May 3, 2023

The most important ophthalmology research updates, delivered directly to you.
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In this week's issue

  • Defocus incorporated multiple segments spectacles may slow the rate of myopia progression 
  • ChatGPT can’t pass OKAP… yet 
  • 5 year data suggest that iStents are safe for the corneal endothelium 

Can special lenses slow myopia progression?


Wear your glasses, kids! They may slow myopia progression. The prevalence of myopia is on the rise, with global prevalence predicted to increase to 49.8% by 2050. The defocus incorporated multiple segments (DIMS) spectacle lens was created to exert myopic defocus on the peripheral retina and slow myopia progression. This study aims to assess the efficacy of DIMS spectacles in clinical practice. Clinical records of 10,477 patients prescribed DIMS and single-vision (SV) spectacle lenses were categorized by length of follow up, baseline age, and spherical equivalent and analyzed to determine change in spherical equivalent refractive error. Significantly slower progression was seen in the DIMS group at both 1 and 2 years. In the 1-year subdataset, 40% and 19% showed myopia progression of no more than 0.25 D for the DIMS and SV groups, respectively (chi-square, 223.43; P < 0.001). In the 2-year subdataset, 33% and 20% showed myopia progression of no more than 0.50 D for the DIMS and SV groups, respectively (chi-square, 31.15; P < 0.001). DIMS spectacles have been shown to be effective in slowing myopia progression in this study, although at a lower extent than reported in previous studies.

The performance of an artificial intelligence chatbot in ophthalmic knowledge assessment

JAMA Ophthalmology

AI-phthalmology. ChatGPT, an artificial intelligence chatbot, has been gaining immense popularity due to its breadth of knowledge and ability to respond to a variety of prompts. With the machine-learning model continuously growing, it has been able to achieve passing scores on multiple standardized tests including the MCAT, Bar Exam, and USMLE Step 1. As the AI continues to receive modeling inputs related to medicine, this study aimed to determine the ability of its system to pass ophthalmology board certification exams. This cross-sectional study utilized the board exam preparation website OphthoQuestions to provide ChatGPT with text-based multiple-choice questions. ChatGPT was able to answer 58/125 (46.4%) of questions correctly, with 11/14 (79%) correct in the general medicine section. The second iteration of ChatGPT was able to improve its score to 73/125 (58%), while stand-alone questions without response choices were answered correctly 42/78 times (54%). At this time ChatGPT is not poised to assist as a study tool as it is not able to reliably answer text-based questions correctly and is further unable to analyze video or image-based questions. With further growth of its learning model, however, ChatGPT may begin to see utility in board preparation and in the classroom.

Evaluating endothelial cell safety in iStent inject use after 5 years

American Journal of Ophthalmology

The battle against glaucoma: one stent at a time! Open-angle glaucoma (POAG) is a chronic ocular disease that can lead to irreversible vision loss and has been the target of minimally-invasive treatment modalities that have been evolving over the last decade. The iStent inject treatment, which involves the placement of small stents in the trabecular meshwork to improve fluid drainage and reduce intraocular pressure, has shown promise as a treatment option for patients with mild-to-moderate POAG. While devices are often safely placed during a patient’s cataract surgery, long-term safety data on this treatment is limited. Researchers aimed to assess the 5-year postoperative safety data of iStent inject, including overall stability, endothelial cell density (ECD), and endothelial cell loss (ECL) in 227 patients with POAG (178 treated with phacoemulsification and iStent; 49 with phacoemulsification alone). The study demonstrated that, after 5 years of follow-up, the iStent inject treatment is safe and stable, with no significant endothelial cell loss or stent-related adverse events. The mean percentage decrease in ECD of the treatment group was not significantly different from that of the control (14.3% ± 13.4% vs 14.8% ± 10.3%; P = 0.8112). The results of this study provide important long-term safety data on the iStent inject treatment for patients managing POAG and have important clinical implications for ophthalmologists and glaucoma specialists regarding the use of iStent inject as a safe and effective treatment option for their patients.

