Journal of Academic Ophthalmology
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Ophthalmology at the Veterans Health Administration: How Sex and Other Factors Affect Salary
No full textPurpose: To determine factors that contribute to current salary differences among ophthalmologists employed by the Veterans Health Administration (VHA).
Methods: We performed a cross-sectional analysis of full-time equivalent salaries of Veterans Health Administration ophthalmologists who received a federal salary in 2021. Differences in average salary with respect to various demographic variables were analyzed.
Results: Data for 632 salaried VHA ophthalmologists (262 females [41.5%]) were included. Although biological sex alone did not have a crude, statistically significant effect on average VHA ophthalmologist salary (p = 0.116), a substantial discrepancy was noted in adjusting for other significant demographic variables, including years spent at the VHA. There was a significant interaction effect between sex and years at the VHA: female ophthalmologists initially earned substantially and significantly less than their male counterparts (−33,673 for chiefs (p = 5.52e-11) and $28,472 for full-time VHA physicians (p = 1.96e-23). Years since residency (p = 3e-4) and h-index (p = 0.03) were each positively and significantly correlated with overall salary. All Veterans Integrated Services Network (VISN) regions, especially the Northeast region, were associated with significantly lower salaries compared with the Southern region.
Conclusion: Female sex is associated with a significantly lower initial compensation for ophthalmologists employed by the VHA when adjusting for chief status, paygrade, VISN region, complexity level, academic rank, and years at the VHA. Although several factors could be involved in the apparent salary disparities found within this study, policy changes may be important to ensure compensation is equitable across VHA centers
Morbidity and Mortality Conference in Ophthalmology: Pilot Study on Maximizing Quality while Optimizing Education
No full textBackground: Discussion of medical and surgical adverse events between peers and learners allows for all members of a learning community to benefit from lessons learned while assessing and resolving the events. The methods by which adverse events are discussed in academic ophthalmology departments and how those discussions impact attending and resident education have received little attention in the published literature.
Purpose: To report the results of our survey of U.S. academic ophthalmology residency programs using a mixed methods analysis to determine the current frequency, structure, purpose, and outcomes of morbidity and mortality (M&M) or other quality improvement conferences.
Methods: An 25-item electronic questionnaire was emailed to 121 program directors with a request to forward the same 25-item questionnaire to their residents. The response period was between May 2023 and July 2023. Two reminders were sent. Questionnaire items were grouped into the following themes: demographics; timing, frequency, and structure; purpose and goals; perceived outcome; and obstacles/areas for improvement. Several participants also attended a focus group to elicit more nuanced qualitative information.
Results: Responses were received from 30 program directors (25%) and 26 of 1,989 residents (1%). The majority of respondents’ programs (31/56 [56%]) held M&M conferences quarterly, with frequency ranging from weekly to quarterly. Residents involved in the patient’s care often were the ones to present cases (51%), which were usually determined by a provider-generated list (53%). Most respondents reported the lack of an anonymous case submission method (75%), and only 31% of participants stated that they had a formalized process for following up on systems issues identified in M&M. The primary obstacle to effective M&Ms was reported to be fear of judgment, embarrassment, or repercussions.
Conclusion: There is significant variation in the way complications are discussed in ophthalmology departments across the country. This study demonstrates a near universal need for increased frequency and duration of M&Ms, a formal complication/mistake reporting system, and a formal follow-up on systems issues identified during M&M. These best practices can benefit the culture around discussing complications and increase adoption of M&M conferences in ophthalmology to facilitate better patient safety and outcomes
20-year Trends in Clinical and Research Roles of Women Physicians in Thyroid Eye Disease
No full textPurpose: To evaluate the role of women physicians in thyroid eye disease (TED) research and clinical care and describe relevance for academic medicine and patient access.
Methods: A cross-sectional study of TED-related publications indexed on PubMed in 2000, 2010, and 2020, and of completed or currently active clinical trials was conducted. Author, journal, and principal investigator (PI) characteristics were noted. Author/PI gender was determined from institutional profile or subsequently via a previously described Google-based algorithm. American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS), American Board of Ophthalmology (ABO), and American Thyroid Association (ATA) information was obtained via direct communication. Trends in participation of men and women were evaluated.
Results: A total of 444 manuscripts (61 from 2000; 117 from 2010; 266 from 2020) were included. The percentage of women as first and senior authors increased from 2000 to 2020 (p \u3c 0.0001 and p = 0.0003, resp.). First author gender distribution was near equal in 2020 (52.6% men, 47.4% women [p = 0.39]), whereas senior authors remained mostly men (68.0% men, 32.0% women [p \u3c 0.0001]). As of 2020, the gender imbalance of senior authors was greater on multidisciplinary author teams (74.8% men, 25.2% women) compared with single specialty author teams (62.2% men, 37.8% women). Of the 98 TED-related clinical trials included, 34 had women PIs (35%). The percentage of women as members in ASOPRS, ABO, and ATA all increased significantly from 2000 to 2020, but remained disproportionately men in 2020 (all p \u3c 0.0001).
