JAMA ophthalmology最新文献

{"title":"Commercial Price Variation in Ophthalmology.","authors":"Alexander P Philips, Christopher Whaley","doi":"10.1001/jamaophthalmol.2025.1693","DOIUrl":"10.1001/jamaophthalmol.2025.1693","url":null,"abstract":"<p><strong>Objective: </strong>To assess the variation in commercial insurance payment rates for common ophthalmology procedures across major national insurers and identify patterns in professional and facility fees.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study used January 2025 Transparency in Coverage data, payment rates negotiated between insurers and health care professionals from 4 large national insurers (Blue Cross Blue Shield, United Healthcare, Cigna, and Aetna) for 10 common ophthalmology procedures. Data included approximately 684 506 professional fee price points from 15 788 physicians and 55 930 facility fee price points from 4697 facilities. Data were analyzed January through March 2025.</p><p><strong>Main outcomes and measures: </strong>The primary outcomes were the distribution of negotiated prices (mean, median, percentiles), coefficients of variation, and volume-weighted price indices by payer for professional and facility payments by commercial insurers. Geographic variation in pricing was also assessed.</p><p><strong>Results: </strong>Negotiated facility fees showed substantially greater price variation than professional fees across all ophthalmology procedures, with facility coefficients of variation exceeding professional coefficients by factors of 2 to 4. Blue Cross Blue Shield maintained consistently higher payments (14% above market average for professional fees; 13% above for facility fees), while Aetna demonstrated dramatic variation with professional fees 54% below average but facility fees 45% above average. Geographic analysis revealed substantial state-level variability, with facility prices for standard cataract surgeries showing up to 5-fold differences between upper and lower bounds across states.</p><p><strong>Conclusions and relevance: </strong>This study reveals substantial variability in commercial insurance payment rates for ophthalmology procedures, particularly in facility fees. These findings indicate that market dynamics, insurer-health care professional negotiations, and geographic factors substantially influence price variation, which has important implications for health care affordability and access to ophthalmologic care.</p>","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":" ","pages":"703-707"},"PeriodicalIF":9.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ophthalmological Question Answering and Reasoning Using OpenAI o1 vs Other Large Language Models","authors":"Sahana Srinivasan, Xuguang Ai, Minjie Zou, Ke Zou, Hyunjae Kim, Thaddaeus Wai Soon Lo, Krithi Pushpanathan, Gabriel Dawei Yang, Jocelyn Hui Lin Goh, Yiming Kong, Anran Li, Maxwell B. Singer, Kai Jin, Fares Antaki, David Ziyou Chen, Dianbo Liu, Ron A. Adelman, Qingyu Chen, Yih Chung Tham","doi":"10.1001/jamaophthalmol.2025.2413","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.2413","url":null,"abstract":"ImportanceOpenAI’s recent large language model (LLM) o1 has dedicated reasoning capabilities, but it remains untested in specialized medical fields like ophthalmology. Evaluating o1 in ophthalmology is crucial to determine whether its general reasoning can meet specialized needs or if domain-specific LLMs are warranted.ObjectiveTo assess the performance and reasoning ability of OpenAI’s o1 compared with other LLMs on ophthalmological questions.Design, Setting, and ParticipantsIn September through October 2024, the LLMs o1, GPT-4o (OpenAI), GPT-4 (OpenAI), GPT-3.5 (OpenAI), Llama 3-8B (Meta), and Gemini 1.5 Pro (Google) were evaluated on 6990 standardized ophthalmology questions from the Medical Multiple-Choice Question Answering (MedMCQA) dataset. The study did not analyze human participants.Main Outcomes and MeasuresModels were evaluated on performance (accuracy and macro F1 score) and reasoning abilities (text-generation metrics: Recall-Oriented Understudy for Gisting Evaluation [ROUGE-L], BERTScore, BARTScore, AlignScore, and Metric for Evaluation of Translation With Explicit Ordering [METEOR]). Mean scores are reported for o1, while mean differences (Δ) from o1’s scores are reported for other models. Expert qualitative evaluation of o1 and GPT-4o responses assessed usefulness, organization, and comprehensibility using 5-point Likert scales.ResultsThe LLM o1 achieved the highest accuracy (mean, 0.877; 95% CI, 0.870 to 0.885) and macro F1 score (mean, 0.877; 95% CI, 0.869 to 0.884) (&lt;jats:italic&gt;P&lt;/jats:italic&gt; &amp;amp;lt; .001). In BERTScore, GPT-4o (Δ = 0.012; 95% CI, 0.012 to 0.013) and GPT-4 (Δ = 0.014; 95% CI, 0.014 to 0.015) outperformed o1 (&lt;jats:italic&gt;P&lt;/jats:italic&gt; &amp;amp;lt; .001). Similarly, in AlignScore, GPT-4o (Δ = 0.019; 95% CI, 0.016 to 0.021) and GPT-4 (Δ = 0.024; 95% CI, 0.021 to 0.026) again performed better (&lt;jats:italic&gt;P&lt;/jats:italic&gt; &amp;amp;lt; .001). In ROUGE-L, GPT-4o (Δ = 0.018; 95% CI, 0.017 to 0.019), GPT-4 (Δ = 0.026; 95% CI, 0.025 to 0.027), and GPT-3.5 (Δ = 0.008; 95% CI, 