CLINICAL RELEVANCE: Artificial intelligence chatbots demonstrate potential as valuable educational resources for patients with dry eye disease, offering complementary information to established medical platforms. BACKGRO...CLINICAL RELEVANCE: Artificial intelligence chatbots demonstrate potential as valuable educational resources for patients with dry eye disease, offering complementary information to established medical platforms. BACKGROUND: The increasing prevalence of dry eye disease necessitates reliable and comprehensible patient information resources. This study evaluates and compares the quality of information provided by contemporary AI chatbots with established ophthalmological sources. METHODS: Three leading AI chatbots (ChatGPT-3.5, Gemini, and Llama) and the American Academy of Ophthalmology (AAO) website were systematically evaluated using 20 common patient questions about dry eye disease. Responses were assessed for accuracy using the Structure of Observed Learning Outcome (SOLO) taxonomy, understandability and actionability using the Patient Education Materials Assessment Tool (PEMAT), and linguistic accessibility using Flesch-Kincaid readability metrics. RESULTS: Gemini demonstrated superior understandability with a mean PEMAT-U score of 73.4 ± 11.4, significantly higher than ChatGPT (65.4 ± 10.6), Llama (63.4 ± 10.3), and AAO (52.5 ± 19.3) ( < 0.001). No significant differences were observed in actionability scores ( = 0.120). The AAO website exhibited the highest reading ease score (50.4 ± 17.9, = 0.015). For accuracy assessment, ChatGPT achieved the highest mean SOLO score (3.4 ± 0.7), followed closely by Gemini (3.3 ± 0.8), with no significant performance differences detected among chatbots ( = 0.574). No instances of incorrect or potentially harmful information were identified across any evaluated source. CONCLUSION: While AI chatbots demonstrate promising capabilities for patient education in dry eye disease, particularly in providing comprehensive and understandable information, their higher linguistic complexity presents a potential accessibility barrier. Future development should focus on enhancing readability while maintaining comprehensive content, positioning chatbots as valuable complements to - rather than replacements for - professional medical consultation.
CLINICAL RELEVANCE: Recently, studies have been carried out on the accuracy of large language models, which are increasingly used, but the reproducibility of the answers given by these language models is as important as...CLINICAL RELEVANCE: Recently, studies have been carried out on the accuracy of large language models, which are increasingly used, but the reproducibility of the answers given by these language models is as important as their accuracy. BACKGROUND: To evaluate the accuracy and reproducibility of the responses of ChatGPT-4.0 to queries about intraocular lenses (IOLs) over a six-month interval. METHODS: This observational, cross-sectional study was conducted using 45 open-ended questions related to IOLs, categorised into three difficulty levels: easy, moderate, and difficult. Two evaluators independently posed these questions to ChatGPT-4.0 at two separate time points (April and October 2024) using the 'new conversation' feature. Responses were analysed for word count, character count, and plagiarism rates, and evaluated on a 5-point Likert scale for accuracy, relevance, and consistency. RESULTS: A total of 90 responses were analysed. Accuracy rates were 93.3%, 86.7%, and 80% for easy, moderate, and difficult questions, respectively. Significant increases in word and character counts were observed between the initial and final evaluations ( < 0.0001). Likert scores improved significantly over time ( = 0.046). ICC analysis showed moderate consistency (0.639) overall, with excellent reproducibility (1.00) for easy questions, acceptable (0.788) for moderate, and moderate (0.550) for difficult questions. CONCLUSIONS: ChatGPT-4.0 demonstrated significant improvements in accuracy and response length over time. While the model exhibited high reproducibility for easy questions, its performance declined with increased question difficulty. Despite its limitations, ChatGPT-4.0 shows promise for use in medical information dissemination, highlighting the need for further studies to enhance its reliability and accuracy.
