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OBJECTIVE: To assess the effect of prompt engineering on the accuracy, comprehensiveness, readability, and empathy of large language model (LLM)-generated responses to patient questions regarding retinal disease. DESIGN: Prospective qualitative study. PARTICIPANTS: Retina specialists, ChatGPT3.5, and GPT4. METHODS: Twenty common patient questions regarding 5 retinal conditions were inputted to ChatGPT3.5 and GPT4 as a stand-alone question or preceded by an optimized prompt (prompt A) or preceded by prompt A with specified limits to length and grade reading level (prompt B). Accuracy and comprehensiveness were graded by 3 retina specialists on a Likert scale from 1 to 5 (1: very poor to 5: very good). Readability of responses was assessed using Readable.com, an online readability tool. RESULTS: There were no significant differences between ChatGPT3.5 and GPT4 across any of the metrics tested. Median accuracy of responses to a stand-alone question, prompt A, and prompt B questions were 5.0, 5.0, and 4.0, respectively. Median comprehensiveness of responses to a stand-alone question, prompt A, and prompt B questions were 5.0, 5.0, and 4.0, respectively. The use of prompt B was associated with a lower accuracy and comprehensiveness than responses to stand-alone question or prompt A questions (p < 0.001). Average-grade reading level of responses across both LLMs were 13.45, 11.5, and 10.3 for a stand-alone question, prompt A, and prompt B questions, respectively (p < 0.001). CONCLUSIONS: Prompt engineering can significantly improve readability of LLM-generated responses, although at the cost of reducing accuracy and comprehensiveness. Further study is needed to understand the utility and bioethical implications of LLMs as a patient educational resource.

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PURPOSE: To report a series of patients who developed neurotrophic keratopathy following scleral fixation of intraocular lenses. METHODS: Retrospective case series of patients undergoing implantation of scleral fixated IOLs with various techniques. RESULTS: Three patients developed NK in the immediate post-operative period following scleral fixation of IOLs. Scleral fixation of IOL was performed using three different techniques (4-point fixation, "Yamane" flanged intrascleral and tunneled intrascleral haptic fixation). None of the patient had any prior risk factors for the development of NK. In all patients, intrascleral haptics or scleral sutures were positioned on the horizontal meridian. All patients also underwent light peripheral retinal endolaser. CONCLUSIONS: NK can rarely occur following scleral fixation of IOLs. The combination of suturing or intrascleral fixation of the IOL on the horizontal meridian and peripheral retinal endolaser may synergistically damage to the long ciliary nerves with a "two-hit" mechanism and cause NK.

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OBJECTIVE: To assess how the University of Toronto Visiting Professors Rounds Series (UTVPRS) influenced the knowledge, perceptions, and clinical decision making of Canadian ophthalmologists. DESIGN: Longitudinal cross-sectional. PARTICIPANTS: Eight hundred and fifty ophthalmologists registered with the Canadian Ophthalmological Society. METHODS: Online surveys, using multiple-choice and reflection questions, were administered before and after online viewing of the University of Toronto Ophthalmology grand rounds as screencasts. RESULTS: At 18 months, 124 users registered and watched 429 screencasts. Most participants found UTVPRS to be organized and user friendly. Mean prescreencast correct scores were 1008 versus 1288 postscreencast (p = 0.002). Postscreencast, 73% of participants replied in favour of changing future practice. CONCLUSIONS: UTVPRS was well received with demonstrated knowledge gain and potential practice change. The long-term and patient-related outcomes of the results require further research.

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OBJECTIVE: To determine whether brand-name glaucoma drops differ from generic equivalents in bottle design, viscosity, surface tension, and volume in North America. DESIGN: Experimental study. PARTICIPANTS: We studied 5 bottles each of 11 kinds of glaucoma drops. METHODS: Density-based calculations of drop volume were assessed using 0.1 mg analytic balance. Viscosity was measured using rotational rheometery. Bottle tip diameter was measured using 0.05 mm Vernier calipers. Surface tension was measured using a Fisher Scientific (Ottawa, ON) tensiometer. RESULTS: For the American brand-name Timoptic XE, the average drop volume was 38 ± 3.1 µL versus 24 ± 1.5 µL of Timolol GFS (p < 0.0001). For the Canadian brand-name Timoptic XE, the average drop volume was 42 ± 4.0 µL versus 25 ± 2 µL of timolol maleate EX (p < 0.0001). The Canadian brand-name Timoptic drop volume was 28 ± 1.4 µL versus 35 ± 1.9 µL Apo-Timop (p < 0.01). At a 0.1 per second shear rate, the viscosity of Canadian Timoptic XE was 20 times higher than that of its generic equivalent, whereas the viscosity of American Timoptic XE differed from the generic by a factor of 100. The surface tension of Canadian Timoptic XE was 31% higher than that of the generic (p < 0.001), whereas the surface tension of American Timoptic XE was 21% higher than that of the generic (p < 0.001). The bottle tips of the Canadian and American Timoptic XE measured about 3.5 times larger than those of their generics. CONCLUSION: American and Canadian Timoptic XE eye drops vary significantly from the generics in drop volume, viscosity, surface tension, and bottle tip. Canadian brand-name Timoptic delivered significantly smaller drop volumes than generic Apo-Timop. Careful consideration should be given to drop viscosity and bottle design when generic ophthalmic products are evaluated for interchangeability and market entry.

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