Assessment of a Large Language Model’s Responses to Questions and Cases About Glaucoma and Retina Management

Abstract

ImportanceLarge language models (LLMs) are revolutionizing medical diagnosis and treatment, offering unprecedented accuracy and ease surpassing conventional search engines. Their integration into medical assistance programs will become pivotal for ophthalmologists as an adjunct for practicing evidence-based medicine. Therefore, the diagnostic and treatment accuracy of LLM-generated responses compared with fellowship-trained ophthalmologists can help assess their accuracy and validate their potential utility in ophthalmic subspecialties.ObjectiveTo compare the diagnostic accuracy and comprehensiveness of responses from an LLM chatbot with those of fellowship-trained glaucoma and retina specialists on ophthalmological questions and real patient case management.Design, Setting, and ParticipantsThis comparative cross-sectional study recruited 15 participants aged 31 to 67 years, including 12 attending physicians and 3 senior trainees, from eye clinics affiliated with the Department of Ophthalmology at Icahn School of Medicine at Mount Sinai, New York, New York. Glaucoma and retina questions (10 of each type) were randomly selected from the American Academy of Ophthalmology’s Commonly Asked Questions. Deidentified glaucoma and retinal cases (10 of each type) were randomly selected from ophthalmology patients seen at Icahn School of Medicine at Mount Sinai–affiliated clinics. The LLM used was GPT-4 (version dated May 12, 2023). Data were collected from June to August 2023.Main Outcomes and MeasuresResponses were assessed via a Likert scale for medical accuracy and completeness. Statistical analysis involved the Mann-Whitney U test and the Kruskal-Wallis test, followed by pairwise comparison.ResultsThe combined question-case mean rank for accuracy was 506.2 for the LLM chatbot and 403.4 for glaucoma specialists (n = 831; Mann-Whitney U = 27976.5; P < .001), and the mean rank for completeness was 528.3 and 398.7, respectively (n = 828; Mann-Whitney U = 25218.5; P < .001). The mean rank for accuracy was 235.3 for the LLM chatbot and 216.1 for retina specialists (n = 440; Mann-Whitney U = 15518.0; P = .17), and the mean rank for completeness was 258.3 and 208.7, respectively (n = 439; Mann-Whitney U = 13123.5; P = .005). The Dunn test revealed a significant difference between all pairwise comparisons, except specialist vs trainee in rating chatbot completeness. The overall pairwise comparisons showed that both trainees and specialists rated the chatbot’s accuracy and completeness more favorably than those of their specialist counterparts, with specialists noting a significant difference in the chatbot’s accuracy (z = 3.23; P = .007) and completeness (z = 5.86; P < .001).Conclusions and RelevanceThis study accentuates the comparative proficiency of LLM chatbots in diagnostic accuracy and completeness compared with fellowship-trained ophthalmologists in various clinical scenarios. The LLM chatbot outperformed glaucoma specialists and matched retina specialists in diagnostic and treatment accuracy, substantiating its role as a promising diagnostic adjunct in ophthalmology.

Service Quality and Residents’ Preferences for Facilitated Self-Service Fundus Disease Screening: Cross-Sectional Study

“…One possible explanation is that uniqueness neglect—a concern that algorithm providers are less able than human providers to account for residents’ (or patients’) unique characteristics and circumstances—drives consumer resistance to digital medical technology [ 23 ]. Therefore, personalized health management solutions based on large language models should be developed urgently [ 24 ] to meet the residents’ individual demands. In addition, a survey of population preferences for medical AI indicated that the most important factor for the public is that physicians are ultimately responsible for diagnosis and treatment planning [ 25 ].…”

Artificial Versus Human Intelligence in the Diagnostic Approach of Ophthalmic Case Scenarios: A Qualitative Evaluation of Performance and Consistency

“…For example, ChatGPT-3.5 had similar or better accuracy than senior ophthalmology residents in diagnosing primary and secondary glaucoma cases retrieved from a public online database [ 7 ]. Similarly, ChatGPT-4 outperformed glaucoma specialists and was comparable with retina specialists in diagnostic and treatment accuracy of glaucoma and retina cases [ 8 ]. By contrast, ChatGPT exhibited reasonable but inferior diagnostic accuracy than human experts in cornea [ 9 ], uveitis [ 10 , 11 ], and neuro-ophthalmology [ 12 ] cases.…”