CLINICAL RELEVANCE: The multifactorial aspect of dry eye disease remains challenging. Demodex folliculorum, a common ectoparasite on human eyelashes, may impact eye conditions such as blepharitis which can be a contribut...CLINICAL RELEVANCE: The multifactorial aspect of dry eye disease remains challenging. Demodex folliculorum, a common ectoparasite on human eyelashes, may impact eye conditions such as blepharitis which can be a contributor to dry eye disease. Exploring risk factors for Demodex helps to raise awareness for early detection potentially improving ocular health. BACKGROUND: found on eyelashes can cause blepharitis. Its gelatinous debris at the base of the lashes, termed cylindrical dandruff is often associated with ocular itching. This study examined the prevalence of in a University population and assessed its relationship to symptoms of dry eye and itching. METHODS: Visual acuity, dry eye questionnaire (OSDI), non-invasive break up time (NIBUT), meibography, and slit-lamp examination were measured. When cylindrical dandruff was observed, lateral tension was exerted on two eyelashes to identify tails. Mann-Whitney tests were applied for comparisons, logistic regressions were applied to determine relationships, and chi-square, Fisher's exact test and Spearman correlation tests determined associations. RESULTS: Of the 101 participants (mean age: 28 ± 12, range: 19-68 years, 90 females), 20% had dry eye (OSDI score ≥ 13 and NIBUT < 10 sec). Demodex tails/lash were significantly more prevalent in the upper (44%) compared with the lower eyelids (19%). Anterior blepharitis and cylindrical dandruff were significantly correlated with Demodex. Ocular itching (prevalence: 39%) was significantly associated with presence of Demodex only for the upper eyelids ( = 0.02). UODS was positively correlated ( < 0.001) with Demodex, cylindrical dandruff and anterior blepharitis. CONCLUSIONS: There was a relatively high prevalence of Demodex among a university population. The prevalence of Demodex was not significantly different in those diagnosed with dry eye. Cylindrical dandruff and anterior blepharitis were significantly associated with the presence of Demodex, while itching was associated with presence of Demodex only for the upper eyelids. The UODS can be a valuable tool to add in future Demodex studies.
CLINICAL RELEVANCE: Undergraduate contact lens (CL) education subjects provide basic background to guarantee eye health in CL wearers that is crucial to avoid CL-related complications and provide better eye-care by best...CLINICAL RELEVANCE: Undergraduate contact lens (CL) education subjects provide basic background to guarantee eye health in CL wearers that is crucial to avoid CL-related complications and provide better eye-care by best qualified optometrists. BACKGROUND: CL training is a very important optometrist skill in most university optometrist training programmes worldwide. The purpose of this study was to assess the teaching time dedicated to CL education in an international sample of 40 universities. METHODS: A review of official university websites offering optometry courses was conducted between 2020 and 2022 in English, Spanish, and Portuguese. Only programmes that provided detailed descriptions of the curriculum were included. The number of CL subjects, total CL teaching hours (calculated using online description of subject credits using available conversion and equivalence tables), and entire program teaching time (in hours) were compared according to the country of each university (grouped geographically). RESULTS: Forty optometry programmes were identified and analysed. North American universities dedicated the most teaching time (3,309 ± 311 hours) with 3.1 ± 1.3 CL subjects, and 188.9 ± 91.8 CL teaching hours (5.7 ± 2.9%), followed by Latin American universities (3,008 ± 307 hours, 2.5 ± 0.8 CL subjects with 141.2 ± 49.4 CL teaching hours, 4.7 ± 1.5%) and Oceanian universities (3,000 hours, 1.5 ± 0.6 CL subjects with 112.5 ± 43.3 CL teaching hours, 3.7 ± 1.4%). European universities showed lower teaching time (2,123 ± 311 hours, 2.1 ± 1.0 subjects with 130.0 ± 49.6 CL teaching hours, 6.0 ± 1.8%). Statistically significant differences in the entire program teaching time ( < 0.01) and CL subjects ( = 0.02) were found; however, CL teaching time ( = 0.43) was not significantly different. CONCLUSION: Approximately 5% of total programme time is dedicated to CL teaching in the optometry programmes analysed. These findings could help university administrators and faculty to refine teaching plans and adjust the time allocated to CL practices. New education techniques based on technology and simulators could help improve CL teaching prior to introducing students into clinical environments.
