ImportanceChatGPT is an artificial intelligence (AI) chatbot that has significant societal implications. Training curricula using AI are being developed in medicine, and the performance of chatbots in ophthalmology has not been characterized.ObjectiveTo assess the performance of ChatGPT in answering practice questions for board certification in ophthalmology.Design, Setting, and ParticipantsThis cross-sectional study used a consecutive sample of text-based multiple-choice questions provided by the OphthoQuestions practice question bank for board certification examination preparation. Of 166 available multiple-choice questions, 125 (75%) were text-based.ExposuresChatGPT answered questions from January 9 to 16, 2023, and on February 17, 2023.Main Outcomes and MeasuresOur primary outcome was the number of board certification examination practice questions that ChatGPT answered correctly. Our secondary outcomes were the proportion of questions for which ChatGPT provided additional explanations, the mean length of questions and responses provided by ChatGPT, the performance of ChatGPT in answering questions without multiple-choice options, and changes in performance over time.ResultsIn January 2023, ChatGPT correctly answered 58 of 125 questions (46%). ChatGPT’s performance was the best in the category general medicine (11/14; 79%) and poorest in retina and vitreous (0%). The proportion of questions for which ChatGPT provided additional explanations was similar between questions answered correctly and incorrectly (difference, 5.82%; 95% CI, −11.0% to 22.0%; χ21 = 0.45; P = .51). The mean length of questions was similar between questions answered correctly and incorrectly (difference, 21.4 characters; SE, 36.8; 95% CI, −51.4 to 94.3; t = 0.58; df = 123; P = .22). The mean length of responses was similar between questions answered correctly and incorrectly (difference, −80.0 characters; SE, 65.4; 95% CI, −209.5 to 49.5; t = −1.22; df = 123; P = .22). ChatGPT selected the same multiple-choice response as the most common answer provided by ophthalmology trainees on OphthoQuestions 44% of the time. In February 2023, ChatGPT provided a correct response to 73 of 125 multiple-choice questions (58%) and 42 of 78 stand-alone questions (54%) without multiple-choice options.Conclusions and RelevanceChatGPT answered approximately half of questions correctly in the OphthoQuestions free trial for ophthalmic board certification preparation. Medical professionals and trainees should appreciate the advances of AI in medicine while acknowledging that ChatGPT as used in this investigation did not answer sufficient multiple-choice questions correctly for it to provide substantial assistance in preparing for board certification at this time.

No abstract

This cross-sectional study assesses the accuracy of answers generated by an updated version of a popular chatbot to board certification examination preparation questions.

No abstract

No abstract

Background: This meta-analysis aims to compare the efficacy and safety of intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents and intravitreal steroids for the treatment of macular edema (ME) secondary to retinal vein occlusion (RVO). Methods: A systematic literature search was conducted on Ovid MEDLINE, EMBASE, and the Cochrane Controlled Register of Trials for studies published between January 2005 and November 2021. Randomized controlled trials (RCTs) reporting on patients with ME secondary to RVO who were treated with intravitreal steroids or anti-VEGF agents were included. A random effects meta-analysis was performed. Results: 867 eyes from 11 RCTs were included. At last study observation, intravitreal anti-VEGF agents were associated with a significantly better BCVA (WMD=-0.14 logMAR, 95% CI=[-0.19,-0.09], p<0.00001) and lower retinal thickness (WMD=-38.01 µm, 95% CI=[-56.17,-19.85], p<0.0001) relative to intravitreal steroids. Similar findings were found at 3-12 month timepoints. Intravitreal anti-VEGF agents were associated with a significantly lower incidence of IOP-related adverse events (RR=0.28, 95% CI=[0.15,0.51], p<0.0001), cataract development/progression (RR=0.22, 95% CI=[0.09,0.49], p=0.0003) and conjunctival hemorrhage (RR=0.52, 95% CI=[0.32,0.86], p=0.01). Conclusion: Our meta-analysis found superiority of intravitreal anti-VEGF agents relative to intravitreal steroids for the treatment of ME secondary to RVO with regards to visual acuity, anatomic outcomes, and safety endpoints.

IMPORTANCEThe association between residual subretinal fluid (SRF) and intraretinal fluid (IRF) and visual acuity following anti-vascular endothelial growth factor (VEGF) treatment is not well understood.OBJECTIVE To examine the association of residual retinal fluid, SRF, and IRF with visual acuity following anti-VEGF treatment in patients with neovascular age-related macular degeneration (nAMD).DATA SOURCES A systematic literature search was performed from January 2005 to August 2021 using Ovid MEDLINE, Embase, and the Cochrane Library.STUDY SELECTION Peer-reviewed articles reporting on visual acuity stratified by the presence or absence of any residual SRF, IRF, or any retinal fluid at last study observation after intravitreal bevacizumab, ranibizumab, aflibercept, or brolucizumab in patients with nAMD were included. Studies that were noncomparative, included fewer than 10 eyes, or reported on other anti-VEGF agents were excluded.DATA EXTRACTION AND SYNTHESIS Two independent reviewers conducted data extraction and synthesis. The Cochrane risk of bias tool 2 and ROBINS-I were used to assess risk of bias and GRADE evaluation was conducted to assess certainty of evidence.MAIN OUTCOMES AND MEASURES Primary outcomes were BCVA at last study observation, change in BCVA from baseline, and retinal thickness at last study observation. RESULTSIn this systematic review and meta-analysis, 11 studies (6 randomized clinical trials [RCTs]) comprising 3092 eyes were included in our analysis. Across all included studies, the BCVA of eyes with residual SRF was better than eyes without SRF (weighted mean difference [WMD], 3.1 letter score; 95% CI, 0.05 to 6.18; P = .05; GRADE, low certainty of evidence; 6 studies; 1931 eyes) but similar in RCTs (WMD, 2.7 letter score; 95% CI, −2.40 to 7.84; P = .30; GRADE, low certainty of evidence; 3 studies; 1406 eyes). The BCVA of eyes with residual IRF was worse than that of eyes without IRF (WMD, −8.2 letter score; 95% CI, −11.79 to −4.50; P < .001; GRADE, low; 7 studies; 2114 eyes). CONCLUSIONS AND RELEVANCEThe findings suggest that the presence of residual SRF was associated with slightly better BCVA at last study observation; however, baseline differences in BCVA existed and this conclusion was primarily driven by 1 study. The presence of residual IRF was associated with substantially worse BCVA at last study observation and less improvement of BCVA from baseline. The conclusions are limited by the inclusion of data from observational studies, heterogeneity, and a low certainty of evidence.

The association between residual retinal fluid and visual acuity for diabetic macular edema (DME) and macular edema (ME) secondary to retinal vein occlusion (RVO) is not well established. We conducted a systematic literature search for peer-reviewed articles reporting on visual acuity stratified by subretinal fluid (SRF), intraretinal fluid (IRF), or any retinal fluid at final follow-up after intravitreal anti-vascular endothelial growth factor therapy injection for treatment of DME or ME secondary to RVO. Two observational studies on ME secondary to RVO and one study for DME found no significant differences between eyes with and without residual retinal fluid for final BCVA. One randomized controlled trial (RCT) found that eyes with residual retinal fluid had significantly worse final best-corrected visual acuity in ME secondary to RVO, whereas another RCT found no significant difference for DME. There is a paucity of evidence examining the impact of residual retinal fluid on visual acuity in DME and ME secondary to RVO. The limited evidence suggests that aggressive fluid resolution is worthwhile. [ Ophthalmic Surg Lasers Imaging Retina 2023;54:50–58.]