Journal of Academic Ophthalmology
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A Bibliometric Analysis of the Top 100 Cited Papers in Trabeculectomy
No full textPurpose: To identify the most frequently cited articles on trabeculectomy through a bibliometric analysis. Methods: The Web of Science was queried using the term “trabeculectomy” to identify the 100 most cited (T100) publications. Articles were listed by title, authors’ affiliated institutions, journal title, year of publication, country of origin, funding sources, and citation count. Results: The T100 articles were published between the years 1975 and 2022. The number of total citations received by each article ranged from 83 to 550. The number one most cited T100 article was titled “Treatment Outcomes in The Tube Versus Trabeculectomy (TVT) Study After Five Years Of Follow-Up”. The greatest number of articles T100 articles were published in 2007 (n = 7) and 2002 (n = 7), followed by 1993 (n = 6) and 2012 (n = 6). The authors with the largest number of unique contributions to the T100 list were Feuer WJ (n = 8), Gedde SJ (n = 8), and Brandt JD (n = 7). The T100 articles appeared in ten journals, with the most contributions by Ophthalmology (n = 41) followed by American Journal of Ophthalmology (n = 28) and Archives of Ophthalmology (n = 7). The most frequently appearing keywords in T100 article titles included open angle glaucoma (6), primary open angle glaucoma (5), bleb (4), and tube versus trabeculectomy study (4). The topics of T100 articles evolved across the decades shifting from trabeculectomy-focused descriptive studies in the 1970s and 1980s, to comparative studies exploring alternative surgical interventions to trabeculectomy in the 2010s and 2020s. Conclusion: The peak of influential trabeculectomy research occurred in the mid 2000s, coinciding with the landmark TVT trial. In the subsequent decades, the topics of research have shifted away to alternative surgical interventions, possibly driven by the advent of newer surgical advances shifting the practice patterns for the management of glaucoma
Teaching Slit Lamp Funduscopy with a Self-guided e-Learning Module with Model Eye and Validation of a Self-Assessment Tool
No full textBackground: Slit lamp funduscopy is an essential diagnostic tool used by ophthalmologists to visualize the posterior structures of the eye. However, the fast-paced nature of outpatient care in ophthalmology often limits preceptor teaching opportunities for medical students during clerkships. This challenge is exacerbated by the minimal preclinical exposure to ophthalmology and the technical complexity of the slit lamp examination. Therefore, curricular reform is needed to improve medical student competency in ophthalmic examination skills.
Purpose: To develop a self-guided e-learning module to teach medical students slit lamp funduscopy and evaluate a self-assessment tool for slit lamp funduscopy skills.
Methods: Medical students (MS1-4) at a single institution were recruited by email for a skills workshop and randomized into two groups. The “self-guided” group received 30 minutes to watch a prerecorded instructional video with model eye practice, while the “preceptor teaching” group received 30 minutes of in-person instruction. Both received another 30 minutes of standardized patient practice. Participants answered questionnaires before and after training, completed self-assessments on slit lamp funduscopy skills, and received objective assessments from a grader masked to participant identity.
Results: Nineteen students participated: 9 in the self-guided group and 10 in the preceptor group. There were no significant differences between the two instructional groups in mean objective assessment scores, mean completion times on objective assessment, and proportion of students able to visualize the retina, retinal blood vessels, and optic nerve. Learners’ self-evaluations and graders’ objective evaluations were found to agree substantially, with a mean agreement rate of 87% across all learner-grader pairs and a mean Gwet’s AC1 of 0.80. Confidence in performing slit lamp funduscopy significantly increased for both the self-guided and preceptor teaching groups by the end of the workshop (p \u3c 0.01).
Conclusion: A self-guided e-learning module is comparable in quality and efficacy to preceptor instruction in teaching medical students slit lamp funduscopy. Self-assessments can be reliable in gauging learner proficiency in slit lamp fundoscopy skills. These educational tools may be a promising adjunct to the traditional methods of instruction and evaluation of highly technical examination techniques
The Impact of a Research Year for Matched US-MD Seniors
No full textBackground: With Step 1 becoming pass/fail, more students are considering taking a research year in ophthalmology prior to entering the application cycle. The purpose of the current study was to compare baseline characteristics and outcomes statistics between matched US-MD ophthalmology applicants with and without a dedicated research year.
Methods: Self-reported data from the publicly available OphthoMatch spreadsheets (2021-2022 and 2022-2023 cycles) were analyzed. US-MD senior applicants were included in the analysis; MD/PhD, DO, IMG students, and reapplicants were excluded.
Results: Of 127 matched US-MD senior applicants, 23 (18.1%) reported taking a research year. Baseline characteristics including underrepresented in medicine (URiM) status, gender, class quartile, USMLE Step 2 score, number of ophthalmology rotations, and having a home department were similar between both groups. Research year students had a statistically significant lower Step 1 score (243.1 ± 8.7) compared with non-research year students (247.3 ± 10.8 [p = 0.030]) as well as significantly lower Alpha Omega Alpha (AOA) membership (33.3%) and Gold Humanism Membership (5.9%) compared with to non-research year students (46.5%; 23% [p \u3c 0.05)]. Both groups received a similar number of interview offers (p = 0.260). Research year students significantly matched higher on their rank lists (1.9 ± 1.8 choice) compared with those without a research year (3.0 ± 2.1 choice; p = 0.002).
