Impact of online learning during COVID-19 pandemic on digital device related ocular health.

Objective: The aim of this study was to evaluate the impact of the COVID-19 pandemic on ocular health related to digital device usage among university students in Lebanon. Design: A cross-sectional design was utilized to examine the association between the pandemic and ocular health. Participants: A total of 255 university students in Lebanon participated in the study, selected based on their enrollment during the pandemic. Methods: An online survey assessed participants' digital device usage, awareness of digital eye strain, and experienced symptoms. The study addressed the relationship between symptom frequency and screen time, especially in their connection to the pandemic and online learning. Results: Prior to the pandemic, the majority of participants (73.0 %) were unaware of digital eye strain. Following the transition to online learning, nearly half of the participants (47.0 %) reported using digital devices for 12 or more hours. The majority (92.0 %) experienced a substantial increase in daily digital device usage for learning, with an average increase of 3-5 h. Symptoms of digital eye strain, including headache, burning of eyes, blurry vision, sensitivity to light, worsening of vision and dryness of the eyes intensified in both frequency and severity during the pandemic and online learning period. Conclusions: The study emphasizes the importance of promoting healthy habits and implementing preventive measures to reduce the prevalence of digital eye strain symptoms among university students. Healthcare professionals and public health authorities should educate individuals on strategies to alleviate digital eye strain, considering the persistent reliance on digital devices beyond the pandemic.

LASIK Videos on TikTok: A Content Analysis of the Top 100 Videos.

Introduction: Social media has increasingly become a prominent source of health information. Platforms like TikTok that allow for videos to reach millions of viewers have become among the most common platforms to share and receive health information. Laser in situ keratomileusis (LASIK) videos and patients' experiences are commonly discussed on social media. The quality of these videos remains to be assessed. The aim of this study is to evaluate the content, quality, and reach of the top 100 videos related to LASIK eye surgery on TikTok. Methods: Video quality was assessed using the DISCERN, JAMA, and GQS instruments which have all been proven to be both reliable and valid. Results: 100 videos were included in the study. Results showed that the videos have an immense reach with a total view count of 245 million views and 21.9 million likes. Two thirds of the videos were posted by personal accounts as compared ophthalmologists that only constituted 26% of the content. Healthcare professionals produced higher quality videos compared to nonhealthcare professionals (p < 0.0001) although there was no significant difference in video duration (p=0.18). Increased duration, view count, comments, shares, saves, and views/day were all associated with increased DISCERN score and quality of the videos. Educational videos were of higher quality compared to entertainment videos, and videos outlining the procedure details had the highest quality score. Conclusions: LASIK videos on TikTok have established a wide reach, whereby viewers are highly interacting and viewing these videos. It appeared that viewers interacted more with the higher quality videos. Ophthalmologists approximately only contributed to a quarter of the videos analyzed in this study. This highlights the need for ophthalmologists to establish a presence on TikTok and produce high quality videos.

Corneal Deposits: A Presentation of Arthrobacter Keratitis.

Introduction: Infectious keratitis, an inflammatory condition of the cornea, poses a significant public health concern globally. Bacterial keratitis, the most common type, primarily involves Staphylococcus aureus and Pseudomonas aeruginosa. Timely diagnosis and treatment are crucial to prevent vision loss. Case Presentation: This case report presents a 78-year-old male patient with a burning sensation persisting for 1 week. The patient was diagnosed with keratitis caused by Arthrobacter, a Gram-positive coccobacillus commonly found in the environment. While the literature reports a few cases of Arthrobacter species keratitis, limited data exist regarding its clinical course and outcomes. Treatment with ciprofloxacin eye drops resulted in complete resolution of symptoms and a clear cornea upon final follow-up. Conclusion: Arthrobacter, a rare causative agent of keratitis, requires early suspicion for accurate diagnosis and treatment. Despite the limited literature on Arthrobacter keratitis, this case highlights the importance of considering uncommon pathogens in corneal infections. Further research is necessary to understand the prevalence and clinical course of Arthrobacter keratitis.

