using invertebrate models as opposed to mice or other mammalian models bypasses ethical concerns. Moreover, financial constraints consistently hover over biological research that requires living subjects, preferably mammals. Earthworms are a rich source of several vital biological macromolecules and other nutrients. They have long been used as food in several cultures such as the Ye'Kuana in Venezuela, the Maori in New Zealand, and the nomadic populations in Papua New Guinea. Earthworms and their nutritious products have been shown to exert significant effects in treating humans for disorders of inflammation and blood coagulation. One area that continues to be examined is the earthworm's ability to regenerate lost appendages, and these effects have been extended to mammals. Evidence reveals that earthworm extracts may actually promote the regeneration of damaged nerves. This presentation will explore how earthworms may reveal significant advances and conclusions that decipher innate immunity. This is intimately associated with them as sources of their various nutritional and medicinal benefits.

Dilong: food for thought and medicine.

EARTHWORMS HAVE SEVERAL NAMES IN DIFFERENT COUNTRIES (IN CHINESE: dì lóng, Japanese: Mimizu, Korean: Jireongi, Spanish: Lombriz de tierra, French: Ver de terre, German: Regenwurm, Italian: Lombrico, Swedish: Daggmask, Portuguese: Minhoca). They have long been used as a food source as well as treatments of various ailments. Many alternative and traditional disciplines of medicine, such as those in China, Japan, and Korea, developed medicinal uses of dilong from an initial utilization as nutrition. Increased curiosity in the potential medicinal properties of dilong has come to fruition through bioprospecting and evidence based research. This increased questioning and searching spawned first from a growing knowledge base about the earthworm's innate immune system. Their importance in understanding the evolution of the innate immune system has long been overlooked because of the ecological importance in soil preservation, earthworm immune systems, being full of leukocytes and humoral products, offer significant advantages when used as medicines. Earthworms offer an unanticipated slew of potential health benefits without common drawbacks that come with other biological, alternative forms of medicine such as cost, ethical and pathological concerns of animal testing.