JAMA Ophthalmology July 2023 Volume 141, Number 7

中文摘要

本文摘要報告了一個案例，該案例是一名12歲的女孩，在連續5個月使用低劑量紅光激光器（repeated low-level red-light laser exposure [蘇州園佳光電技術]）治療雙側中度近視後，出現了雙視力喪失2週。在患者出現之前1個月，患者在接觸光線後抱怨有異常明亮的光和持久的殘影現象。最佳矯正視力從20/20下降到20/30 OU。未見發炎現象。眼底照片顯示僅雙眼黯淡的黃斑和自動螢光成像中的低自動螢光色素斑darkened foveae with a hypoautofluorescent plaque.。光學相干斷層掃描識別到雙眼黃斑橢圓形區和相互交錯區的破裂oveal ellipsoid zone disruption and interdigitation zone discontinuity。磁共振成像未顯示視神經或中樞神經系統病變。感染和炎症檢查結果均為陰性。多焦點電視節目顯示雙眼視盤顏色和自動螢光成像，右眼視盤顏色和自動螢光成像，Multifocal electroretinogram showed moderately and mildly decreased response in the central macula and paramacula.三個月後，雙眼黃斑受傷部分恢復，右眼和左眼的視力恢復到20/25 OU。討論：該患者在RLRL治療後出現黃斑結構損傷和功能喪失。儘管橢圓形區域被破壞，但在外部視網膜層未注意到高反射物質積聚，這與多發性透明白點綜合癥有所不同。黃斑光感受器外分泌的損失與急性區域神秘外隱形綜合癥有所區別，後者通常是黃斑寬恢復。太陽和雷射指示燈黃斑損傷也表現為外部視網膜層的破裂。雖然患者否認了這兩個風險因素，但不能排除它們。此外，RLRL激光曝曬可能是造成視網膜損傷的另一個可能原因。

English Abstract

The content discusses a case report of a 12-year-old girl who experienced bilateral vision loss after 5 months of repeated low-level red-light laser exposure for myopia treatment. The patient complained of bright light and prolonged afterimages after exposure to light. Fundus photographs showed darkened foveae with a hypoautofluorescent plaque. Optical coherence tomography (OCT) revealed foveal ellipsoid zone disruption and interdigitation zone discontinuity. Magnetic resonance imaging did not show any CNS lesions, and no inflammation was noted. Multifocal electroretinogram showed moderately and mildly decreased response in the central macula and paramacula. Three months later, partial foveal recovery and improvement in visual acuity were observed. The report suggests that the retinal damage may be associated with the instability of the laser’s light power, prolonged exposure, or the patient’s sensitivity to light toxicity. The case highlights the need for rigorous clinical trials and strict monitoring in the use of laser therapy for myopia.

JAMA Ophthalmology

中文摘要

這篇研究報告評估了人工智能（AI）聊天機器人ChatGPT在眼科知識評估中的表現。研究使用了由OphthoQuestions提供的眼科認證考試準備的多選題作為資料，並分析了ChatGPT在2023年1月9日至16日和2月17日回答問題的情況。研究的主要結果是ChatGPT正確回答的認證考試練習題數量，次要結果包括ChatGPT提供額外解釋的問題比例、ChatGPT回答問題和回應的平均長度、ChatGPT回答沒有多選選項的問題的表現，以及表現的時間變化。結果顯示，ChatGPT在OphthoQuestions眼科認證考試準備的免費試用中大約正確回答了一半的問題。然而，該研究指出，在目前的情況下，ChatGPT的表現還不足以在認證考試的準備中提供實質性的幫助。作者強調了醫學專業人士應該重視人工智能在醫學領域的進展，同時也應該認識到ChatGPT在這項研究中的表現還不足以提供充分的協助。

English Abstract

This study assessed the performance of an artificial intelligence (AI) chatbot called ChatGPT in answering ophthalmic knowledge test questions. The study used a sample of text-based multiple-choice questions from a practice question bank. The primary outcome was the number of questions that ChatGPT answered correctly. The secondary outcomes included the proportion of questions for which ChatGPT provided explanations, the length of questions and responses, performance in answering questions without multiple-choice options, and changes in performance over time. The study found that ChatGPT answered approximately half of the questions correctly (58 of 125 questions, 46% in Jan, 2023 and 73 of 125 questions, 58% in Feb, 2023), and provided explanations for most questions. However, its performance was not sufficient to provide substantial assistance in preparing for board certification exams. The authors emphasized the importance of responsible use of AI systems in medical education and clinical practice.

中文摘要

本研究旨在評估個人層次和社區層次的貧困程度是否與青光眼或疑似青光眼的篩檢陽性結果相關?研究結果顯示，個人層次的貧困（不開私人車前往預約地點）和社區層次的貧困都與青光眼或疑似青光眼的篩檢陽性率增加有關。人們的社會經濟地位越低，罹患青光眼的風險越高。本研究還發現，沒有開私人車前往預約地點、種族（黑人）、居住在更貧困的社區以及有眼科醫療服務提供者與篩檢陽性結果有顯著相關。總結而言，貧困程度以及個人和社區層次的貧困與青光眼或疑似青光眼的篩檢陽性結果有關。這些結果強調了社會風險因素對青光眼篩檢結果的影響，並呼籲相應的公共衛生政策幫助改善貧困社區青光眼篩檢的水平，以提升青光眼診斷和治療的可及性。其中，篩檢陽性後提供的持續支持，有助於減少不必要的、不可逆的視力損失和失明。