Conclusion: Gender-based discrepancies persist in TED research, especially among senior authors, who determine research direction, and on multidisciplinary teams, which reflect the preferred model of care. Further efforts are required to determine whether these findings affect patients with TED
Analyzing the Research Publications of Successful Ophthalmology Residency Matches in 2024: Trends, Impact, and Outcomes
No full textPurpose: To analyze the quantity and quality of research publications of medical students who matched into the top 25 ophthalmology programs in the 2024 cycle and compare these results to previous match cycles.
Methods: This was a retrospective cross-sectional study. Participants included matriculating ophthalmology residents attending the top 25 programs as determined by Doximity. The Doximity Residency Navigator website was used to determine which programs were ranked in the top 25 in the country, and several websites were used to determine which students matched at the top 25 residencies. Once these students were identified, their research publications were collected via PubMed and analyzed. This data was compared with that of previous ophthalmology match cycles. The main outcome measures were total number of publications retrieved for each student. For each publication, the following publication-specific data were retrieved: including journal name, authorship rank, date of publication, whether publication related to ophthalmology, study type, h5-index score, and citation count were obtained for each publication.
Results: A total of 147 matriculating ophthalmology residents were included. The mean number of publications was 6.79 ± 7.65 (median, 5) and the most frequent number of publications was 3 (n = 24). The mean number of first-author publications was 2.35 ± 2.91; of second-author publications, 1.42 ± 1.72); and of third-author publications, 0.92 ± 1.30. A two-tailed independent samples t test showed no significant difference in total publications between students (n = 66) entering programs ranked in the top 10 (mean, 8.20 ± 9.97) versus students (n = 81) entering programs ranked 11-25 (mean, 5.74 ± 4.96) (t[145] = 1.94, p = 0.054, Cohen’s d estimate = 0.323). There was a significant increase in publications compared to 2021 (mean 2.70 ± 3.10 [p \u3c 0.01]) and 2022 (mean, 3.04 ± 0.350 [p = 0.0180]).
Conclusion: Within matched applicants of the top 25 ophthalmology programs, there has been a significant increase in the number of research publications compared with that of the last 3 years
Altmetric Attention and Citations in Ophthalmology Research from 2012 to 2021
No full textBackground: The Altmetric Attention Score (AAS) is a quantitative measure of the attention, or “mentions,” that a research output, such as a journal article or data set, has received from various sources, including news, social media, policy documents, blogs, and online reference managers. Our objective was to examine the relationship between AAS, citation count, and open access status of peer-reviewed ophthalmology articles over a 10-year period.
Methods: A cross-sectional, scientometric analysis of ophthalmology-centric articles published from January 1, 2012, to December 31, 2021, was conducted using publicly available online data from Altmetric Explorer. The dataset comprised 89,957 ophthalmology research articles from 106 journals. Social media and other forms of digital media mentions were quantified by the Altmetric Attention Score (AAS) and citation count were evaluated for included articles both in summation and with respect to open access (OA) versus subscription access (SA) status.
Results: Of the 89,957 included articles, 73,133 received at least one mention (i.e., a nonzero AAS score). Analysis of individual articles revealed an overall weak positive correlation between AAS and citation count (r = 0.17, p \u3c 0.05). A strong correlation was observed between total AAS and total citations accrued by each journal (r = 0.60, p \u3c 0.05), but this correlation was no longer statistically significant when examining average AAS and citations per journal article. In addition, there was a tenfold increase in total media mentions as measured by AAS per year from 7,000 in 2012 to over 70,000 by 2021. The academic landscape also shifted toward open access, with OA articles (6,480 [56.4%]) outnumbering subscription access (SA) articles (5,012 [43.6%]) by the end of 2021. Furthermore, OA articles outperformed SA articles in social media engagement, averaging 8.77 media mentions compared to 4.47 for SA in 2021 (p \u3c 0.05).
Conclusions: In the field of ophthalmology, AAS and citation count have a weak but significant correlation at the individual article level, and this correlation strengthens at the journal level. In addition, there is a trend toward open-access publications in ophthalmology that have a significant positive relationship with AAS
Zooming In: Past, Present, and Future Impact of Virtual Interviews on Ophthalmology Match for Applicants with Home versus No Home Programs
No full textPurpose: To compare the trends in matched ophthalmology residency applicants from schools with and without home ophthalmology residency programs during in-person and virtual interview application years.
