Ophthalmology is a specialty that has its own unique vocabulary and culture. It can be thought of as a “black box” not only for the general population but also for physicians outside of the specialty. Within ophthalmology, the language and ways of practice might also be poorly understood among those in different subspecialities, which can lead to confusion and potentially influence outcomes for shared patients. It is not surprising that written notes and instruction sheets are an important part of the way ophthalmologists communicate, and the audience, whether patients or health care colleagues, often rely on these resources to understand how to follow instructions and what current and future plans might be for optimal delivery of care. One specific and common example in eye care involves written instructions on how to use glaucoma medications and what to expect from this method of treatment.

Glaucoma Care’s Greatest Challenge

Optimal management of glaucoma requires patients, and sometime their relatives, to understand their condition and how to use medications appropriately. Giving clear instructions often requires long clinic consultations with or without use of written documents that are created in a generic form to help cover scenarios that apply to a general patient population. These instructional episodes are frequently followed by phone calls and digital messages from patients and relatives asking for clarification about directions for use. Using multiple topical medications can be confusing, so it is not surprising that poor adherence to therapy is common unless effective consultation is performed and the patient effectively receives the information.¹

A study found that a customized consultation tailored to the patient’s understanding and beliefs, rather than generic ones, will significantly improve adherence.² However, giving personalized information and instruction sheets for each patient has been considered impractical and is not done in most clinics around the globe.

An Opportunity for Improved Medication Adherence

The newly introduced artificial intelligence (AI) chatbot, ChatGPT, may be a tool to ameliorate this issue. ChatGPT was launched by the company OpenAI as a prototype for public use on November 30, 2022. It functions through a software-based application that can perform online tasks, mimicking human conversations with a question-and-answer format. It can complete tasks such as rewriting paragraphs, suggesting edits to supplied text, and even helping with creative endeavors such as writing poetry, programming computers, and composing fairy tales.

Figures 1 and 2 represent instructions given to ChatGPT from the viewpoint of a hypothetical glaucoma patient who is using a prostaglandin analogue eye drop. Figure 1 illustrates simple instructions that do not require a high level of specialization to answer. However, upon asking common patient questions that require a higher level of specialization — the sort often received in clinic through digital messaging or follow-up phone calls — ChatGPT provided high-quality answers (Figure 2) that meet the expectations of practicing ophthalmologists. This is an indication that, with future improvements and customization, use of such chatbot systems might help provide individualized instructions and improve patient adherence to therapy.

This could be just one example of how AI chatbots can be used effectively to help in glaucoma care. Other examples might include suggesting language for operative notes (Figure 3), composing referral letters to other doctors (Figure 4), and composing letters of recommendation for residents (Figure 5).

Conclusions

Given that the language used in glaucoma care settings is often highly specialized and instructions for care can be difficult to understand, personalized notes and instruction sheets could potentially impact care in a meaningful way. Even without fine-tuning, the ChatGPT base model can provide accurate and acceptable answers to medical queries, and future refinements or a human review layer could further enhance the quality of these answers. While it is still premature to predict how such high-quality chatbots can be implemented in medicine, a highly regulated field, AI-driven chatbots are likely to have an important role in enhancing communication and improving patient satisfaction while also lessening the time burden on health care workers.

References

1. Welge-Lussen U, Weise S, Yu AL. Assessing the adherence behavior of glaucoma patients to topical eye drops. Patient Prefer Adherence. 2014;9:17-23. doi:10.2147/PPA.S69943
2. Gray TA, Fenerty C, Harper R, et al. Individualised patient care as an adjunct to standard care for promoting adherence to ocular hypotensive therapy: an exploratory randomised controlled trial. Eye (Lond). 2012;26(3):407-417. doi:10.1038/eye.2011.269