Courtney Lynn Kraus

Purpose: Social networking sites are an increasingly popular source of health information and a natural place for connection and support among patients and their loved ones. This study analyzes the content of a Facebook support group for congenital cataracts to understand the concerns, informational needs, and support-seeking behaviors in this community. Methods: A qualitative evaluation was conducted on the Facebook group Children with Congenital Cataracts, the largest group for congenital cataracts on the platform. The most recent 150 discussion posts were selected for review. Posts were categorized into one of 5 themes: surgery, contact lens, disease related, tips/advice, and miscellaneous. Additional information recorded included the identity of the post’s author (caregiver/patient) and level of engagement. Two investigators reviewed the posts. Results: The majority of posters were mothers of children with congenital cataracts (142/150 or 94.67%), with two posts from adults with the condition. The average number of replies per post was 9 (range: 0– 63). Posts with image attachments had more engagement in terms of reactions obtained compared to posts without images (p = < 0.001). The majority of posts were questions, followed by news sharing. Discussion post topics fell under the following categories: tips/advice, surgery related, contact lens related, miscellaneous, and disease related. The most common topics within each category were questions regarding surgical complications (n=12, 8%), inserting and removing (usage of) contact lens (n=12, 8%), etiology of disease (n=3, 2%), and advice on patching (n=13, 8.67%) and glasses (n=13, 8.67%). Conclusion: Awareness of the community and knowledge sharing in the online social space is important for pediatric cataract surgeons. Understanding parental knowledge gaps can help healthcare providers address concerns and improve patient education strategies. Community-driven resources, such as unused contact lens resale, highlight impressive grassroots efforts to assist in care. Plain Language Summary: Parents of children with less common conditions such as congenital cataracts often turn to the internet for answers, support, and advice. One of the largest Facebook groups dedicated to this topic is Children with Congenital Cataracts, where caregivers share their experiences and ask questions. This study looked at 150 of the group’s most recent posts to better understand what kinds of support parents are looking for and what concerns they commonly face. Most of the posts were written by mothers, and nearly all were focused on asking questions. Often, the questions were about surgery, using contact lenses, or how to manage daily care like patching and glasses. Posts that included images received more reactions and likes, showing that visuals may help others connect or offer support. Some parents also used the group to share news, explain their child’s diagnosis, or offer tips that have helped them. By learning more about what parents talk about in online spaces like this, healthcare providers can better understand the kinds of challenges families face and what information they may be missing. Doctors and care teams can then use this insight to improve how they communicate with families and support them over time. This study also showed how families help one another directly, demonstrating how powerful online communities can be in filling gaps in care.

PurposeTo evaluate the accuracy and appropriateness of responses provided by ChatGPT in identifying congenital glaucoma from a series of written and image-based prompts.MethodsA series of questions regarding common signs and symptoms of congenital glaucoma were developed and queried to ChatGPT-3.5 and ChatGPT-4.0, and a set of publicly available images of patients with congenital glaucoma were queried to the image search function of ChatGPT-4.0. Outputs were graded by three pediatric ophthalmologists with expertise in congenital glaucoma. Completeness of response, accuracy, potential for harm, and concern for glaucoma were assessed by each reviewer.ResultsA higher proportion of prompt responses from ChatGPT-4.0 were graded to be acceptable/appropriate than from ChatGPT-3.5 (22/33 vs 9/33 [P = 0.001]) among text-based queries. A higher proportion of ChatGPT-4.0 responses were felt to raise appropriate concern for congenital glaucoma (8/11 vs 2/11 [P = 0.03]) and a lower proportion of responses had incorrect or inappropriate information of major clinical significance (0/33 vs 6/33 [P = 0.02]) than ChatGPT-3.5 responses. There was no significant difference in the proportion of responses from ChatGPT-3.5 and ChatGPT-4.0 that were deemed to have potential likelihood of harm (P = 0.17). Among clinical images queried to ChatGPT-4.0, responses to two of three images were universally felt to be unacceptable with a major amount of incorrect or inappropriate clinical information and high/definitive likelihood of harm. Among readability indices, the SMOG Index score showed more difficult readability scores for ChatGPT-4.0 than for ChatGPT-3.5 (14.8 ± 1.2 vs 14.0 ± 1.4 [P = 0.009]). ConclusionsDespite superior performance from ChatGPT-4.0 compared with ChatGPT-3.5 in raising concern for congenital glaucoma and appropriateness of responses from text-based prompts, it performed poorly in recognizing clinical images of congenital glaucoma.