English Abstract

The content discusses the association between poverty, socioeconomic status, and glaucoma. It highlights that personal poverty, as indicated by not driving a personal vehicle to the appointment, and neighborhood-level poverty are linked to higher rates of screening positive for glaucoma or suspected glaucoma. The article also points out that people with lower socioeconomic status, particularly Black Americans who are disproportionately affected by poverty, are more likely to develop glaucoma. Additionally, it emphasizes the impact of earlier onset and more severe disease on morbidity and quality of life. The article mentions that a significant number of glaucoma cases remain undiagnosed, with many individuals unaware of their condition. Notably, social risk factors, including personal-level and neighborhood-level deprivation, are analyzed in relation to the likelihood of screening positive for glaucoma or suspected glaucoma. The content suggests implementing telemedicine or technology-based programs in high-poverty neighborhoods to improve access to glaucoma diagnosis and treatment. Overall, the research contributes to understanding the genetic and environmental factors influencing glaucoma risk and highlights the need for targeted interventions in underserved communities.

中文摘要

本研究旨在評估批地樂普眼科溶液(lotilaner ophthalmic solution) 0.25%與對照組的安全性和有效性。研究對象為412名患有睫毛蠕形蟲性眼瞼炎的患者，隨機分配到兩組中。結果顯示，批地樂普組的蠕形蟲密度顯著降低，且治療組在蠕形蟲根除率方面優於對照組。六週每日兩次使用批地樂普眼科溶液0.25%治療對於蠕形蟲性眼瞼炎的有效性被證實，在安全性方面也沒有出現顯著不良事件。因此，批地樂普眼科溶液0.25%可以作為蠕形蟲性眼瞼炎的治療選擇。另紅腫(erythema)治癒率似乎在與細胞皮(collarette) 以及蟎蟲根除(mite eradication)相比的後期時間點達到高峰。研究提出假設，消除或解決蟎蟲和細胞皮後，炎症需要一定的時間才能緩解。

English Abstract

The content is a summary of a study evaluating the safety and effectiveness of lotilaner ophthalmic solution 0.25% (bid x 6 weeks) for the treatment of Demodex blepharitis. Lotilaner is an antiparasitic agent that targets Demodex mites, which infest the eyelash follicles and can cause damage. The study involved 412 patients who were randomly assigned to receive either lotilaner or a placebo. Mite density was measured as the number of mites per lash. The study found that the lotilaner group had significantly lower mite density and a higher proportion of patients achieving mite eradication compared to the placebo group. The study found significant differences between the study group and the control group by week 2, with the rate of erythema cure peaking at later time points compared to collarette and mite eradication. The treatment was well-tolerated with no clinically significant adverse effects observed. Overall, the study concluded that lotilaner ophthalmic solution 0.25% is an effective treatment for Demodex blepharitis. The study concluded that it may take time for inflammation to resolve after mites and collarettes have been eradicated

中文摘要

本研究旨在研究具有中等年齡相關黃斑變性（intermediate age-related macular degeneration, iAMD）的眼睛上可視化的持續性脈絡膜色素超高壁（hypertransmission defects , hyperTDs）的出現和增長，以確定它們是否可作為新的臨床試驗終點。研究中使用6×6mm的光學相干斷層掃描術（OCT）血管成像來觀察眼睛的基線和隨訪檢查期間的變化。結果顯示，使用光學相干斷層掃描術成像可以輕鬆地檢測到持續的hyperTDs，並且其具有高靈敏度、準確性、陽性預測值和評分者間的一致性。該研究還發現，iAMD眼睛中hyperTDs的形成和增大與晚期AMD的發展密切相關。該研究為未來評估可能能夠減緩疾病進展的治療方法提供了新的臨床試驗終點。然而，人們對於超高壁斷層掃描（SS-OCT，SD-OCT）的可用性越來越了解，而更容易取得的SD-OCT儀器能夠生產可以用於檢測和監測超高壁的正面影像。兩者結合起來，持續超高壁的發生和進展可以作為從年齡相關黃斑變性（iAMD）到晚期黃斑變性（AMD）疾病進展的新型臨床試驗終點。

English Abstract

The content discusses a clinical trial that aims to study the onset and progression of persistent choroidal hypertransmission defects (hyperTDs) in intermediate age-related macular degeneration (iAMD). The trial analyzes en face swept-source optical coherence tomography (SS-OCT) images to determine if hyperTDs can serve as novel clinical trial endpoints. The study involves evaluating baseline and follow-up visits of patients with iAMD using SS-OCT angiography imaging. The researchers found that hyperTDs can be detected and studied using en face OCT imaging, and they can potentially be used as endpoints for assessing the effectiveness of therapies to slow the progression of iAMD. The article also discusses the classification of AMD into progressive stages using color fundus imaging and the advantages of using en face OCT imaging in iAMD. Additionally, it explores the methodology, statistical analysis, and the potential implications of the findings in the context of clinical trials and disease progression evaluation.The content discusses the enrollment of subjects in a clinical trial for emerging novel therapies to prevent the enlargement of geographic atrophy (GA). The availability of en face imaging techniques like SS-OCT and SD-OCT can be used to detect and monitor hyperTDs, which can serve as novel clinical trial endpoints to study therapies that may slow disease progression.