Minimally invasive glaucoma surgery (MIGS) has emerged as a novel approach in the glaucoma treatment spectrum, offering a range of diverse procedures and devices aimed at reducing intraocular pressure (IOP). MIGS can be broadly classified into several categories: those that enhance trabecular outflow (Trabectome, iStent, Hydrus Microstent, Kahook Dual Blade, high frequency deep sclerotomy, and gonioscopy-assisted transluminal trabeculotomy), those that augment suprachoroidal outflow (CyPass Microstent and iStent Supra), those that target Schlemm’s canal (TRAB360 and the OMNI Surgical System, Streamline, and Ab Interno Canaloplasty), and conjunctival bleb-forming procedures (EX-PRESS Glaucoma Filtration Device, Xen Gel Stent and PreserFlo MicroShunt). MIGS is considered to have a shorter surgical time and fewer severe complications when compared to traditional glaucoma surgeries such as trabeculectomy and glaucoma drainage device implantation (Ahmed, Baerveldt, and Molteno valves). This literature review comprehensively examines the distinct MIGS devices and procedures, their underlying mechanisms, and clinical outcomes, emphasizing the importance of evaluating the efficacy and complications of each approach individually. As the field of MIGS continues to evolve, it is crucial to prioritize high-quality, long-term studies to better understand the safety and effectiveness of these innovative interventions in glaucoma management.

Integrating large language models (LLMs) like GPT-4 into medical ethics is a novel concept, and understanding the effectiveness of these models in aiding ethicists with decision-making can have significant implications for the healthcare sector. Thus, the objective of this study was to evaluate the performance of GPT-4 in responding to complex medical ethical vignettes and to gauge its utility and limitations for aiding medical ethicists. Using a mixed-methods, cross-sectional survey approach, a panel of six ethicists assessed LLM-generated responses to eight ethical vignettes. The main outcomes measured were relevance, reasoning, depth, technical and non-technical clarity, as well as acceptability of GPT-4’s responses. The readability of the responses was also assessed. Of the six metrics evaluating the effectiveness of GPT-4’s responses, the overall mean score was 4.1/5. GPT-4 was rated highest in providing technical (4.7/5) and non-technical clarity (4.4/5), whereas the lowest rated metrics were depth (3.8/5) and acceptability (3.8/5). There was poor-to-moderate inter-rater reliability characterised by an intraclass coefficient of 0.54 (95% CI: 0.30 to 0.71). Based on panellist feedback, GPT-4 was able to identify and articulate key ethical issues but struggled to appreciate the nuanced aspects of ethical dilemmas and misapplied certain moral principles. This study reveals limitations in the ability of GPT-4 to appreciate the depth and nuanced acceptability of real-world ethical dilemmas, particularly those that require a thorough understanding of relational complexities and context-specific values. Ongoing evaluation of LLM capabilities within medical ethics remains paramount, and further refinement is needed before it can be used effectively in clinical settings.

Objective . Recording and stimulating from the peripheral nervous system are becoming important components in a new generation of bioelectronics systems. Although neurostimulation has seen a history of successful chronic applications in humans, peripheral nerve recording in humans chronically remains a challenge. Multi-contact nerve cuff electrode configurations have the potential to improve recording selectivity. We introduce the idea of using a convolutional neural network (CNN) to associate recordings of individual naturally evoked compound action potentials (CAPs) with neural pathways of interest, by exploiting the spatiotemporal patterns in multi-contact nerve cuff recordings. Approach . Nine Long-Evan rats were implanted with a 56-channel nerve cuff electrode on the sciatic nerve and afferent activity was selectively evoked in different fascicles (tibial, peroneal, sural) using mechanical stimuli. A recurrent neural network was then used to predict joint angles based on the predicted firing patterns from the CNN. Performance was measured based on the classification accuracy, F ₁ -score and the ability to track the ankle joint angle. Main results . Classification accuracy and F ₁ -score of the best CNN configuration were and 0.747 ± 0.114, respectively. The mean Pearson correlation coefficient between the manually measured ankle angle and the angle predicted from the estimated firing rate was Significance . The proposed method demonstrates that CAP-based classification can be achieved with high accuracy and can be used to track a physiological meaningful measure (e.g. joint angle). These results provide a promising direction for realizing more effective and intuitive neuroprosthetic systems.

Background/aims: To compare the performance and cost-effectiveness of DeepSeek-R1 with OpenAI o1 in diagnosing and managing ophthalmology clinical cases. Methods: In this cross-sectional study, a total of 300 clinical cases spanning 10 ophthalmology subspecialties were collected from StatPearls, each with a multiple-choice question on diagnosis or management. DeepSeek-R1 was accessed through its public chat interface, while OpenAI o1 was queried via its Application Programming Interface with a standardised temperature of 0.3. Both models were prompted using plan-and-solve+. Performance was calculated as the proportion of correct answers. McNemar’s test was employed to compare the two models’ performance on paired data. Intermodel agreement for correct diagnoses was evaluated via Cohen’s kappa. Token-based cost analyses were performed to estimate the comparative expenditures of running each model at scale, including input prompts and model-generated output. Results: DeepSeek-R1 and OpenAI o1 achieved an identical overall performance of 82.0% (n=246/300; 95% CI: 77.3 to 85.9). Subspecialty-specific analysis revealed numerical variation in performance, though none of these comparisons reached statistical significance (p>0.05). Agreement in performance between the models was moderate overall (κ=0.503, p<0.001), with substantial agreement in refractive management/intervention (κ=0.698, p<0.001) and moderate agreement in retina/vitreous (κ=0.561, p<0.001) and ocular pathology/oncology (κ=0.495, p<0.01) cases. Cost analysis indicated an approximately 15-fold reduction in per-query, token-related expenses when using DeepSeek-R1 vs OpenAI o1 for the same workload. Conclusions: DeepSeek-R1 shows strong diagnostic and management performance comparable to OpenAI o1 across ophthalmic subspecialties, while significantly reducing costs. These results support its use as a cost-effective, open-weight alternative to proprietary models.

Artificial intelligence (AI) is becoming increasingly influential in ophthalmology, particularly through advancements in machine learning, deep learning, robotics, neural networks, and natural language processing (NLP). Among these, NLP-based chatbots are the most readily accessible and are driven by AI-based large language models (LLMs). These chatbots have facilitated new research avenues and have gained traction in both clinical and surgical applications in ophthalmology. They are also increasingly being utilized in studies on ophthalmology-related exams, particularly those containing multiple-choice questions (MCQs). This narrative review evaluates both the opportunities and the challenges of integrating chatbots into ophthalmology research, with separate assessments of studies involving open- and close-ended questions. While chatbots have demonstrated sufficient accuracy in handling MCQ-based studies, supporting their use in education, additional exam security measures are necessary. The research on open-ended question responses suggests that AI-based LLM chatbots could be applied across nearly all areas of ophthalmology. They have shown promise for addressing patient inquiries, offering medical advice, patient education, supporting triage, facilitating diagnosis and differential diagnosis, and aiding in surgical planning. However, the ethical implications, confidentiality concerns, physician liability, and issues surrounding patient privacy remain pressing challenges. Although AI has demonstrated significant promise in clinical patient care, it is currently most effective as a supportive tool rather than as a replacement for human physicians.