0.007 to 0.009) all outperformed o1 (&lt;jats:italic&gt;P&lt;/jats:italic&gt; &amp;amp;lt; .001). Conversely, o1 led in BARTScore (mean, –4.787; 95% CI, –4.813 to –4.762; &lt;jats:italic&gt;P&lt;/jats:italic&gt; &amp;amp;lt; .001) and METEOR (mean, 0.221; 95% CI, 0.218 to 0.223; &lt;jats:italic&gt;P&lt;/jats:italic&gt; &amp;amp;lt; .001 except GPT-4o). Also, o1 outperformed GPT-4o in usefulness (o1: mean, 4.81; 95% CI, 4.73 to 4.89; GPT-4o: mean, 4.53; 95% CI, 4.40 to 4.65; &lt;jats:italic&gt;P&lt;/jats:italic&gt; &amp;amp;lt; .001) and organization (o1: mean, 4.83; 95% CI, 4.75 to 4.90; GPT-4o: mean, 4.63; 95% CI, 4.51 to 4.74; &lt;jats:italic&gt;P&lt;/jats:italic&gt; = .003).Conclusions and RelevanceThis study found that o1 excelled in accuracy but showed inconsistencies in text-generation metrics, trailing GPT-4o and GPT-4; expert reviews found o1’s responses to be more clinically useful and better organized than GPT-4o. While o1 demonstrated promise, its performance in addressing ophthalmology-","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"27 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144747826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GLP-1 RAs and Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Older Patients With Diabetes","authors":"Kin Wah Fung, Fitsum Baye, Seo H. Baik, Clement J. McDonald","doi":"10.1001/jamaophthalmol.2025.2299","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.2299","url":null,"abstract":"This observational cohort study assesses the effects of glucagon-like peptide-1 receptor agonist (GLP-1 RA) use on the incidence of nonarteritic anterior ischemic optic neuropathy in older patients with type 2 diabetes.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"33 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144747825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incorrect Conclusions From Misinterpreting Point Estimates and CIs.","authors":"Mahyar Etminan,Mohit Sodhi,Mohammad Ali Mansournia","doi":"10.1001/jamaophthalmol.2025.2248","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.2248","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"115 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144693411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GLP-1RA Exposure and Nonarteritic Anterior Ischemic Optic Neuropathy Prevalence by Diabetes Status.","authors":"Pallavi Nagdeve,Russell Griffin","doi":"10.1001/jamaophthalmol.2025.2332","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.2332","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"113 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144693356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Steroids and Cross-Linking for Ulcer Treatment: The SCUT II Randomized Clinical Trial.","authors":"N Venkatesh Prajna,Prajna Lalitha,Sumithra Chandru,Naveen Radhakrishnan,Josephine Christy,Anitha Karthikeyan,Revathi Rajaraman,Rahul Ramesh,Guillermo Amescua,Kunal Mandlik,Sarah Abdelrahman,Nicole Varnado,Maalika Kanchugantla,Ben Arnold,Thomas M Lietman,Jennifer R Rose-Nussbaumer","doi":"10.1001/jamaophthalmol.2025.2188","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.2188","url":null,"abstract":"ImportanceAdjunctive topical corticosteroids and/or corneal cross-linking (CXL) have the potential to improve outcomes in bacterial keratitis.ObjectiveTo determine the benefit of adjunctive topical difluprednate and CXL with riboflavin in addition to topical antibiotics.Design, Setting, and ParticipantsThis was a National Institutes of Health (NIH)-funded, sham, placebo-controlled trial randomizing participants to topical moxifloxacin, 0.5%, plus topical placebo plus sham CXL, vs topical moxifloxacin, 0.5%, plus difluprednate, 0.05%, plus sham CXL, vs topical moxifloxacin, 0.5%, plus difluprednate, 0.05%, plus CXL. Between September 2020 and October 2023, participants in clinics at the Aravind Eye Hospitals in India and Bascom Palmer Eye Institute, University of Miami, in Miami, Florida, were screened for inclusion. Included participants had smear- and/or culture-positive bacterial corneal ulcers with Snellen visual acuity of 20/40 or worse.Main Outcomes and MeasuresThe primary outcome was logMAR best spectacle-corrected visual acuity (BSCVA) at 6 months.ResultsOf the 1992 participants with smear-positive bacterial corneal ulcers screened, 280 participants (14%; mean [SD] age, 51 [16] years; 182 male [65%]) were enrolled. After controlling for baseline, there was no difference in 6-month VA with adjunctive topical steroids vs placebo (-0.04; 95% CI, -0.18 to 0.09; P = .58) or with adjunctive CXL and topical steroids vs topical steroids alone (0.04; 95% CI, -0.09 to 0.17; P = .62). Adjunctive topical corticosteroids also did not improve scar size at 6 months after controlling for baseline infiltrate and/or scar size (-0.22; 95% CI, -0.53 to 0.10; P = .65). CXL plus corticosteroids increased scar size compared with steroids alone after controlling for baseline infiltrate and/or scar size (0.56; 95% CI, 0.20-0.92; P = .02). There was 0.78 (95% CI, 0.27-2.24; P = .65) times the hazard of perforation or the need for therapeutic penetrating keratoplasty (TPK) in the early-steroid arm and 0.48 (95% CI, 0.14-1.67; P = .25) times the hazard of perforation or the need for TPK in the CXL arm after controlling for infiltrate depth.Conclusions and RelevanceResults of this randomized clinical trial reveal that adjunctive topical corticosteroids were not superior to placebo, and adjunctive CXL had increased scar size, suggesting that these alternative therapies, on average, may not be superior to topical antibiotics alone for treatment of bacterial keratitis.Trial RegistrationClinicalTrials.gov Identifier: NCT04097730.