Conclusion: US-MD matched students completing a research year before applying to residency tended to have lower Step 1 scores and AOA and Gold Humanism membership rates, and they matched closer to their top choice compared with non-research year students; however, there was no difference in number of interview offers between the two groups
Trends in Resident Cataract Surgery Complication Rates Under A Single Experienced Supervising Attending
No full textPurpose: To evaluate resident surgical complication rates under the supervision of an experienced attending surgeon over five years. Setting: A single academic medical center at University of North Carolina at Chapel Hill, Chapel Hill, NC. Design: Retrospective chart review Methods: Retrospective review of the first 30-50 cases performed by five classes of residents supervised by a single experienced attending surgeon with over twenty years of experience as a surgical educator. Data was collected from Accreditation Council for Graduate Medical Education (ACGME) surgical logs and operative notes. Preoperative risk factors, operative technique, and intraoperative complication rates were analyzed. Results: A total of 1028 cataract cases over the five-year study period were reviewed and 890 cases in 645 patients were included. The overall complication rate was 14.4% with no significant trend observed in the rate of intraoperative complications across study years. Multivariate analysis found that complications during cataract surgery were more likely to occur in eyes with a preoperative risk factor (
Cross-Sectional Analysis of International Rotations Among Ophthalmology Residency Programs
No full textBackground: Applicants to ophthalmology residency programs have increasingly expressed interest in international surgical rotations. As such, ophthalmology residency program directors (PDs) have expanded international offerings to meet this desire but the true number of residency programs with international offerings is unknown. Methods: In February 2023, the official residency websites of all 125 accredited US-based ophthalmology residency programs were analyzed for any mention of international rotations. Websites were identified using a Google™ search by entering the program name and “ophthalmology residency.” All websites were surveyed for information regarding international rotations including the presence/absence of an international rotation and any additional information on the rotation provided including elective length, location, program year, and any other relevant information available. Results: Of the 125 accredited ophthalmology residency programs in the US, only 35% (n=44) mentioned an international rotation on their website. Of those, the majority sent residents abroad during later years of residency (postgraduate year three or four). Rotation length was variable with an average of two weeks (range one to eight weeks). The geographic location of international rotations included sites in Central and South America, Africa, Asia, and Europe. The most frequently listed country was India where 30% (n=13/44) of programs had an international rotation including several with connections to the Aravind Eye Care System. Conclusions: The majority of US-based, ACGME accredited ophthalmology residency programs do not mention international rotations on their official websites. Those that do tend to offer rotations to senior residents with India being the most common location. This study contrasts prior surveys which reported that a majority of programs offer or are developing international rotations. This discrepancy may exist because PDs with international rotations may be more likely to respond to surveys on this subject or residency program websites may not accurately reflect current initiatives
Career or Identity: Investigating specialty selection among LGBTQ+ medical students using a multi-institutional questionnaire
No full textBackground: A workforce representative of all populations, including lesbian, gay, bisexual, transgender and queer/questioning/other (LGBTQ+) medical students, is critical to providing care to patients of all backgrounds. Understanding why LGBTQ+ students choose one specialty over another is important to identify targets of focus to ensure this balanced recruitment of LGBTQ+ students to specialties in medicine.
Purpose: To compare factors influencing career choices among LGBTQ+ compared to non-LGBTQ+ students and to identify specific reasons for or against pursuing Ophthalmology, Dermatology and Otolaryngology.
Methods: Multi-institutional survey distributed to medical students in their final year of training through institutional email and social media posting. The questionnaire was distributed 2 weeks prior to Ophthalmology Match Day and closed the day following Ophthalmology Match Day (March 19, 2021). Survey respondents were asked to rate the importance of specific considerations for choosing a particular specialty on a 3-point Likert scale.
Results: 286 medical students in their final year of training responded to the questionnaire. Forty-three (18%, n=237) respondents identified as LGBTQ+. LGBTQ+ students were 55% less likely to cite extremely high importance of having a mentor in the same field as non-LGBTQ+ students (OR = 0.45, 95% CI = 0.22 – 0.92, p = 0.040). They were equally likely compared to non-LGBTQ+ students to value mentorship, work-life balance, job availability, social recognition, and high income potential. More LGBTQ+ students cited competitiveness as a reason against pursuing Dermatology compared to their non-LGBTQ+ peers (70.7% vs. 51.7%, p=0.027), and more LGBTQ+ students cited an inability to find same-sexual-orientation role models as a reason against pursuing Otolaryngology compared to non-LGBTQ+ students (9.8% vs. 2.8%, p=0.043).
