Credit: HCPLive

Our April month in review for ophthalmology focuses on the latest in digital technology use, the connection between visual impairment and mental health, and cross-specialty public health interest in eye care.

This review showcases the nearly “expert-level” performance of ChatGPT-4, a large language model (LLM) in an ophthalmology examination, the low use of digital technology among older adults with vision issues, and adults with strabismus being more likely to experience anxiety and depression. In addition, the review breaks down the risk of suicidal tendencies linked to visual impairment, the COVID-19 vaccine's impact on uveitis recurrence, and the geographic distribution of pediatric eye care specialists across the United States.

Digital Technology

GPT-4 Nears 'Expert-Level' Performance in Ophthalmology Examination

State-of-the-art large language models (LLMs), including ChatGPT-4, are nearing expert-level clinical knowledge and reasoning in ophthalmology, based on a head-to-head cross-sectional analysis.

GPT-4 exhibited a pass-worthy performance on the mock ophthalmological examination, performing well against expert ophthalmologists and specialty trainees, but top-performing doctors remained superior in the knowledge examination.

“The models could follow clear algorithms already in use, and we’ve found GPT-4 is as good as expert clinicians at processing eye symptoms and signs to answer more complicated questions,” lead study author Arun J. Thirunavukarasu, MB BChir, explained in a statement.

Older Adults with Vision Issues Report Lower Digital Technology Use

Recent cross-sectional research identified an unbalanced divide in the use and knowledge of digital health technology between older adults with and without vision impairment in the United States. Those without vision impairment showed a reduced likelihood of digital technology access, indicating the importance of education and proper technology use, to increase the equitable use of telemedicine.

“Approximately 30% of Americans 71 years or older have vision impairment, and as the US population continues to age, it is crucial to identify trends in use patterns among older adults with disabilities that could further prevent them from engaging with telehealth,” investigators wrote.

Mental Health

Adults with Strabismus More Likely to Experience Mental Health Conditions

Adults with strabismus were more likely to experience mental health conditions than those without eye misalignment, across a diverse and nationwide cohort in the US. Those with strabismus were 2 to 3 times more likely to exhibit mental health conditions, including anxiety and depression.

“Clinicians caring for patients with strabismus should be aware of the prevalence of mental health conditions–especially among individuals from historically marginalized and socioeconomically disadvantaged backgrounds,” investigators wrote.

Visual Impairment Associated with Heightened Risk of Suicidal Tendencies

A systematic review and meta-analysis identified a notable association between visual impairment and a raised risk of suicidal ideation, suicidal behavior, and suicide death. Across more than 30 studies, and involving nearly 6 million people, the study showed the association was particularly pronounced among adolescents reporting vision issues.

“This finding emphasizes the importance of eye health to overall mental well-being. It is recommended that clinicians remain attentive to the elevated risk and be ready to implement suitable suicide prevention measures when required, especially when dealing with adolescents,” investigators wrote.

Public Health

COVID-19 Vaccination May Raise Risk of Uveitis Recurrence

A new cohort study supported an association between COVID-19 vaccination and uveitis, a rare inflammatory eye condition, with both vaccine type and post-vaccination period mediating the risk. The incidence of uveitis was 8.6% and 16.8% during the 3-month and 1-year periods after COVID-19 vaccinations, suggesting more than half of these incidences occurred soon after the immunization.

“The results emphasize the importance of vigilance and monitoring for uveitis in the context of vaccinations, including COVID-19 vaccinations, particularly in individuals with a history of uveitis,” investigators wrote.

Geographic Disparities Persist in Access to Pediatric Eye Care in US

A look into geographic disparities in pediatric eye care access revealed substantial overlap between the distribution of pediatric optometrists and pediatric ophthalmologists across the US in 2023.

The percentage of countries without pediatric ophthalmologists (90.2%) remained unchanged since 2022, but 93.5% of counties lacked pediatric optometrists in 2023. Distribution data showed nearly twice the number of pediatric ophthalmologists than pediatric optometrists in the US, influenced by demographic factors, such as socioeconomic status.