ABSTRACT
INTRODUCTION: The purpose of this study was to evaluate the capabilities of large language models such as Chat Generative Pretrained Transformer (ChatGPT) to diagnose glaucoma based on specific clinical case descriptions with comparison to the performance of senior ophthalmology resident trainees. METHODS: We selected 11 cases with primary and secondary glaucoma from a publicly accessible online database of case reports. A total of four cases had primary glaucoma including open-angle, juvenile, normal-tension, and angle-closure glaucoma, while seven cases had secondary glaucoma including pseudo-exfoliation, pigment dispersion glaucoma, glaucomatocyclitic crisis, aphakic, neovascular, aqueous misdirection, and inflammatory glaucoma. We input the text of each case detail into ChatGPT and asked for provisional and differential diagnoses. We then presented the details of 11 cases to three senior ophthalmology residents and recorded their provisional and differential diagnoses. We finally evaluated the responses based on the correct diagnoses and evaluated agreements. RESULTS: The provisional diagnosis based on ChatGPT was correct in eight out of 11 (72.7%) cases and three ophthalmology residents were correct in six (54.5%), eight (72.7%), and eight (72.7%) cases, respectively. The agreement between ChatGPT and the first, second, and third ophthalmology residents were 9, 7, and 7, respectively. CONCLUSIONS: The accuracy of ChatGPT in diagnosing patients with primary and secondary glaucoma, using specific case examples, was similar or better than senior ophthalmology residents. With further development, ChatGPT may have the potential to be used in clinical care settings, such as primary care offices, for triaging and in eye care clinical practices to provide objective and quick diagnoses of patients with glaucoma.
ABSTRACT
PURPOSE: We describe a case of Purtscher-like retinopathy associated with adult-onset Still's disease, complicated by the development of central serous chorioretinopathy secondary to high dose corticosteroids. OBSERVATIONS: A 53 year old female diagnosed with adult-onset Still's disease (AOSD) presented to us with findings consistent with Purtscher-like retinopathy in both eyes, with 20/70 visual acuity in the right eye and 20/20 visual acuity in the left eye. She was initiated on high dose corticosteroids by her rheumatologists for her AOSD. A month later, her vision worsened significantly to counting fingers at 3 feet in the right eye and 20/60 visual acuity in the left. Her examination revealed serous macular detachments involving her fovea consistent with central serous chorioretinopathy secondary to exogenous steroids. After discussion with her rheumatologists, she was tapered off her steroids quickly and bridged to steroid sparing agents, with subsequent resolution of her serous macular detachments and improvement of vision back to baseline. CONCLUSION AND IMPORTANCE: The association of Purtscher-like retinopathy and AOSD is important from a multidisciplinary standpoint due to the possibility of life-threatening systemic thrombotic microangiopathy. In addition, patients undergoing treatment for AOSD with exogenous corticosteroids may develop central serous retinopathy with vision loss, and may require quick transitioning to steroid-sparing agents if focal laser is not feasible.