Conclusions: LGBTQ+ students surveyed differed slightly from non-LGBTQ+ counterparts when taking factors into consideration for their medical specialty, as they all value mentorship, work-life balance, job availability, social recognition, and high income potential. When considering subspecialties of Dermatology, Otolaryngology and Ophthalmology, there is a decreased emphasis among LGBTQ+ students to find mentors in their field of choice. The reasons for this need to be further evaluated
Implementation of a Web-based Diabetic Retinopathy Training Module for Medical Students
No full textPurpose The use of kiosk technology in the healthcare setting has become increasingly common, although its use has not been formally evaluated in ophthalmology. The purpose of this study was to assess patient satisfaction and specific barriers to successful usage after the implementation of self check-in kiosks in an academic ophthalmology department. Methods We performed a cross-sectional study comparing patients who were kiosk users to those who utilized in-person check-in. We also enrolled patients to participate in a voluntary, IRB-approved electronic survey administered by two interviewers in a comprehensive ophthalmology clinic at an urban academic medical center. To identify patient satisfaction and barriers to usage, we surveyed randomly selected participants, including kiosk and non-kiosk users. The survey consisted of questions with a fivepoint Likert scale derived from a previously established framework based on the World Health Organization (WHO) conceptual model on patient satisfaction. Aggregate demographic and socioeconomic data were obtained from electronic health records. Results Records of 9,824 patients were reviewed. There were 137 kiosk users (1.4%). We received 100 survey responses among kiosk and non-kiosk users. Kiosk users were younger compared to non-kiosk users (median age 46 vs. 58, respectively, p \u3c 0.01). The proportion of primarily Spanish-speaking patients was lower in the kiosk cohort (12.1% vs. 19.1%, respectively, p \u3c 0.001). Among the 16 kiosk users who participated in the survey, 10 (63%) patients strongly agreed with the statement that they were satisfied with their check-in experience, as compared to 71 of 84 (84%) non-kiosk users (p \u3c 0.05). Sixty-three percent of all survey respondents (n = 63), regardless of check-in method, were initially unaware of the intended purpose of the kiosks. While 55% of all survey respondents (n = 55) had used a kiosk in a different setting previously, only 16% (n = 16) felt comfortable successfully using a kiosk in this setting. Conclusions Implementing kiosks in ophthalmology may pose distinct logistical challenges. In this study, kiosks were less likely to be used among patients over 50, non-English speaking patients, and those without insurance. There are unique barriers to kiosk usage reported by visually impaired patients
Potential Cost Savings at a Single Tertiary Care Center through Implementation of a 340B-compliant Multiuse Drop Protocol for Cataract Surgery
No full textThe University of Missouri Healthcare system is seeking to implement a multiuse drop protocol for cataract surgeries, allowing preoperative eye drop bottles to be utilized for multiple patients rather than being discarded after single use. This presents an opportunity for reducing medical waste and achieving considerable cost savings. A key challenge, however, lies in maintaining compliance with the 340B Drug Pricing Program, which currently limits our ability to fully adopt this practice. We additionally encountered barriers including infection control concerns and staff adaptation to new workflows. We detail the barriers we have encountered thus far and present a potential 340B-compliant multiuse drop protocol for cataract surgery that can serve as a guide for other institutions seeking to reduce costs associated with drop wast
Program Leaders’ Plans, Perceptions, and Anticipated Effects of Preference Signaling Before Implementation in Ophthalmology
No full textPurpose: To assess the plans, perceptions, and anticipated effects of preference signaling on the 2024e2025 match cycle among ophthalmology program directors and associate program directors. Methods: A 16-item questionnaire was distributed to 177 ophthalmology program directors and associate program directors prior to the start of the 2024e2025 application cycle. Results: The questionnaire was completed by 71 ophthalmology program directors and associate directors (40 % response rate). Sixty-two program leaders (89 %) planned to incorporate signaling into the application review process. The most common plan was to give additional consideration throughout the application review process (n ¼ 45 [63 %]) followed by additional consideration later in the review process during interview offers (n ¼ 18 [25 %]). Signaling was ranked relatively low for resident selection compared with other metrics. Most program leaders reported that signaling would benefit residency programs (n ¼ 64 [90 %]) and applicants (n ¼ 71 [96 %]). Most respondents thought that implementing preference signaling would not affect the number of applications received this year (n ¼ 52 [73 %]) or submitted per applicant (n ¼ 50 [70 %]). Most respondents (n ¼ 58 [83 %]) indicated that applicants who signaled their program would be more likely to receive an interview. Many responded they would prefer more signals to be offered. Conclusion: In the inaugural year of preference signaling in ophthalmology, program leaders planned to use signals to give additional consideration to applicants. Despite this intention, preference signaling was ranked low among the factors most important for resident selection. Program leaders reported that preference signaling would benefit both programs and applicants, with the most agreed-upon benefit being an increased chance of receiving an interview at signaled programs. However, program leaders responded that using seven signals would not lead to a decrease in application volume