Performance of GPT-4V(ision) in Ophthalmology: Use of Images in Clinical Questions

Background/aims: To compare the diagnostic accuracy of Generative Pre-trained Transformer with Vision (GPT)-4 and GPT-4 with Vision (GPT-4V) for clinical questions in ophthalmology. Methods: The questions were collected from the "Diagnosis This" section on the American Academy of Ophthalmology website. We tested 580 questions and presented GPT-4V with the same questions under two conditions: 1) multimodal model, incorporating both the question text and associated images, and 2) text-only model. We then compared the difference in accuracy between the two conditions using the chi-square test. The percentage of general correct answers was also collected from the website. Results: The GPT-4V model demonstrated higher accuracy with images (71.7%) than without images (66.7%, p<0.001). Both GPT-4 models showed higher accuracy than the general correct answers on the website [64.6 (95%CI, 62.9 to 66.3)]. Conclusions: The addition of information from images enhances the performance of GPT-4V in diagnosing clinical questions in ophthalmology. This suggests that integrating multimodal data could be crucial in developing more effective and reliable diagnostic tools in medical fields. ### Competing Interest Statement K.T.: Lecture fees - Senju Pharmaceutical, Chugai Pharmaceutical, and KOWA T.N: Consultant - Topcon Y.K.: None M.M.: None K.K.: None ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.