To review and evaluate the current literature on the application and impact of large language models (LLMs) in the field of ophthalmology, focusing on studies published in high-ranking ophthalmology journals. This is a retrospective review of published articles. This study did not involve human participation. Articles published in the first quartile (Q1) of ophthalmology journals on Scimago Journal & Country Rank discussing different LLMs up to June 7, 2024, were reviewed, parsed, and analyzed. All available articles were parsed and analyzed, which included the article and author characteristics and data regarding the LLM used and its applications, focusing on its use in medical education, clinical assistance, research, and patient education. There were 35 Q1-ranked journals identified, 19 of which contained articles discussing LLMs, with 101 articles eligible for review. One-third were original investigations (32%; 32/101), with an average of 5.3 authors per article. The United States (50.4%; 51/101) was the most represented country, followed by the United Kingdom (25.7%; 26/101) and Canada (16.8%; 17/101). ChatGPT was the most used LLM among the studies, with different versions discussed and compared. Large language model applications were discussed relevant to their implications in medical education, clinical assistance, research, and patient education. The numerous publications on the use of LLM in ophthalmology can provide valuable insights for stakeholders and consumers of these applications. Large language models present significant opportunities for advancement in ophthalmology, particularly in team science, education, clinical assistance, and research. Although LLMs show promise, they also show challenges such as performance inconsistencies, bias, and ethical concerns. The study emphasizes the need for ongoing artificial intelligence improvement, ethical guidelines, and multidisciplinary collaboration. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Ultra-widefield (UWF) imaging is commonly used in ophthalmology in tandem with scleral depressed examinations (SDE) to evaluate peripheral retinal disease. Because of the increased reliance on this technology in tele-ophthalmology, it is critical to evaluate its efficacy for detecting the peripheral retina when performed in isolation. Therefore, we sought to evaluate UWF imaging sensitivity in detecting retinal horseshoe tears (HSTs). Retrospective clinical validity and reliability study. A single-institutional retrospective analysis was performed on patients at the Shiley Eye Institute, University of California, San Diego. Patients with HSTs seen on SDE who underwent treatment with laser were included in the study. A total of 140 patients with HSTs in the right and/or left eyes met the inclusion criteria. Those with concomitant ruptured globes, retinal detachments, and vitreous hemorrhages were excluded. A total of 123 patients with 135 HSTs were included in the final analysis. The primary outcome was the number of HSTs detected by UWF imaging. A secondary outcome was HST location. Sensitivity was measured with respect to HST location, and statistical significance was calculated by Fisher exact testing. A total of 69 (51.1%) HSTs were visualized on UWF images and 66 (48.9%) were not visualized. The sensitivity of UWF imaging in capturing HSTs was 7 of 41 (17.1%), 8 of 25 (32.0%), 7 of 14 (50.0%), and 47 of 55 (85.5%) for the superior, inferior, nasal, and temporal quadrants, respectively. Sensitivities between HST visibility and location were statistically significant (P < .001). Nearly half of HSTs were missed by UWF imaging. This study demonstrates that UWF imaging alone is not sufficiently sensitive to exclude the presence of HSTs.

Purpose: To assess genetic associations for pentosan polysufate sodium maculopathy. Methods: Genetic testing for inherited retinal dystrophy genes using exome testing and for 14 age-related macular degeneration-associated single nucleotide polymorphisms (SNPs) using panel testing were performed. In addition, full-field electroretinograms (ffERG) were obtained to identify any cone–rod dystrophy. Results: Eleven of 15 patients were women, with a mean age of 69 (range 46–85). Inherited retinal dystrophy exome testing in five patients revealed six pathogenic variants, but failed to confirm inherited retinal dystrophy in any patient genetically. FfERG performed in 12 patients demonstrated only nonspecific a- and b-wave abnormalities in 11 cases and was normal in one case. For age-related macular degeneration single nucleotide polymorphisms, CFH rs3766405 (P = 0.003) and CETP (P = 0.027) were found to be statistically significantly associated with pentosan polysulfate maculopathy phenotype compared with the control population. Conclusion: Pentosan polysulfate maculopathy is not associated with Mendelian inherited retinal dystrophy genes. However, several age-related macular degeneration risk alleles were identified to be associated with maculopathy compared with their frequency in the normal population. This suggests a role for genes in disease pathology, particularly the alternative complement pathway. These findings would benefit from further investigation to understand the risk of developing maculopathy in taking pentosan polysulfate.