Nguyen K, Yoo K, Frediani T
… +4 more, Lang T, Shan J, Toy B, Xu BY
Clin Exp Optom
· 2026 Jan · PMID 40566656
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CLINICAL RELEVANCE: Few studies have examined the utility of glaucoma referrals among young adults aged 18-40 years, as glaucoma is primarily a disease of the elderly. There are sparse data about prevalence of myopia, wh...CLINICAL RELEVANCE: Few studies have examined the utility of glaucoma referrals among young adults aged 18-40 years, as glaucoma is primarily a disease of the elderly. There are sparse data about prevalence of myopia, which may confound glaucoma diagnosis in this population. BACKGROUND: To examine the prevalence and characteristics of primary open angle glaucoma (POAG) patients and suspects among young adults aged 18-39 years referred by optometry for in-office evaluation by glaucoma specialists. METHODS: Eligible participants who were referred for glaucoma evaluation between 1 January 2015 to 31 December 2019 were identified in the electronic medical record database. Study inclusion required glaucoma suspect diagnosis by optometry with subsequent referral and evaluation by a fellowship-trained glaucoma specialist. Diagnoses of glaucoma suspect and POAG by the glaucoma specialists were ascertained through International Classification of Diseases Tenth Revision codes and confirmed through manual chart review. Electronic medical record data were reviewed for age at time of referral, sex, cup-to-disc ratio, intraocular pressure (IOP), central corneal thickness, spherical equivalent refractive error, and family history of glaucoma. Ocular data from one eye of each included patient was selected at random and compared between glaucoma suspects and glaucoma patients. RESULTS: Among 660 patients referred by optometrists for glaucoma evaluation, 151 (22.9%) followed up with referrals. Among evaluated patients, 6 (4.0%) were diagnosed with glaucoma. Glaucoma patients tended to have more severe myopia and higher cup-to-disc ratio compared to glaucoma suspects. CONCLUSION: The utility of referring young adults for glaucoma evaluation was low in this patient population and practice setting, with only one out of 25 evaluations yielding a positive diagnosis and over 75% of referred patients failing to present for evaluation. Evidence-based methods to risk-stratify patients and establish standardised referral guidelines could be beneficial to ensure proper allocation of glaucoma care resources.
CLINICAL RELEVANCE: Tear meniscus turbidity and percentage area occupied by particles (PAOP), which are non-invasively measured tear meniscus parameters, may serve as new indicators of dry eye in haemodialysis patients....CLINICAL RELEVANCE: Tear meniscus turbidity and percentage area occupied by particles (PAOP), which are non-invasively measured tear meniscus parameters, may serve as new indicators of dry eye in haemodialysis patients. BACKGROUND: The aim of this study was to evaluate tear meniscus parameters in patients with end-stage renal disease undergoing haemodialysis. METHOD: This prospective and case-control study included 28 end-stage renal disease patients with self-reported dry eye symptoms (group 1), 31 end-stage renal disease patients who did not have any dry eye symptoms (group 2), and a control group composed of 30 healthy age- and sex-matched participants. Thirty minutes before and after haemodialysis, tear meniscuses were evaluated using Spectral Domain Optical Coherence Tomography. Tear meniscus parameters, including tear meniscus height, depth, turbidity, and PAOP in the inferior tear meniscus, were measured using Optical Coherence Tomography and ImageJ software. RESULTS: In pre- haemodialysis measurements, tear break-up time, Schirmer I, tear meniscus height, and depth values were significantly lower, and turbidity, PAOP, OSDI, serum osmolality, creatinine, and blood urea nitrogen values in group 1 were significantly higher than the values in other groups ( < 0.05). Turbidity and PAOP values were significantly higher, and the tear break-up time values were significantly lower in group 2 than those in group 3 at the pre-haemodialysis measurements ( < 0.05). Following haemodialysis, tear break-up time, Schirmer I, tear meniscus height, and depth decreased, while turbidity and PAOP increased significantly in end-stage renal disease patients ( < 0.05). In post-haemodialysis measurements, turbidity, PAOP, and tear break-up time measurements were not significantly different between groups 1 and 2 ( < 0.05). CONCLUSION: The patients with end-stage renal disease had higher turbidity, PAOP values, and lower tear meniscus height, depth, tear break-up time, and Schirmer I test values. Turbidity and PAOP may be used as diagnostic parameters for dry eye in haemodialysis patients.
