As Automatic Speech Recognition (ASR) is increasingly deployed in clinical dialogue, standard evaluations still rely heavily on Word Error Rate (WER). This paper challenges that standard, investigating whether WER or other common metrics correlate with the clinical impact of transcription errors. We establish a gold-standard benchmark by having expert clinicians compare ground-truth utterances to their ASR-generated counterparts, labeling the clinical impact of any discrepancies found in two distinct doctor-patient dialogue datasets. Our analysis reveals that WER and a comprehensive suite of existing metrics correlate poorly with the clinician-assigned risk labels (No, Minimal, or Significant Impact). To bridge this evaluation gap, we introduce an LLM-as-a-Judge, programmatically optimized using GEPA to replicate expert clinical assessment. The optimized judge (Gemini-2.5-Pro) achieves human-comparable performance, obtaining 90
The International Society for Clinical Electrophysiology of Vision (ISCEV) Standard for full-field electroretinography (ERG) describes a minimum procedure, but encourages more extensive testing. This ISCEV extended protocol describes an extension to the full-field ERG Standard, namely the ERG responses to silent substitution stimuli that are directed at the response modulation of single photoreceptor types. The method can be used to detect selective defects in distinct photoreceptor types and post-receptoral retinal pathways. This document, based on existing literature, provides protocols for recording and analyzing the responses to a single class of photoreceptor directed stimuli. For each photoreceptor type (rods, L-, M- and S-cones), optimal luminance conditions and temporal frequencies for Ganzfeld recordings are provided. The exact stimulus conditions depend on the spectral properties of the stimulator. An accompanying technical report describes an app that is meant to provide support in calculating stimuli for individual stimulators.
PURPOSE:To investigate the relationship of structural progression, β-zone parapapillary atrophy (PPA) progression, and microvascular dropout (MvD) in glaucoma suspect eyes. DESIGN:Retrospective cohort study. METHODS:Eyes were included if optic disc photographs were available at least 5 years before optical coherence tomography angiography imaging. During follow-up, structural progression and β-zone PPA progression were recorded. Structural progression was graded using stereophotographs; eyes were classified as progressing if new or enlarged retinal nerve fiber layer defects or neuroretinal rim thinning were detected. β-zone PPA was quantified (area, radial width, angular extent), with progression defined as a ≥20% increase in any parameter. The presence of MvD at the last visit was evaluated using en-face choroidal vessel density maps. Multivariable logistic regression was used to assess the association between MvD and structural progression, adjusting for covariates and β-zone PPA progression. Margins analysis was performed to estimate predicted probabilities of structural progression by MvD status and β-zone PPA progression. RESULTS:A total of 180 eyes from 134 glaucoma suspect patients were included, of which 58 eyes (32.2%) had MvD. The mean follow-up duration for fundus photographs was 19.0 (95% CI, 17.9-20.1) years. The presence of MvD and also β-zone PPA progression were significantly associated with structural progression (15.8 [95% CI, 5.6-44.6], P < .001; 3.8 [95% CI, 1.2-11.7], P = .022, respectively). Margin plots indicated that eyes exhibiting both MvD and β-zone PPA progression had the highest estimated probability of structural progression (0.75). CONCLUSIONS:In glaucoma suspect eyes, the presence of both MvD and β-zone PPA progression were independently associated with structural optic disc progression. These structural changes were observed in glaucoma suspect eyes that remained clinically stable and did not convert to perimetric glaucoma during the period of observation in this study. Recognition of these changes may enhance more timely management to prevent glaucomatous vision loss.
PURPOSE:To compare canaloplasty and trabecular micro-bypass surgery outcomes in primary open-angle glaucoma (POAG). METHODS:Ambispective study using data from the International Glaucoma Surgery Registry (IGSR) to evaluate mild-to-moderate POAG patients who underwent iTrack ab-interno canaloplasty (Nova Eye Medical, USA) (prospective cohort) or iStent trabecular micro-bypass implantation (Glaukos, USA) (retrospective cohort), with or without concomitant phacoemulsification, and ≥12 months of follow-up. Primary outcomes were intraocular pressure (IOP), medication usage, and surgical success as defined by the American Academy of Ophthalmology (2024). RESULTS:The study included 339 eyes (iStent: n = 115; iTrack: n = 224) of which ≥94% underwent concomitant phacoemulsification (iStent: n = 109, iTrack: n = 210). There were nonsignificant differences in baseline IOP (p = 0.417) and medications (p = 0.741) between groups. At last follow-up, mean IOP (mmHg) and medication usage decreased from 17.3 ± 4.2 and 2.0 ± 1.1 at baseline to 14.2 ± 3.5 and 1.3 ± 1.1 in the iStent group (p < 0.001; mean follow-up: 27.2 ± 14.5 months), and from 16.9 ± 5.0 and 2.0 ± 1.1 at baseline to 14.3 ± 3.4 and 1.1 ± 1.3 in the iTrack group (p < 0.001; mean follow-up: 20.3 ± 7.7 months). Both groups showed no significant differences in reduction of IOP (p = 0.422) and medications (p = 0.211). More eyes were medication-free in the iTrack group (42% vs 29%; p = 0.029). Success was achieved in 61% of eyes in both groups (p = 1.000). Postoperatively, both groups demonstrated infrequent and self-limited complications, no sight-threatening events, and low reoperation rates. CONCLUSION:In POAG, iTrack canaloplasty and iStent implantation showed no statistically significant differences in effectiveness outcomes. Both procedures had favourable safety profiles with limited additional glaucoma surgeries. More canaloplasty eyes were medication-free compared to stent eyes.