Background: The outcomes of pediatric glaucoma suspects with a history of ocular trauma remains unknown; we describe the rate of conversion to glaucoma of this population of patients at a research-intensive academic center. Methods: We conducted a retrospective case series of pediatric patients with a history of open- or closed-globe trauma who were being monitored as pediatric glaucoma suspects at the Wilmer Eye Institute between 2005 and 2016. Results: A total of 62 eyes from 62 patients with a history of ocular trauma were identified with a median age at presentation of 9.7 years (7.8 years) and a median follow-up of 2.7 (5.8 years). There were 29 eyes (46.8%) with open-globe injuries and 33 eyes (53.2%) with closed-globe injuries. A higher proportion of eyes that sustained closed-globe injuries were started on topical therapy for persistent ocular hypertension than eyes that sustained open-globe injuries (36.4% versus 10.3%, X² = 5.6976, p = 0.017). Five eyes (8.1%) developed glaucoma during the follow-up period, all of which had a history of closed-globe injury (15.2%, X² = 4.7794, p = 0.029). Four eyes of these eyes underwent glaucoma-related surgical intervention. Most eyes (3/5, 60%) that went on to develop post-traumatic glaucoma had undergone additional and/or concurrent intraocular surgical interventions to address sequelae of ocular trauma, such as traumatic cataract and retinal detachment. Conclusions: All eyes that developed glaucomatous damage or underwent glaucoma-related surgical intervention in this cohort of patients with a history of ocular trauma were those that had sustained close-globe injuries. No eyes that sustained open-globe injury progressed to glaucoma.

Purpose: Compare cup-to-disc ratio (CDR) measured by clinical assessment and optical coherence tomography (OCT) in pediatric eyes being monitored as glaucoma suspects for suspicious optic disc appearance.Design: Retrospective cross-sectional study.Methods: An institutional study following 221 eyes from 122 unique pediatric glaucoma suspects being monitored due to increased or asymmetric appearance of CDR. Ophthalmologic findings, including visual acuity, intraocular pressure, CDR measured by clinical assessment, average retinal nerve fiber layer thickness, and average CDR measured by OCT, were recorded for each participant’s initial and final examinations. CDRs measured clinically and by OCT were compared at both initial and final presentations.Results: Average age at presentation was 9.0 years old (95% CI: 8.0-9.9), and mean length of follow-up was 5.0 years (95% CI: 5.4-4.5). At initial presentation, 53 eyes had CDRs recorded by both clinical assessment and OCT, and at final presentation, 93 eyes had CDRs measured by both modalities. CDR measured by OCT was significantly larger than CDR measured clinically on initial and final presentation (p=0.002, p<0.001).Conclusions: Measurements of CDR by clinician assessment were significantly smaller than measurements obtained via OCT imaging. However, the average difference between CDR measured clinically and by OCT was <0.1. Thus, OCT may be a suitable way to measure CDR in pediatric glaucoma suspects, especially when clinical exam proves difficult. Further research is needed to assess CDR in glaucoma suspects using OCT longitudinally and in the context of other optic disc measurements, such as disc area.

Background: Ectopia lentis is the dislocation of the natural crystalline lens and usually presents in the setting of trauma or other systemic diseases. Herein, we describe a case of an otherwise healthy four-year-old boy with isolated ectopia lentis whose partial lens dislocation was captured on a smartphone by the patient’s father several days prior. Case presentation: A four-year-old boy with no past medical, developmental, or trauma history presented with bilateral partial anterior lens dislocation with pupillary block. Initial ophthalmic evaluation two months prior was notable for uncorrected visual acuity at 20/100 OD, 20/250 OS, bilateral iridodenesis, and partially dislocated lenses inferonasally OD and inferiorly OS on slit lamp. Genetic testing found no abnormalities. Ten months later, the patient developed sudden onset of left eye pain. A dislocated lens and temporarily dilated left pupil were captured on a smartphone by the patient’s father. He was evaluated 3 days later after a second episode and found to have hand motion vision OS, a fixed 8 mm left pupil with the crystalline lens subluxed into the pupil space and accompanying intraocular pressure OS of 40 mmHg. The lens was surgically removed with a limited anterior vitrectomy. Four and a half years after surgery, visual acuity was 20/125 OS with aphakic correction. The right eye eventually underwent prophylactic lensectomy and was 20/30 in aphakic correction. Conclusions: This report presents a unique presentation of isolated ectopia lentis with anterior lens dislocation and pupillary block and illustrates the role of smartphone photography in assisting in the triage of eye emergencies.