Post-menopausal dry eye disease is one of the frequently encountered conditions in ophthalmic and optometric practice. Despite the conventional treatment, it is often observed that these patients repeatedly show up to se...Post-menopausal dry eye disease is one of the frequently encountered conditions in ophthalmic and optometric practice. Despite the conventional treatment, it is often observed that these patients repeatedly show up to seek for help since their symptoms did not improve. In addition to pointing to the hormonal imbalance linked to post-menopause as a potential cause of dry eye, this also highlights the urgent need to review the necessary therapeutic approach. Evidence suggests that ocular testosterone therapy, particularly 0.03% testosterone eye drops, can significantly improve tear film stability and relieve dry eye symptoms. Furthermore, it has an added benefit of bypassing the systemic circulation, providing a targeted ocular effect with minimal side effects. However, challenges such as ocular barrier penetration, formulation stability, and regulatory issues in India hinder its widespread adoption. This review critically evaluates the efficacy and challenges of topical androgen treatment in this context. The necessity for more studies to confirm the safety and effectiveness of ocular testosterone therapy in improving the quality of life for postmenopausal women with dry eyes is also emphasised.
Vision impairment is a global public health concern affecting 1.1 billion people worldwide. The coronavirus disease or COVID-19 outbreak caused by the SARS-CoV-2 virus in 2019 affected many aspects of everyday life and p...Vision impairment is a global public health concern affecting 1.1 billion people worldwide. The coronavirus disease or COVID-19 outbreak caused by the SARS-CoV-2 virus in 2019 affected many aspects of everyday life and prompted various preventative health measures. Persons with visual impairment face multiple challenges daily, and with the onset of the COVID-19 pandemic, these challenges were likely worsened. With various studies conducted globally to explore the experiences of persons with visual impairment, this scoping review aims to provide an overview of the impact of the COVID-19 pandemic on persons with visual impairment within a global context. The five-step framework by Arksey and O'Malley was applied, involving a literature search across nine electronic databases, with specific search terms formulated from the research question. Data were screened for eligibility by the three reviewers using pre-decided study criteria. Of the 263 articles identified from December 2019 to October 2022, 49 were included in this review. More than 80% of the articles were published in the early years of the pandemic (2020 and 2021), and 77.5% of the studies had persons with visual impairment as participants. The themes identified included psychosocial, access to COVID-19 information and technology, healthcare, everyday activities, education, economic situation, adherence to regulations, and support. Overall, the COVID-19 pandemic worsened the challenges faced by persons with visual impairment, especially those affecting their independence and daily routines. Governments and stakeholders should make more efforts to address the challenges experienced by persons with visual impairment, as this will directly impact their quality of life.
CLINICAL RELEVANCE: Nerf guns can lead to significant ocular injury. Understanding the incidence and types of complications that can result can lead to improved diagnoses, management, and prevention. BACKGROUND: The inte...CLINICAL RELEVANCE: Nerf guns can lead to significant ocular injury. Understanding the incidence and types of complications that can result can lead to improved diagnoses, management, and prevention. BACKGROUND: The intention of this study is to characterise the incidence, ocular findings, and specific visual outcomes associated with Nerf gun injuries at the Illinois College of Optometry, an academic optometric setting. METHODS: A retrospective chart review of electronic medical records at the IEI was conducted from December 2017 to December 2022. Patient charts were identified using the search options in the electronic medical system. The following words and combinations were used during the electronic medical system search: Nerf, dart, bullet, foam, projectile, rubber. Charts were reviewed for accuracy. RESULTS: Thirty-five patients were identified (21 females, 14 males) The average age of presentation was 24 years old (range 3-56 years). No patients were wearing protective eyewear. All injuries were unilateral. The follow-up period varied from 1 day to 1 month. Average entering best corrected visual acuity (BCVA) was 6/9, ranging between 6/6 and 6/45. All patients eventually returned to 6/6. Twenty-one patients (60%) were diagnosed with traumatic anterior uveitis. All 21 patients were treated with a topical steroid. All patients were dilated at the initial visit and at the follow-up visit. There were no findings in the intermediate and posterior segments of the eye secondary to nerf gun injuries. CONCLUSION: This current study specifically focuses on Nerf gun-related ocular injuries and their definite visual outcomes in a larger study population and period in an optometric setting. Most injuries are limited to the anterior segment with limited to no visual sequalae. Poorer visual outcomes are still possible and therefore proper safety eyewear, safe play, and safe distancing when using Nerf gun-type projectiles is recommended.