Nationwide inventory on retinopathy of prematurity screening in the Netherlands

British Journal of Ophthalmology

Premature babies may be small, but their eyesight is a big deal! Timely screening and treatment remain the foundation for preventing irreversible vision loss due to progressive retinopathy of prematurity (ROP). The first Dutch nationwide ROP inventory, the NEDROP study, resulted in the implementation of a new ROP screening and treatment guideline in 2013. This is a retrospective study comparing all preterm infants born in the Netherlands in 2017 and were eligible for ROP screening to data in the first national NEDROP study in 2009. The study found that in 2017, 1492 infants were born with gestational age (GA) <32 weeks, and 1287 infants were eligible for ROP screening. Ophthalmologists screened 1085 infants, which is a 28.4% decrease in screened infants compared to the first national ROP inventory in 2009. Among surviving infants with GA <32 weeks, ROP was found in 305 babies, 20.4% of which had stage ≥3. Treatment was performed in 39 infants. The overall ROP incidence expressed as a percentage remained stable, but the number of infants that developed severe ROP nearly doubled. A notable decrease in retinal detachment delineates improved treatment outcome. These results suggest that the new national ROP guideline has been successful in identifying high-risk infants and preventing severe ROP. This study is limited by its generalizability on long-term outcomes and other populations since it is only a single-year study from one country.


CT findings in open globe injury can help predict OTS stage and prognosis

Ophthalmic Plastic and Reconstructive Surgery

Help! My eye is busted open! Ocular trauma scores (OTS) use clinical features to provide a summary measure of ocular trauma severity and can predict visual outcomes. However, several of the features used in the OTS calculation can be difficult to assess immediately after trauma. Thus, the authors of this study sought to assess the association between CT findings and OTS in 182 ocular trauma patients. The authors conducted a multivariate analysis to assess the association of 5 CT findings (scleral irregularity with decreased globe volume, dislocation of the crystalline lens, abnormal vitreous density, thickening of the chorioretinal layer, and intraocular foreign body/air) with various OTS stages. Abnormal vitreous density (odds ratio [OR] = 2.11), chorioretinal thickening (OR = 1.89), and intraocular foreign body/air (OR = 1.58) were associated with more advanced OTS stages (I or II).  Additionally, presence of 2 (OR = 2.46) and 3 (OR = 2.92) CT findings were associated with more advanced OTS stages (I or II). In conclusion, the number and type of CT findings may be helpful in predicting OTS stage and visual prognosis in patients with open globe injury.

Lens Landmarks

When things seem blurry, a PIVOT in your vision can bring them back into focus. The aim of this study was to evaluate and compare the results of pneumatic retinopexy (PnR, n=77) and pars plana vitrectomy (PPV=73) as treatment options for primary rhegmatogenous retinal detachment (RRD) involving the superior retina.

Key Points:
  • ETDRS scores for PnR were better than PPV by 4.9 letters at 12 months (79.9 ±10.4 letters vs. 75.0 ±15.2 letters; P=0.024).
  • Vertical metamorphopsia scores were superior for the PnR group compared with the PPV group at 12 months (0.14±0.29 vs.0.28±0.42; P=0.026).
  • Primary anatomic success at 12 months was achieved by 80.8% of patients undergoing PnR versus 93.2% undergoing PPV (P=0.045), with 98.7% and 98.6%, respectively, achieving secondary anatomic success.
Overall, the PIVOT landmark study demonstrated that pneumatic retinopexy is recommended as the initial treatment for eligible superior RRDs, as it offers superior visual acuity, fewer metamorphopsias, and a lower complication rate compared to vitrectomy.

Question of the Week

A 15-year old male presents with blurred vision in both eyes. Examination revealed visibility of the lens equator on full mydriasis. Subsequent genetic testing identified a mutation in the ADAMTS10 gene. Following further testing, the patient was diagnosed with microspherophakia.
Which of the following is not true regarding this condition?

A. It is due to faulty development of secondary lens fibers
B. It is associated with high myopia
C. It can cause pupillary block with subsequent angle closure glaucoma
D. Cycloplegics should be avoided as treatment as they can close an already crowded angle

Keep scrolling for answer or click here

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Quiz Answer: D
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