Factors Associated With Incidental Retinal Emboli in the U.S. Adult Population.

PURPOSE: We sought to estimate the prevalence of incidental retinal emboli and identify associated factors using a nationally representative sample of the U.S. DESIGN: Cross-sectional study. METHODS: We included adult (age ≥40 years) participants of the 2005-2008 National Health and Nutrition Examination Survey (NHANES). Incidental retinal emboli were identified through retinal fundus photography. Multivariable logistic regression was used to determine the association between the presence of retinal emboli and sociodemographic, lifestyle, and clinical factors (age, sex, race/ethnicity, education, income, smoking, alcohol use, body mass index [BMI], hypertension, diabetes, hypercholesterolemia, and history of cardiovascular disease). RESULTS: This study included 5,764 adults (53% female). Incidental retinal emboli were identified in 0.7% (39/5764) of individuals. The survey-weighted prevalence of retinal emboli increased with age, from 0.1% in participants 40-49 years of age to 1.4% in participants≥70 years of age. The prevalence did not differ by sex or race/ethnicity. Factors associated with retinal emboli after adjusting for age and sex included underweight BMI (odds ratio [OR] 7.24 [95% confidence interval {CI} 1.06-49.3]), current smoking (OR 6.16 [95% CI 1.49-25.5]), low household income (OR 4.41 [95% CI 1.3-15.0]), and hypertension (OR 2.67 [95% CI 1.31-5.44]). CONCLUSIONS: In a cohort representative of the U.S. adult population, the prevalence of incidental retinal emboli increased with age but did not differ by sex, race, or ethnicity. Further investigation into the potential association of socioeconomic and nutritional status with retinal emboli may enable opportunities to identify individuals with underlying cardiovascular risk.

Improved Performance of ChatGPT-4 on the OKAP Examination: A Comparative Study with ChatGPT-3.5.

Introduction: This study aims to evaluate the performance of ChatGPT-4, an advanced artificial intelligence (AI) language model, on the Ophthalmology Knowledge Assessment Program (OKAP) examination compared to its predecessor, ChatGPT-3.5. Methods: Both models were tested on 180 OKAP practice questions covering various ophthalmology subject categories. Results: ChatGPT-4 significantly outperformed ChatGPT-3.5 (81% vs. 57%; p <0.001), indicating improvements in medical knowledge assessment. Discussion: The superior performance of ChatGPT-4 suggests potential applicability in ophthalmologic education and clinical decision support systems. Future research should focus on refining AI models, ensuring a balanced representation of fundamental and specialized knowledge, and determining the optimal method of integrating AI into medical education and practice.

The Association of Vision Concerns With the Physical and Mental Well-being of Adolescents in the United States.

PURPOSE: To describe the prevalence of vision concerns among US adolescents and the association of time spent worrying about eyesight with physical and mental health. DESIGN: Cross-sectional study. METHODS: This study included adolescent children (age 12 to ≤18 years) particpating in the 2005-2008 National Health and Nutrition Examination Survey with completed visual function questionnaires and eye examinations. Vision concerns were identified by a survey question of time spent worrying about eyesight and response was treated as a dichotomous variable. Recent poor physical and mental health was defined as at least 1 day of poor health within the last month. Odds ratios (ORs) derived from survey-weighted multivariable logistic regression models were used to identify factors associated with vision concerns in the adolescent population, adjusting for participant demographics and refractive correction. RESULTS: The survey participants included 3100 adolescents (mean [SD] age, 15.5 [2.0] years; 49% [n = 1545] female). Vision concerns were expressed by 24% (n=865) of adolescents. Vision concerns were more prevalent among female (29% vs 19%, P < .001), low-income (30% vs 23%, P < .001), and uninsured (31% vs 22%, P = .006) adolescents. Participants worried about their eyesight were more likely to have undercorrected refractive error (OR 2.07, 95% CI 1.43-2.98). Poor recent mental health (OR 1.30, 95% CI 1.01-1.67), but not physical health (OR 1.00, 95% CI 0.69-1.45), was associated with adolescent vision concerns. CONCLUSIONS: Female, low-income, and uninsured adolescents living in the United States are more likely to report worrying about their vision and often have uncorrected or undercorrected refractive errors.

2021 Patient Preferences for Point of Care Testing Survey: More Acceptance and Less Concern.

BACKGROUND: The evolving opinions of our community members provide insights into how end-users perceive the value and identify key point-of-care test (POCT) characteristics. METHODS: We deployed our validated 45-item English-language survey to uncompensated volunteers and compared the results from 1264 respondents in 2021 with those obtained in 2020. RESULTS: Average responses for items regarding the benefits of POCTs demonstrated that the 2021 respondents indicated agreement with all 14 potential benefits. Average responses for items regarding concerns were distinctly different from those for benefits. The only concern item that scored in the agree range was "not having insurance coverage for POCTs." Average responses to the other 13 concern items were in the disagree range. For 8 of these items, the magnitude of disagreement was greater in the 2021 survey than was observed for the 2020 survey. Differences in POCT exposure over time and by US regions suggest that higher levels of exposure to POCTs in the East are associated with stronger public support. CONCLUSIONS: Community members strongly support the development of accurate, convenient, easy-to-use, affordable, equitably available, in-home POCTs that produce immediate results. This empowers patients and home caregivers to diagnose, manage, enhance their adherence to medical treatments, and more efficiently engage their physicians.