An Emerging Ophthalmology Challenge: A Narrative Review of TikTok Trends Impacting Eye Health Among Children and Adolescents.

In today's digital age, children and teenagers are deeply entrenched in the world of personal electronic devices including laptops, tablets, and smartphones. These serve as gateways to captivate online content. With children as young as 4 years old having access to these gadgets, the potential benefits of technology coexist with many possible risks. One such risk is the growing global issue of myopia. TikTok, a mobile application that gained immense popularity since its inception in 2016, has garnered 1.7 billion active monthly users in 2023 and is expected to reach two billion in 2024. A significant portion of TikTok's user base consists of adolescents, with approximately 41% falling in the 16-24 age group and a third aged 14 or younger. This social media platform has given rise to the phenomenon of "internet challenges," where users complete and share various tasks through videos. While most of these challenges are harmless, some pose serious risks to teenagers who eagerly seek validation and attention from their peers. This manuscript sheds light on a specific subset of TikTok challenges, namely those related to ophthalmological risks. These challenges include "rubbing castor oil trend," "bleach/bright eye challenge," "mucus fishing challenge," "eggsplosions", "beezin challenge", "Orbeez challenge", "blow-drying eyelashes", "sun gazing," and "popping styes". The manuscript emphasizes the importance of monitoring and regulating potentially dangerous content on social media platforms like TikTok. While these platforms offer educational opportunities, they can also promote life-threatening actions, necessitating efforts to protect vulnerable young users and promote safe online engagement.

Performance of ChatGPT on Ophthalmology-Related Questions Across Various Examination Levels: Observational Study.

BACKGROUND: ChatGPT and language learning models have gained attention recently for their ability to answer questions on various examinations across various disciplines. The question of whether ChatGPT could be used to aid in medical education is yet to be answered, particularly in the field of ophthalmology. OBJECTIVE: The aim of this study is to assess the ability of ChatGPT-3.5 (GPT-3.5) and ChatGPT-4.0 (GPT-4.0) to answer ophthalmology-related questions across different levels of ophthalmology training. METHODS: Questions from the United States Medical Licensing Examination (USMLE) steps 1 (n=44), 2 (n=60), and 3 (n=28) were extracted from AMBOSS, and 248 questions (64 easy, 122 medium, and 62 difficult questions) were extracted from the book, Ophthalmology Board Review Q&A, for the Ophthalmic Knowledge Assessment Program and the Board of Ophthalmology (OB) Written Qualifying Examination (WQE). Questions were prompted identically and inputted to GPT-3.5 and GPT-4.0. RESULTS: GPT-3.5 achieved a total of 55% (n=210) of correct answers, while GPT-4.0 achieved a total of 70% (n=270) of correct answers. GPT-3.5 answered 75% (n=33) of questions correctly in USMLE step 1, 73.33% (n=44) in USMLE step 2, 60.71% (n=17) in USMLE step 3, and 46.77% (n=116) in the OB-WQE. GPT-4.0 answered 70.45% (n=31) of questions correctly in USMLE step 1, 90.32% (n=56) in USMLE step 2, 96.43% (n=27) in USMLE step 3, and 62.90% (n=156) in the OB-WQE. GPT-3.5 performed poorer as examination levels advanced (P<.001), while GPT-4.0 performed better on USMLE steps 2 and 3 and worse on USMLE step 1 and the OB-WQE (P<.001). The coefficient of correlation (r) between ChatGPT answering correctly and human users answering correctly was 0.21 (P=.01) for GPT-3.5 as compared to -0.31 (P<.001) for GPT-4.0. GPT-3.5 performed similarly across difficulty levels, while GPT-4.0 performed more poorly with an increase in the difficulty level. Both GPT models performed significantly better on certain topics than on others. CONCLUSIONS: ChatGPT is far from being considered a part of mainstream medical education. Future models with higher accuracy are needed for the platform to be effective in medical education.