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"32 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144693408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interpreting Myopia Control Modalities in a 2-Year Trial.","authors":"Jan Roelof Polling,Caroline C W Klaver","doi":"10.1001/jamaophthalmol.2025.2484","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.2484","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"4 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144693409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incorrect Conclusions From Misinterpreting Point Estimates and CIs-Reply.","authors":"Alan Y Hsu, Chun-Ju Lin, James Cheng-Chung Wei","doi":"10.1001/jamaophthalmol.2025.2251","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.2251","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Orthokeratology, 0.04% Atropine, and 0.01% Atropine for Myopia Control: A Randomized Clinical Trial.","authors":"Hannan Xu,Moxin Chen,Luyao Ye,Qin Shu,Yajun Peng,Xiaoyi Liang,Tao Yu,Yongrong Ji,Shanshan Li,Qin Shen,Jiangnan He,Lin Li,Jianfeng Zhu,Xun Xu","doi":"10.1001/jamaophthalmol.2025.2321","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.2321","url":null,"abstract":"ImportanceInvestigating the antimyopia efficacy and safety of orthokeratology and varying atropine doses in specific age groups could optimize personalized treatment choices.ObjectiveTo evaluate the efficacy and safety of orthokeratology, 0.04% atropine, and 0.01% atropine in controlling myopia among older children and adolescents over a 2-year treatment period.Design, Setting, and ParticipantsThis 3-arm, parallel-design, multicenter randomized clinical trial was conducted from June 2021 to August 2023 at the Shanghai Eye Disease Prevention and Treatment Center and the Shanghai Ninth People's Hospital. A total of 209 children aged 8 to 15 years with refractive errors between -1.0 diopter (D) and -4.0 D were enrolled in this study. Primary data analysis was conducted from December 2024 to January 2025, with additional analysis conducted from April 2025 to May 2025.InterventionsAtropine, 0.01% or 0.04%, administered daily, or overnight orthokeratology for 2 years.Main Outcomes and MeasuresThe primary outcome was 2-year axial length (AL) growth.ResultsAmong 209 children enrolled in this study, mean (SD) age was 10.5 (1.79) years, and 104 participants (49.8%) were female. Mean (SD) spherical equivalent (SE) was -2.55 (0.85) D, and mean (SD) AL was 24.7 (0.79) mm. Of 209 enrolled children, 48 of 69 in the 0.01% atropine group (69.6%), 48 of 68 in the 0.04% atropine group (70.6%), and 53 of 72 in the orthokeratology group (73.6%) completed the 2-year follow-up. Children receiving 0.04% atropine had a significantly reduced AL increase than those receiving 0.01% atropine (difference, 0.18 mm; 95% CI, 0.11-0.26; P < .001). Nonsignificant but clinically meaningful difference was found between the 0.01% atropine group and the orthokeratology group (difference, 0.08 mm; 95% CI, 0.003-0.15; P = .04). Regression analyses revealed that older age was associated with less AL growth for all groups, while a more myopic SE at baseline predicted slower axial elongation for the orthokeratology group. The 0.04% atropine group had a higher risk of photophobia than the 0.01% atropine group (11 of 48 patients [22.9%] vs 1 of 48 patients [2.1%], respectively; difference, 20.8%; 95% CI, 8.3%-33.4%; P = .002). In the orthokeratology group, 19 of 72 participants (26.4%) showed slight corneal fluorescein staining.Conclusions and RelevanceIn this randomized clinical trial of participants aged 8 to 15 years, 0.04% atropine was more effective than 0.01% atropine or orthokeratology to control myopia, despite a higher incidence of photophobia. These findings support 0.04% atropine as a superior treatment compared with orthokeratology or 0.01% atropine for older children and adolescents with myopia similar to those enrolled in this trial, although longer-term follow-up is warranted.Trial RegistrationClinicalTrials.gov Identifier: NCT05357326.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"67 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144693410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lung Adenocarcinoma With Metastasis to Extraocular Muscle.","authors":"Hongyu Si,Lijuan Tang,Wei Xiao","doi":"10.1001/jamaophthalmol.2025.1571","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.1571","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"109 1","pages":"e251571"},"PeriodicalIF":8.1,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144645815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}