This study aims to evaluate the association of optic cup-to-disc ratio (CDR) with magnification-adjusted optical coherence tomography (OCT) peripapillary retinal nerve fibre layer (RNFL) and macula ganglion cell complex (GCC) thickness in Asian myopic children, to help clinicians better evaluate glaucoma risk in myopic children with increased CDR. In a prospective clinical cohort study, myopic children aged 7–16 years were assessed annually over 2 years, excluding children with overt glaucomatous changes. Right eye data including visual acuity, intraocular pressure, cycloplegic autorefraction, axial length, fundus photographs and magnification-adjusted OCT of the optic disc and macula were collected. Children were divided into three OCT-assessed vertical CDR (vCDR) subgroups (0.00-0.39, 0.40–0.59, and 0.60–0.90) for analyses. Among 901 eyes, 162 (18.2
Extended reality (XR), encompassing virtual reality (VR), augmented reality (AR), and mixed reality (MR) technologies offer immersive and interactive experiences that are poised to transform clinical neurology. This review describes the technological foundations of XR systems, from multi-sensor headsets and real-time rendering pipelines to networked platforms, which together support emerging applications. In clinical practice, XR enables more sensitive and ecologically valid assessments of cognitive, motor, and sensory function; neurosurgical training and intraoperative XR guidance improve spatial understanding and decision support; and immersive rehabilitation programs for stroke, chronic neurological disorders, and pediatric conditions enhance engagement and functional recovery. Finally, we summarize adoption challenges and required supports for the clinical implementation of XR and highlight future directions. With continued interdisciplinary innovation and careful evaluation, XR is positioned to reshape neurology by providing powerful tools for understanding the brain and treating neurological disorders.
Medical Large Language Models (MLLMs) play a crucial role in ophthalmic diagnosis, holding significant potential to address vision-threatening diseases. However, their accuracy is constrained by hallucinations stemming from limited ophthalmic knowledge, insufficient visual localization and reasoning capabilities, and a scarcity of multimodal ophthalmic data, which collectively impede precise lesion detection and disease diagnosis. Furthermore, existing medical benchmarks fail to effectively evaluate various types of hallucinations or provide actionable solutions to mitigate them. To address the above challenges, we introduce EH-Benchmark, a novel ophthalmology benchmark designed to evaluate hallucinations in MLLMs. We categorize MLLMs' hallucinations based on specific tasks and error types into two primary classes: Visual Understanding and Logical Composition, each comprising multiple subclasses. Given that MLLMs predominantly rely on language-based reasoning rather than visual processing, we propose an agent-centric, three-phase framework, including the Knowledge-Level Retrieval stage, the Task-Level Case Studies stage, and the Result-Level Validation stage. Experimental results show that our multi-agent framework significantly mitigates both types of hallucinations, enhancing accuracy, interpretability, and reliability. Our project is available at https://github.com/ppxy1/EH-Benchmark.
Developments in large language models (LLMs) in the past 2 years have shifted the focus from text, image, and audio generation to LLMs capable of multistep reasoning (thinking). The development of LLMs is particularly important for medicine and health care, but the translation of these models has been limited by the black-box nature of previous LLMs. New reasoning-driven LLMs incorporate chain-of-thought prompting and reveal intermediate reasoning steps, offering transparency and traceability, potentially improving the clinical adoption and utility of LLMs. In this Viewpoint, we examine four emerging reasoning-driven LLMs, namely OpenAI's o1 and o3-mini, Google's Gemini 2.0 Flash Thinking, and DeepSeek R1. We compare their methodological approaches, benchmark their performance on medical question-answering tasks, and assess their potential for clinical integration. We highlight both opportunities and challenges associated with deploying reasoning-driven LLMs. Key future considerations include real-world validation, rigorous benchmarking with ethical safeguards, and advancements in improving the efficiency and sustainability of reasoning-driven LLMs. Addressing these challenges will enable the fine-tuning of these LLMs for specific medical applications, enhancing their potential clinical decision support, patient education, medical training, and evidence synthesis.
AIM:To evaluate the effectiveness of atropine 0.01% in young premyopic and low-myopic children. METHODS:Children (5-9 years old) with premyopia (spherical equivalent refraction, SER+1.00 to -0.49D, n 156) or low myopia (SER -0.50 to -1.50D, n 52), with at least 1 parent with myopia <-3.00D, were randomised to receive placebo or atropine 0.01% eye-drops in a 1:1 ratio. Cycloplegic autorefraction and axial length were measured every 6 months over 2 years. RESULTS:Mean baseline SER was +0.5+/-0.04D in premyopia and -1.00±0.06D in the low-myopia eyes. Progression over 2 years in premyopic eyes was -0.96±0.10D vs -0.82±0.10D (p=0.328), or 0.72±0.03 mm vs 0.63±0.04 mm (p=0.161) in the placebo and atropine groups, respectively. Progression in eyes remaining emmetropic was -0.43±0.37D vs -0.29±0.37D (p=0.007) or 0.49±0.22 mm vs 0.41±0.38 mm (p=0.209) in the placebo versus atropine-treated eyes, respectively; while eyes which became myopic progressed by -1.78±0.82D vs -1.63±0.82D (p=0.121) or 1.08±0.34 mm vs 0.96±0.14 mm (p=0.010). Incident myopia at 2 years was 42.6% in placebo and 44.8% in atropine 0.01% treated eyes (p=0.896). In the low-myopia group, placebo versus atropine treated eyes progressed by -1.65±0.15D vs -1.23±0.15D (p=0.066) or 0.86±0.07 mm vs 0.68±0.05 mm (p=0.062) at 2 years. There was no difference in near acuity, glare (2.7%) or allergy (6.0%) between treatment groups. CONCLUSIONS:Although there were no significant differences in myopia progression between atropine and placebo treated eyes, there were trends towards less myopic shift in atropine-treated eyes in premyopic eyes which remained emmetropic and in eyes with low myopia.