Bromfenac 0.09% for the Treatment of Macular Edema Secondary to Noninfectious Uveitis.

PURPOSE: The topical nonsteroidal anti-inflammatory drug bromfenac 0.09% has a potential benefit in uveitic macular edema (UME) with a safe side effect profile. The aim of the study is to assess the efficacy of bromfenac sodium solution in the treatment of UME. METHODS: The charts of 10 patients with macular edema due to noninfectious uveitis treated with bromfenac 0.09% were reviewed retrospectively. The main outcomes studied were the best-corrected visual acuity (BCVA) and the central retinal thickness (CRT) compared 4 months before bromfenac initiation, at the time of its initiation, and 4 months later. RESULTS: Twelve eyes of 10 patients were included. BCVA and CRT were unchanged 4 months befoew bromfenac compared to the time of bromfenac initiation (P = 1.0 and P = 0.2, respectively). There were a significant improvement in BCVA after 4 months of bromfenac treatment (P = 0.043) and a significant decrease in CRT (P = 0.002). Subretinal fluid resolved completely in 8/9 eyes, and 4/9 eyes had a complete resolution of cystoid macular edema at 4 months. CONCLUSION: Bromfenac may be a useful addition to the treatment of UME.

Perceived Surgeon Stress During No-Sedation Topical Phacoemulsification.

PURPOSE: To determine the patient-related factors that contribute to surgeon stress during phacoemulsification cataract extraction (PCE) performed under unassisted topical anesthesia. METHODS: This is a prospective study of perceived surgeon stress during phacoemulsification by a single surgeon of consecutive patients undergoing PCE. At the conclusion of each procedure, the surgeon recorded the perceived stress according to the following three indices: surgeon score, qualitative score (yes or no), and total score (sum of itemized causes of stress). Patient variables included in the analysis included gender, age, diabetes mellitus, morbid obesity, intake of oral alpha blockers, floppy iris, laterality, pseudo-exfoliation, intraocular lens power, and initial visual acuity. RESULTS: During the 10-year study, 1097 eyes underwent surgery. The following patient variables were seen frequently: floppy iris syndrome (92), pseudo-exfoliation (72), and morbid obesity (36). Surgeon identified stress was reported after 250 procedures. On multivariable analysis, the following patient characteristics were associated with surgeon stress: age >80 years; morbid obesity; floppy iris syndrome; severe nuclear sclerosis; and poor baseline distance corrected visual acuity. CONCLUSION: Several ocular and systemic patient-related characteristics contribute to surgeon stress during PCE.

Nontraumatic Epithelial Ingrowth 15 Years Post Laser In Situ Keratomileusis.

Purpose. Epithelial ingrowth occurring many years after primary Laser in Situ Keratomileusis (LASIK) without a preceding traumatic event is very rare. Case Report. We describe the case of a 61-year-old woman with epithelial ingrowth in her right eye 15 years after primary LASIK. She presented with right eye redness, pain, and decreased vision and denied any preceding trauma. An epithelial cells' tract was visible on Optical Coherence Tomography. Conservative treatment lead to the stabilization of the epithelial nests. Discussion. Epithelial ingrowth can occur many years after LASIK and may be due to a microtrauma to the edge of the flap.

Instability of TCF4 Triplet Repeat Expansion With Parent-Child Transmission in Fuchs' Endothelial Corneal Dystrophy.

