: To compare large language models (LLMs) and human reviewers in the peer review process of manuscripts submitted to 3 ophthalmology-related journals. This retrospective study comprised 300 randomly selected manuscripts from 3 anonymized journals under 1 editor between June 2023 and July 2024. Comments from 2 LLMs (Chat Generative Pre-Trained Transformer [ChatGPT] 4o and Gemini) and human reviewers (324 ophthalmologists) were compared. LLMs were prompted to accept, accept with major or minor revisions, or reject each manuscript in addition to providing comments. A 5-point Likert scale was used to assess the “favorability” of comments and compare manuscripts that were accepted or rejected by the editor. A 4-category quality assessment was used to compare the number of comments, detail/specificity, critical analysis, and literature support. Human reviewers rejected manuscripts more frequently (73.33% vs 2.00% ChatGPT and 2.00% Gemini; P < .001) and suggested major (22.67% vs 68.00% ChatGPT and 31.33% Gemini; P < .001) or minor revisions (3.33% vs 30.00% ChatGPT and 66.33% Gemini; P < .001) less often. Human reviewers gave more negative feedback for rejected manuscripts (−1.05 vs −0.02 ChatGPT and 0.24 Gemini; P < .015). ChatGPT repeated “novelty,” “sample size,” and “clarity” in 75%, 60%, and 50% of cases, respectively, while Gemini did so in 80%, 70%, and 65% of cases. Both lacked specificity, omitting line numbers and references. Although it is hoped that LLMs will one day be able to augment the role of peer reviewers, in their current state, LLMs should not be used for manuscript revision.

Purpose: To report a case of post–keratorefractive lenticule extraction (KLEx) ectasia in the United States followed by a comprehensive literature review of all published KLEx ectasia cases with an analysis of risk factors and prevalence rates. Methods: A systematic literature search of PubMed, Embase, Google Scholar, and institutional databases for studies published between January 2008 and April 2026 was conducted. Studies reporting cases of post-KLEx ectasia and large cohort studies with a minimum of 3-year follow-up without ectasia were included. Demographic, tomographic, and surgical parameters were extracted. Comparative statistical analysis between cohorts with and without ectasia was performed. Results: At our institution, a 34-year-old woman developed ectasia 4 years after KLEx, with borderline risk factors and possible subclinical keratoconus. Including this case, 69 eyes from 41 patients across 25 studies were identified with post-KLEx ectasia. Common preoperative abnormalities included elevated Belin/Ambrosio Display Deviation score, reduced Ambrosio Relational Thickness maximum, and tomographic abnormalities. Compared with international nonectatic cohorts, ectatic eyes were significantly younger, had thinner corneas, and higher astigmatism. Overall prevalence of post-KLEx ectasia at our institution was 0.3% over an 8-year period. Conclusions: Post-KLEx ectasia is a rare but recognized complication with several predisposing factors. Younger age, higher astigmatism, and tomographic abnormalities were more prevalent among the ectasia cohort, mirroring established risk factors for post-LASIK and post-PRK ectasia. The development of ectasia even in tomographically normal eyes poses the question of whether refractive surgery induces ectasia de novo or unmasks subclinical keratoconus.

Objectives: To evaluate a general-purpose large language model (LLM)’s ability to perform surgeon-level decision-making in choosing an intraocular lens (IOL) power when provided the same preoperative data. Methods: This study included 293 eyes (174 patients) that underwent monofocal or toric cataract surgery performed by a single surgeon. GPT-5.2 analyzed the same biometric printouts, topographic displays, and preoperative data used in surgical planning. Postoperative refraction for GPT-5.2-selected IOLs was simulated from the measured postoperative refraction using a fixed conversion factor. The mean refractive deviation from target, mean absolute error (MAE), and number of eyes within ±0.25 D and ±0.50 D of target refraction were calculated. A subgroup analysis evaluated toric IOL cylinder magnitude and axis. Results: GPT-5.2-selected IOL power differed significantly from that of the surgeon (19.24 ± 4.01 vs. 19.64 ± 4.07 D [mean ± SD], p < 0.001). Using simulated refractive outcomes for GPT-5.2, MAE was higher than for surgeon-selected IOLs (0.45 ± 0.03 vs. 0.35 ± 0.02 D [mean ± SE], p = 0.002), and a greater percentage of eyes fell within ±0.25 D of target refraction for the surgeon (51.9% vs. 44.7%, p < 0.01), with no difference within ±0.50 D (p = 0.06). In toric eyes, the cylinder magnitude did not differ, but simulated residual astigmatism was higher for GPT-5.2 (0.78 ± 0.55 vs. 0.58 ± 0.47 D, p < 0.001), with an axis flip in 47.1% versus 39.2% of eyes. Conclusions: GPT-5.2 synthesized clinical data and approximated surgeon IOL selection, but its simulated refractive outcomes were less accurate than the surgeon’s measured outcomes. These findings suggest that a domain-specific LLM may serve as a support tool in IOL selection and cataract surgery planning.

Background/Objectives: To compare visual outcomes of the U.S. Food and Drug Administration (FDA) premarket approval trials of two refractive excimer laser platforms used for the correction of myopia with and without astigmatism, hyperopia with and without astigmatism, and mixed astigmatism. Methods: Clinical outcomes were analyzed between the recently approved MEL90 excimer laser (Carl Zeiss Meditec AG, Jena, Germany) and the WaveLight (now termed EX500) excimer laser (Alcon Laboratories, Inc., Fort Worth, TX). Results: A total of 714 eyes (358 patients) from MEL90 and 1353 eyes (706 patients) from EX500 were analyzed up to 6 months postoperatively. In the hyperopia/hyperopic astigmatism cohort, the EX500 demonstrated greater efficacy relative to MEL90, with more eyes achieving a postoperative uncorrected distance visual acuity (UDVA) of 20/20 or better (48.6% vs 68.7%, respectively; P < .001). In both the MEL90 and EX500, at least 85% of eyes with myopia/myopic astigmatism and 68% with mixed astigmatism achieved a postoperative UDVA of 20/20 or better. For all refractive cohorts, more than 95% of eyes achieved a UDVA of 20/40 or better at 6 months (all P > .05). The EX500 was more likely to demonstrate an improvement of more than 2 lines of UDVA compared to baseline CDVA (all P < .05). In contrast, the MEL90 showed greater predictability of spherical equivalent within ±0.50 D and ±1.00 D for the hyperopia/hyperopic astigmatism cohort (both P = .007), as well as within ±0.50 D for the myopia/myopic astigmatism cohort (P < .001). Postoperatively, both platforms were associated with decreased glare and halos, although findings were variable in the EX500 mixed astigmatism cohort. Conclusions: Both excimer lasers demonstrated safe and effective outcomes that exceed the threshold set by the FDA.