Ocular Drug Delivery: Advancements and Innovations.

Ocular drug delivery has been significantly advanced for not only pharmaceutical compounds, such as steroids, nonsteroidal anti-inflammatory drugs, immune modulators, antibiotics, and so forth, but also for the rapidly progressed gene therapy products. For conventional non-gene therapy drugs, appropriate surgical approaches and releasing systems are the main deliberation to achieve adequate treatment outcomes, whereas the scope of "drug delivery" for gene therapy drugs further expands to transgene construct optimization, vector selection, and vector engineering. The eye is the particularly well-suited organ as the gene therapy target, owing to multiple advantages. In this review, we will delve into three main aspects of ocular drug delivery for both conventional drugs and adeno-associated virus (AAV)-based gene therapy products: (1) the development of AAV vector systems for ocular gene therapy, (2) the innovative carriers of medication, and (3) administration routes progression.

COVID-19: a gray swan's impact on the adoption of novel medical technologies.

The COVID-19 pandemic offers a unique context and opportunity to investigate changes in healthcare professional perceptions towards the adoption of novel medical technologies, such as point-of-care technologies (POCTs). POCTs are a nascent technology that has experienced rapid growth as a result of COVID-19 due to their ability to increase healthcare accessibility via near-patient delivery, including at-home. We surveyed healthcare professionals before and during COVID-19 to explore whether the pandemic altered their perceptions about the usefulness of POCTs. Our network analysis method provided a structure for understanding this changing phenomenon. We uncovered that POCTs are not only useful for diagnosing COVID-19, but healthcare professionals also perceive them as increasingly important for diagnosing other diseases, such as cardiovascular, endocrine, respiratory, and metabolic diseases. Healthcare professionals also viewed POCTs as facilitating the humanization of epidemiology by improving disease management/monitoring and strengthening the clinician-patient relationship. As the accuracy and integration of these technologies into mainstream healthcare delivery improves, hurdles to their adoption dissipate, thereby encouraging healthcare professionals to rely upon them more frequently to diagnose, manage, and monitor diseases. The technological advances made in POCTs during COVID-19, combined with shifting positive perceptions of their utility by healthcare professionals, may better prepare us for the next pandemic.

Understanding Healthcare Professionals' Perspectives on Point-of-Care Testing.

Point-of-care testing (POCT) is an emerging technology that provides crucial assistance in delivering healthcare. The COVID-19 pandemic led to the accelerated importance of POCT technology due to its in-home accessibility. While POCT use and implementation has increased, little research has been published about how healthcare professionals perceive these technologies. The objective of our study was to examine the current perspectives of healthcare professionals towards POCT. We surveyed healthcare professionals to quantify perceptions of POCT usage, adoption, benefits, and concerns between October 2020 and November 2020. Questions regarding POCT perception were assessed on a 5-point Likert Scale. We received a total of 287 survey responses. Of the respondents, 53.7% were male, 66.6% were white, and 30.7% have been in practice for over 20 years. We found that the most supported benefit was POCTs ability to improve patient management (92%) and that the most supported concern was that POCTs lead to over-testing (30%). This study provides a better understanding of healthcare workers' perspectives on POCT. To improve patient outcomes through the usage of POCT, greater research is needed to assess the needs and concerns of industry and healthcare stakeholders.

Patient Preferences for Point-of-Care Testing: Survey Validation and Results.

BACKGROUND: Studies of current opinion of our community members for the characteristics, mode, and location of use, use cases, and overall enthusiasm for point-of-care testing (POCT) diagnosis and management tools are needed. STUDY DESIGN AND METHODS: Qualitative research methods were used to develop, refine, and evaluate hardcopy and electronic versions of a 45-item English language survey. The accuracy of the instrument was measured by recorded structured interview, and its precision was measured by comparison to its administration to a group of uncompensated volunteers. MAIN FINDINGS AND RESULTS: Comparison of survey and structured interview data demonstrated high levels of accuracy. Highly concordant with significant levels of correlation and of direct association indicated favorable precision. Ninety-three percent of respondents believed that POCT could improve their care, and 56% identified having a POCT in their home as a top priority. Accuracy, insurance coverage, immediacy of results, and ease of use were identified as the most important characteristics of a POCT. CONCLUSIONS: Community members strongly support the development of accurate, in-home devices that produce immediate results that can be used to diagnose, manage, and encourage their adherence to treatments for their medical conditions.