Methods: In this retrospective study, U.S. allopathic medical school seniors were assessed retrospectively for their match list published on each institution’s official website and the SF Match (2019-2023). Data collected included medical school of matched students, home residency program status, residency program matched into, and residency program type. Data was stratified by the 2019-2020 (in-person) and the 2021-2023 (virtual) match years. An odds ratio (OR) analysis was conducted to determine the likelihood of matching and in-state versus out-of-state matching, and geographic distribution of matches, comparing in-person to virtual interviews. Successful match to an ophthalmology program was the main outcome measure.
Results: A total of 1,541 graduates from United States MD-granting institutions that matched into ophthalmology residency programs from 2019 to 2023 were included. During this period, match data showed increases in the number of offered positions, participating U.S. allopathic seniors, applications submitted per individual, and average Step 1 scores of matched applicants, whereas match rates declined. Candidates with home programs displayed higher match likelihoods (in-person: OR = 1.3; p \u3c 0.001, virtual: OR = 1.6; p \u3c 0.001) compared to those without. In-state matches were more prevalent for candidates with a home program (p \u3c 0.001). Key geographic preferences overall included New York, Texas, and Illinois, with no statistically significant ORs; applicants with a home program had a greater likelihood of matching into California (OR = 3.4; p \u3c 0.01) and Florida than those without (OR = 2.6; p \u3c 0.01).
Conclusions: Our analysis highlights the persistent advantage of having a home program in securing matches with an increasing disparity during virtual interviews. To address the limitations of virtual interviews, applicants without a home program might benefit from additional away rotations or opting for in-person interviews if offered in a hybrid format. These insights offer practical guidance for both applicants and program directors navigating the evolving ophthalmology residency match process
Quantifying the Bibliometric Impact of Published Research Associated with the IRIS Registry: A Comprehensive Analysis to Date
No full textPurpose: To characterize trends in publications utilizing the American Academy of Ophthalmology’s Intelligent Research In Sight (IRIS) Registry.
Methods: Data was collected for the IRIS Registry publications as of December 2022 listed on the American Academy of Ophthalmology’s website. Type of literature, subspecialty topic, and specific disease/procedure of interest were categorized by two independent researchers and discordance was resolved by a third researcher. The main outcome measures were article year of publication, journal, type of literature, subspecialty topic, specific disease or procedure of interest, and source of funding.
Results: A total of 54 articles were included. The rate of publication increased over time; in 2015 and 2016, only two IRIS Registry publications were recorded, whereas in 2021 and 2022, 36 publications were recorded. Ophthalmology published 43% of the articles; American Journal of Ophthalmology, 17%; and Ophthalmology Science, 7%. JAMA Ophthalmology, Ophthalmology Retina, and Ophthalmology Glaucoma each published 6% of IRIS Registry articles. The most prevalent subspeciality topics were retina (35%), glaucoma (17%), and cataract (15%). Specific procedural treatments were the subject of 48% of the publications; disease epidemiology, of 17%; and specific medical treatments, of 13%. Most publications were original articles (82%). With regard to funding, 6% of publications reported funding solely from the IRIS grant, 41% obtained funding solely from other means, and 19% of publications obtained funding from a combination of the IRIS grant and other means. The most studied diseases among IRIS Registry publications were glaucoma (19%), age-related macular degeneration (9%), and cataract (7%). The two most studied treatments were anti–vascular endothelial growth factors (11%) and cataract surgery (11%).
Conclusions: Since 2015, the IRIS Registry has proved an increasingly valuable font of data and support for original research in a range of subspecialties, leading to publication of insightful studies in prominent ophthalmology journals
Evaluating the Diagnostic Accuracy of Ophthalmology Residents: Balancing Resident Autonomy with Patient Safety
No full textBackground: Ophthalmology residency programs aim to cultivate competent, independent-thinking ophthalmologists. However, achieving a balance between resident autonomy and patient safety presents a difficult challenge.
Purpose: To evaluate the diagnostic accuracy and safety of a resident-driven on-call model, wherein consulting with a senior resident or attending physician is at the discretion of a postgraduate year 2 or 3 resident.
Methods: This was a retrospective study evaluating emergency department ophthalmology consultations at Erie County Medical Center, a level one trauma center in Western New York, between 1 January 2019 and 31 December 2021. Resident diagnoses and critical examination findings were categorized as delineated in The Wills Eye Manual, 7th edition, and compared with attending ophthalmologist documentation at a follow-up visit at Ross Eye Institute. Each consultation was graded as accurate, partially accurate, or inaccurate. Partially accurate and inaccurate diagnoses were individually reviewed to assess patient safety.