CLINICAL RELEVANCE: Meibomian gland dysfunction (MGD) is a major contributor to dry eye disease, affecting a large proportion of the population and leading to significant discomfort and ocular surface complications. Unde...CLINICAL RELEVANCE: Meibomian gland dysfunction (MGD) is a major contributor to dry eye disease, affecting a large proportion of the population and leading to significant discomfort and ocular surface complications. Understanding trends in MGD research, including advancements in diagnostic technologies, therapeutic approaches, and interdisciplinary collaborations, is critical for improving clinical practices. BACKGROUND: This study aims to perform a bibliometric analysis on MGD to assess the current international status of meibomian gland dysfunction research and identify the most influential contributors (journals, countries, authors) and research topics in this field. METHODS: Data from studies on MGD were obtained using the Web of Science Core Collection on Science Citation Index Expanded database. Information regarding journals, titles, text, keywords, references, citations, author names, author institutions, and countries was recorded for each publication. The data were analysed using features of the Web of Science Core Collection website and the VOSviewer visualisation tool. RESULTS: A total of 1313 articles published between 1980 and 2024 were identified. The number of articles published in the last 10 years was found to be 3.01 times greater than in all previous years combined. The United States and China were the most productive countries, with the highest number of articles and citations. The most productive institutions were located in the United States and Japan. The most prolific author was Reiko Arita. The most frequently cited article was titled 'The International Workshop on Meibomian Gland Dysfunction: Report of the Subcommittee on Anatomy, Physiology, and Pathophysiology of the Meibomian Gland'. Recent and emerging keywords include 'intense pulsed light', 'meibography', 'lipiflow', 'artificial intelligence', 'meibogenesis', 'lipidomics' and 'human meibomian gland epithelium', reflecting current trends in MGD research. CONCLUSIONS: This study provides an overview of the current status and trends in MGD research, which may help clinicians and researchers better understand this field and predict its future directions.
CLINICAL RELEVANCE: Spectacle lenses with aspherical lenslets are effective in controlling axial elongation and slowing myopia progression in children with myopia, and its effectiveness may extend to children at risk of...CLINICAL RELEVANCE: Spectacle lenses with aspherical lenslets are effective in controlling axial elongation and slowing myopia progression in children with myopia, and its effectiveness may extend to children at risk of developing myopia. BACKGROUND: This study aims to examine the effectiveness of plano highly aspherical lenslets (HAL) spectacle lenses in slowing down axial elongation and spherical equivalent refraction (SER) progression among non-myopic children, using retrospective data records. METHODS: This retrospective study included data from medical records from an eye hospital network (Wellem Group) in Shanghai, China. Non-myopic children (non-cycloplegic SER between >-0.50 and ≤+0.75 D) aged 4-9 years, prescribed plano HAL lenses, were reviewed ( = 147). With available data prior to intervention, annualised changes in axial length and SER before and after wearing plano HAL lenses were computed. Effectiveness was evaluated with pre-treatment rates acting as controls, and differences in changes over time were calculated. RESULTS: A total of 105 non-myopic children were prescribed plano HAL lenses and had both pre-treatment and post-treatment visits (≥6 months). The mean ±SD age, SER, and axial length was 6.8 ± 1.3 years, 0.22 ± 0.29 D, and 23.1 ± 0.7 mm, respectively. The mean ±SE axial length and SER pre-treatment change was +0.44 ± 0.01 mm/year and -0.28 ± 0.03 D/year, respectively. After treatment, the mean axial length and SER change were +0.13 ± 0.01 mm/year and +0.14 ± 0.03 D/year, respectively. The mean difference in axial length and SER change over time was significantly different at -0.31 ± 0.02 mm/year and 0.42 ± 0.06 D/year, respectively (both < 0.001). Lens wearing time was significantly associated with difference in axial length change over time (R = 0.19, < 0.001). CONCLUSION: Plano HAL lenses are effective in slowing axial elongation and SER progression among non-myopic children aged 4-9 years, which can potentially help in delaying myopia onset.
