Challenges of Integrating Chatbot Use in Ophthalmology Diagnostics

Abstract

Oke et al requested the percentage of ophthalmology referrals, and we included these in our article in Figure 1B and in the Results section. Rates of referral increased from 17.0% (1279 of 7505) in 2015 to 23.6% (1836 of 7792) in 2018, then decreased to 15.7% (997 of 6354) in 2022. 1 Regarding completed referrals, we found a similar trend: 7.2% (543 of 7505) in 2015, increasing to 11% (855 of 7792) in 2018, and then decreasing to 6.7% (426 of 6354) in 2022. As posited by Oke et al, we observed in the completed referrals similar racial and ethnic disparities as reported in the article 1 for referral orders, with Asian individuals having the highest completion and White individuals having the lowest completion from 2015 to 2022 for both referral orders (Asian, 23.6% [4531 of 19 164]; Black, 17.6% [59 of 335]; Hispanic, 18% [1094 of 6067]; and White, 14.9% [2026 of 13 613]; P < .001) and completed referrals (Asian, 10% [1921 of 19 164]; Black, 9% [30 of 335]; Hispanic, 7.5% [456 of 6067]; and White, 7.5% [1015 of 13 613]; P < .001) (race and ethnicity data were obtained from the electronic health record, which listed the following options: Asian, Black, Hispanic, White, other [American Indian, multiracial, Native Hawaiian, and other race not further specified], and unknown).We agree it is interesting that there has been a decrease in amblyopia diagnoses, and to answer the question from Oke et al, the diagnoses were made by both primary care and specialists during the study time frame. Given that there may have been some additional well-child care visits toward the end of 2022, there may be some missed amblyopia diagnoses as the patients may not have had sufficient follow-up time in which to observe a subsequent appointment and diagnosis.We concur that future analyses should use some more quasi-experimental methods like difference-in-differences or interrupted time series to further evaluate the impact of interventions. It is important to follow children up over longer periods and to identify those at risk of preventable vision loss.