Results: A total of 1,021 consultations were analyzed. Resident diagnoses were accurate in 95.9% of cases, partially accurate in 1.6% of cases, and inaccurate in 2.5% of cases. Only 2 cases (0.2%) required emergent treatment and workup after an inaccurate resident diagnosis that was identified at the follow-up visit. Trauma diagnoses and correct examination findings during the consultation were associated with greater diagnostic accuracy. Orbital diagnoses were associated with a lower rate of diagnostic accuracy.
Conclusions: A resident-driven on-call model, utilized by many ophthalmology residency programs, enables residents to hone their independent decision-making skills while maintaining a high level of patient safety
Impact of Video-guided Indirect Ophthalmoscopy on Medical Student Confidence and Ability
No full textBackground: Binocular indirect ophthalmoscopy (BIO) is a challenging skill to learn and teach.
Purpose: To evaluate the utility of video-guided BIO for training medical students without prior BIO experience using Scanoptix, a novel, wireless, ophthalmoscope-mounted camera.
Methods: This was a mixed-methods study including a survey and prospective, double-armed intervention. Medical students at the University of Virginia School of Medicine without prior BIO experience were recruited via email and randomized into video-guided and non-video-guided indirect ophthalmoscopy training groups (VIO and nVIO, resp.). Both groups underwent a demonstration session led by a retina specialist followed by an instructional session with real-time feedback on examination technique by the retina specialist. During the VIO sessions, the retina specialist and students had access to live video recordings of the examination, whereas the nVIO group did not. All students were asked to perform BIO examination of a model eye pre- and post-intervention, and deidentified recordings were transmitted wirelessly from a novel ophthalmoscope-mounted camera to a smart tablet. Two independent retina specialists graded students’ examination videos for competency pre- and post-intervention. Students also completed a questionnaire regarding their confidence performing BIO before and after the intervention. Changes in confidence and competency were analyzed in Excel using paired and unpaired t tests. Main outcome measures were medical student confidence and competency performing BIO examination of the posterior pole.
Results: A total of 38 medical students participated: 20 in the VIO group and 18 in the nVIO group. Students in both groups demonstrated significant improvement in examination skills and confidence following intervention (for skills, VIO p \u3c 0.0001 and nVIO p = 0.0004; for confidence, VIO and nVIO p \u3c 0.0001). Comparing post-intervention scores, VIO examination scores were not significantly greater than those for nVIO (7.95 vs 7.29, resp. [p = 0.441]); however, the VIO group achieved a greater degree of improvement from baseline compared with nVIO controls (Δ = 6.73 vs Δ = 4.49, resp.), with results approaching significance (p = 0.082).
Conclusions: BIO-naive medical students benefitted from formal instruction with or without video guidance. Additional studies are required to determine whether an ophthalmoscope-mounted camera would enhance BIO education for naive learners
Ophthalmology Virtual Shadowing and Mentorship Program for Undergraduates Underrepresented in Medicine: Framework and 2-year Survey
No full textBackground: Increasing underrepresented in medicine (URiM) trainees in ophthalmology is crucial to better serve a diverse patient population. Purpose: To assess the impact of a virtual shadowing and mentorship program for undergraduate students who self-identified as URiM on student interest in medicine, research, and ophthalmology. Methods: A structured, semester-long mentorship program was publicized to premedical undergraduate students at two local universities. Depending on interest, students chose to participate in any of the three following program components: 1) virtual shadowing sessions where faculty presented patient cases and shared career paths, 2) mentorship on a range of topics (e.g. research, career planning), and 3) inperson shadowing in the operating room or clinic. Students completed a voluntary questionnaire at the end of each semester. Results: A total of 59 students, 38 mentors, and 22 faculty presenters participated in the program over the two-year period. Excluding those who joined in the fourth semester, sixty percent (25/42) of students and 75% (15/20) of mentors continued for at least two semesters. Students and mentors participated in the program for a median of 2 semesters (IQR: students 1-3, mentors 1.75-3). Fifty-nine percent (35/59) of students completed the questionnaire after one semester of participation. Among these students, 91% (32/35), 60% (21/35), and 91% (32/35) of respondents reported increased interest in medicine, research, and ophthalmology, respectively. Ninety-four percent (33/35) attended at least one virtual shadowing session with a median of 3 (IQR 2-4) sessions attended. Eighty-three percent (29/35) met with their assigned mentor and 97% (34/35) indicated they would like to continue the program the following semester. No significant difference in these metrics was observed comparing responses from the first, second, third, and fourth semester of participation. Conclusion: A virtual shadowing and mentorship program for URiM undergraduates increased interest in medicine, research, and ophthalmology. A 1-year longitudinal program may be the optimal length with 2-4 shadowing sessions per semester. This program may serve as a framework for ongoing and future initiatives targeting various levels of the training pipeline