CLINICAL RELEVANCE: The management of dry eye disease remains a challenge due to its multifactorial nature and the involvement of chronic inflammation. Exploring the connection between gut health and eye inflammation is...CLINICAL RELEVANCE: The management of dry eye disease remains a challenge due to its multifactorial nature and the involvement of chronic inflammation. Exploring the connection between gut health and eye inflammation is essential for developing more effective, holistic treatment strategies. BACKGROUND: Dry eye disease is considered to have an inflammatory component. The gut microbiome plays an important role in the regulation of low-grade chronic inflammation in different parts of the body including the eye. Probiotics and prebiotics are recognised for their beneficial effects on gut health and have been previously reported to alleviate dry eye symptoms. This study aimed to further investigate the impact of these supplements on tear and blood serum inflammatory biomarkers. METHODS: In this double-masked, randomised trial (registration number ACTRN12624000444583), 41 dry eye participants received either the probiotic and prebiotic supplements (treatment group, = 23), or their respective placebos (control group, = 18), for a duration of four months. The participants were followed up at one month and four months, and again one month after treatment cessation. Tear levels of inflammatory markers matrix metalloproteinase-9 (MMP-9) and tissue inhibitors of metalloproteinase-1 (TIMP-1), and serum C-reactive protein levels were determined. The MMP-9:TIMP-1 ratio also was calculated. RESULTS: No significant changes in MMP-9, TIMP-1, or C-reactive protein levels were observed in either group during treatment ( > 0.05). Post-treatment, MMP-9 levels rose in the treatment group ( < 0.05), and MMP-9:TIMP-1 ratios increased in both groups ( < 0.05). CONCLUSIONS: No significant changes were found in the examined biomarkers in either group during the intervention. The apparent post-treatment rise in these markers requires further investigation, particularly in light of reported associations between MMP-9, inflammation, and ocular discomfort.
The aim of this review is to evaluate corneal microstructural changes and nephropathy in participants with diabetic peripheral neuropathy (DPN+) and without (DPN-) in each of type 1 (T1DM) and type 2 diabetes (T2DM). A s...The aim of this review is to evaluate corneal microstructural changes and nephropathy in participants with diabetic peripheral neuropathy (DPN+) and without (DPN-) in each of type 1 (T1DM) and type 2 diabetes (T2DM). A systematic review of primary studies was conducted that quantified corneal sub-basal nerve plexus parameters using laser scanning corneal confocal microscopy (CCM) and DPN+ in at least five humans with diabetes mellitus. CCM parameters examined were corneal nerve fibre density (NFD), nerve branch density (NBD) and nerve fibre length (NFL). Weighted mean difference (±standard error) is reported. Twenty-six studies were included in this meta-analysis (18 for T1DM, 14 for T2DM). This comprised 1,357 participants with T1DM (573,784; DPN+, DPN-), 1,119 with T2DM (598,521; DPN+, DPN-) and 1,032 non-diabetic controls. Compared to T2DM, T1DM participants had larger differences in NFD (8.54 ± 0.83 vs 3.61 ± 0.41), NBD (11.92 ± 1.93 vs 3.56 ± 1.03) and NFL (4.24 ± 0.41 vs 1.65 ± 0.18) between DPN+ and DPN- groups. T1DM participants also had larger differences than T2DM participants in NBD (-21.26 ± 2.90 vs -6.15 ± 1.69) and NFL (-4.25 ± 0.59 vs -2.65 ± 0.31) between DPN- and non-diabetic controls, but smaller, insignificant difference, in NFD (-5.93 ± 0.90 vs -6.39 ± 0.92). eGFR was significantly different between DPN+ and DPN- in T1DM ( < 0.00001) but not in T2DM ( = 0.46). When comparing DPN- to DPN+, ACR was reduced in T1DM (-2.72 ± 1.14) and T2DM (-20.85 ± 8.91). Corneal sub-basal nerve changes and glomerular nephropathy likely precede peripheral neuropathy in T1DM and T2DM, with greater corneal neuropathy in T1DM. The current evidence suggests that CCM may be useful for monitoring the progression of diabetic neuropathy and nephropathy.