Purpose: Fuchs' endothelial corneal dystrophy (FECD) caused by the CTG triplet repeat expansion in the TCF4 gene (CTG18.1 locus) is the most common repeat expansion disorder. Intergenerational instability of expanded repeats and clinical anticipation are hallmarks of other repeat expansion disorders. In this study, we examine stability of triplet repeat allele length and FECD disease severity in parent-child transmission of the expanded CTG18.1 allele. Methods: We studied 44 parent-child transmissions of the mutant expanded CTG18.1 allele from 26 FECD families. The CTG18.1 polymorphism was genotyped using short tandem repeat analysis, triplet repeat primed PCR assay, and Southern blot analysis. FECD severity was assessed using modified Krachmer grading (KG) system. Triplet repeat length of mutant allele and KG severity were compared between generations. Results: Instability of the expanded allele was seen in 14 of 44 (31.8%) parent-child transmissions, and the likelihood of an unstable event increased with the size of the parental allele (P = 5.9 x 10^-3). A tendency for contraction was seen in transmission of large alleles (repeat length > 120), whereas intermediate alleles (repeat length between 77 and 120) had predilection for further expansion (P = 1.3 x 10^ - 3). Although we noted increased KG severity in the offspring in three pairs, none of these transmissions were associated with allele instability. Conclusions: We observed instability of the TCF4 triplet repeat expansion in nearly a third of parent-child transmissions. Large mutant CTG18.1 alleles are prone to contraction, whereas intermediate mutant alleles tend to expand when unstably transmitted. Intergenerational instability of TCF4 repeat expansion has implications on FECD disease inheritance.

Ocular Rosacea Causing Corneal Melt in an African American Patient and a Hispanic Patient.

PURPOSE: To discuss two rare presentations of ocular rosacea in a Hispanic patient and an African American patient with unusual ocular manifestations. CASE REPORT: Case 1: a 43-year-old Hispanic woman presented with right eye corneal perforation. Her prior medical history was significant for rosacea only, diagnosed clinically by a dermatologist. Her eye exam showed signs of bilateral ocular rosacea. An emergent full thickness tectonic corneal patch graft was done. The patient's bilateral eye symptoms improved one month after initiating rosacea treatment. Case 2: a 51-year-old African American man with long standing history of untreated rosacea presented with bilateral peripheral corneal thinning with neovascularization that led to right eye corneal perforation. Glue and bandage contact lens were applied. The patient did well 4 weeks after starting antibacterial, oral steroids, and rosacea treatment. DISCUSSION: Ocular rosacea can present in Hispanic and African American patients with severe manifestations such as corneal perforation.

Iritis, glaucoma and corneal decompensation associated with BrightOcular cosmetic iris implant.

PURPOSE: NewColorIris cosmetic iris implants have a record of high ocular morbidity and are no longer in use. Newer generation of iris implants, BrightOcular, have patented posterior grooves in order to decrease iris touch and facilitate aqueous flow around the implant. However, little is known about their safety despite their implantations in 10 countries. METHODS: Collaborative case series of patients who had bilateral implantation of cosmetic iris implants solely for cosmetic reasons. RESULTS: 12 cases were collected being distributed as Caucasian (10) and Asian (2), women (11) and man (1) and with a mean age of 32 years. Ocular manifestations were present in 11 subjects and included anterior uveitis (10 of 12; 83.3%), glaucoma (7 of 12; 58.3%) and corneal decompensation (6 of 12; 50%). Visual acuity was normal in seven, decreased in five with two having visual recovery following explantation of the implant. Glaucoma could not be controlled medically in two patients. CONCLUSIONS: Cosmetic iris implants carry the risk of ocular damage when implanted in the anterior chamber of normal phakic eyes.

Convergence Insufficiency/Divergence Insufficiency Convergence Excess/Divergence Excess: Some Facts and Fictions.

Great discrepancies are often encountered between the distance fixation and the near-fixation esodeviations and exodeviations. They are all attributed to either anomalies of the AC/A ratio or anomalies of the fusional convergence or divergence amplitudes. We report a case with pseudoconvergence insufficiency and another one with pseudoaccommodative convergence excess. In both cases, conv./div. excess and insufficiency were erroneously attributed to anomalies of the AC/A ratio or to anomalies of the fusional amplitudes. Our purpose is to show that numerous factors, other than anomalies in the AC/A ratio or anomalies in the fusional conv. or divergence amplitudes, can contaminate either the distance or the near deviations. This results in significant discrepancies between the distance and the near deviations despite a normal AC/A ratio and normal fusional amplitudes, leading to erroneous diagnoses and inappropriate treatment models.