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PURPOSE: The objective of this study was to evaluate the relationship between research activity and National Institutes of Health (NIH) funding status of the United States (US) academic ophthalmologists. METHODS: A retrospective cross-sectional analysis of bibliometric data was conducted. The NIH Research Portfolio Online Reporting Tools Expenditures and Reports (rePORTER) website was utilized to identify ophthalmology departments in the US that received NIH funding. Affiliated faculty from these institutions were then identified using NIH rePORTER and institutional websites. H-index was calculated using the Scopus database, and the NIH iCite tool was used to determine the Relative Citation Ratio (RCR). The h-index and w-RCR quantified research productivity, while m-RCR measured research impact. RESULTS: Data on 2688 faculty members from 66 departments we re identified, of which 21% were NIH-funded. Faculty members who received NIH-funding had significantly greater research productivity and impact as measured by h-index (32.5 vs 16.6; p < .001), m-RCR (2.2 vs 1.6; p < .001), and w-RCR (147.2 vs 70.1; p < .001) than their non-funded peers. When stratified by academic rank, NIH-funded faculty still had significantly higher h-index (16.1 vs 7.9; p < .001), m-RCR (2.2 vs 1.4; p < .001), and w-RCR (63.2 vs 61.8; p < .001) than non-funded peers. A similar trend was observed among non-tenured faculty members. CONCLUSION: NIH funding is associated with higher research productivity and impact among US academic ophthalmologists as measured by h-index and RCR, which suggests that NIH funding may be a critical factor in enhancing scholarly contributions of ophthalmologists. These findings underscore the importance of continued investment in NIH funding to foster high-impact research within the field of ophthalmology.
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PURPOSE: Keratoconus is a progressive disease characterized by changes in corneal shape, resulting in loss of visual function. There remains a lack of comprehensive understanding regarding its underlying pathophysiology. This review aims to bridge this gap by exploring structural failures and inflammatory processes involved in the etiology and progression of keratoconus. METHODS: A literature review was conducted using PubMed and Google Scholar databases, screening for articles published in English using the keyword combinations of "keratoconus" with "pathophysiology," "pathology," "metabolism," "inflammatory," "oxidative stress," "cytokines," "enzymes," "collagen," and "cornea." Articles published between January 1, 1970, and June 1, 2023, were queried and reviewed, with greater emphasis placed on more recent data. Fifty-six relevant studies were examined to develop a thorough review of the pathophysiological mechanisms at play in keratoconus. RESULTS: Biomechanical structural failures in the cornea seem to be the primary militating factors in keratoconus etiology and progression. These include disruptions in the arrangement in the collagen lamellae, a decrease in collagen levels, a decrease in natural collagen crosslinking, and changes in lysosomal enzyme activity. Immunologic changes have also been identified in keratoconus, challenging the traditional view of the condition as noninflammatory. Elevated levels of proinflammatory cytokines like IL-1b, IL-6, IL-17, and TNF-α have been observed, along with increased apoptosis of keratocytes. Increased oxidative stress leads to the activation of collagenase and gelatinase enzymes. CONCLUSIONS: Keratoconus is a complex condition influenced by both structural defects and inflammatory processes. Understanding these mechanisms can inform clinical management and potentially lead to more effective treatments.
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OBJECTIVE: Evaluation of the demographic and academic characteristics of current neurosurgery residents may provide prospective students with insight into factors that affect research output. Therefore, this study aimed to evaluate the research output among neurosurgery residents. METHODS: US neurosurgery residency programs were abstracted from the American Association of Neurological Surgeons website. Demographic data on 1690 current residents across 119 programs were collected using publicly available institutional websites, Doximity, and LinkedIn. The h-index of each resident was recorded using Scopus and exported into the NIH iCite tool to determine the weighted relative citation ratio (w-RCR) and mean relative citation ratio (m-RCR). The total number of publications, h-index, and w-RCR were used as a proxy for research output, while m-RCR was used to measure research impact. One-way ANOVA and Kruskal-Wallis H-tests were used to assess the statistical significance of relationships between demographic data and measures of research activity. RESULTS: A total of 1690 residents (25.4% female), representing 119 programs, were evaluated. Neurosurgery residents had an average of 17 publications, h-index of 5.5, m-RCR of 1.4, and w-RCR of 16.9, with an upward trend of research activity by postgraduate year (PGY) class. Male residents on average had a greater total number of publications (p < 0.001), higher h-index (p < 0.001), and higher w-RCR (p = 0.002) compared with their female peers. Significant differences in research activity were also observed by degree (Doctor of Medicine [MD], Doctor of Osteopathy [DO], or other), where those with MD and other degrees had higher metrics than those with DO degrees. International medical graduates (IMGs) also had higher research output than American medical graduates (AMGs) (p < 0.001). Differences in all measures of research activity except impact were also observed in research activity when pre-residency medical school ranks were compared. CONCLUSIONS: The authors observed overall high research activity among neurosurgery residents. Factors such as gender, degree, PGY, IMG/AMG status, and medical school rank may therefore be related to the success of matching within neurological surgery. Although large disparities in gender representation have been identified in neurosurgery, newer classes are trending toward shrinking the gap. These data may be used by prospective residents to gauge changes and progress occurring in the neurosurgery match.
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Background: Online physician reviews increase transparency in health care, helping patients make informed decisions about their provider. Language processing techniques can quantify this data and allow providers to better understand patients' experiences, perspectives, and priorities. The objective of this study was to assess patient satisfaction and understand the aspects of care that are valued by patients seeking refractive care using sentiment and word frequency analysis. Methods: Written reviews and Star ratings for members of the Refractive Surgery Alliance Society practicing in the United States were collected from Healthgrades, a popular physician rating website. Surgeons with at least one written review were included in the study. Reviews were scored from -1 (most negative) to +1 (most positive) using Valence Aware Dictionary sEntiment Reasoner (VADER). Reviews were stratified by demographic characteristics, namely gender, region, and years in practice. Word frequency analysis was applied to find the most common words and phrases. Results: A total of 254 specialists and 3104 reviews were analyzed, with an average of 4.4/5 stars and mean 48 ratings each. Most physicians had positive reviews (96%, average VADER â= â0.69). Younger physicians (<20 years since residency) had significantly higher Stars rating than senior peers (>20 years) (P â< â0.001). A similar trend was observed in VADER score (0.71 vs 0.69), although not statistically significant (P â= â0.06). No statistical differences were observed between Stars rating and VADER score by gender (P â= â0.66, P â= â0.83) or by geographical region (P â= â0.74, P â= â0.07). "Staff" (n â= â1269), "professional" (n â= â631), "office" (n â= â523), "questions" (n â= â424), and "friendly" (n â= â386) were frequently used in reviews, along with phrases such as "the staff" (n â= â273) and "my questions" (n â= â174). "Surgery" (n â= â719), "staff" (n â= â576), "procedure" (n â= â251), "experience" (n â= â243), and "professional" (n â= â240) were the most common words in positive reviews, while "surgery" (n â= â147), "office" (n â= â86), "staff" (n â= â54), "time" (n â= â47), and "insurance" (n â= â28) were the most commonly used in negative reviews. Conclusions: Both the average Stars and VADER sentiment score suggest a high satisfaction among refractive patients. Word frequency analysis revealed that patients value non-clinical aspects of care, including interactions with staff, insurance coverage, and wait-times, suggesting that improving non-clinical factors could enhance patient satisfaction with refractive surgery.
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PURPOSE: The academic success of ophthalmology fellows may be significantly impacted by their research engagement. Evaluating the research activity of fellows by subspecialty may provide insight into trends useful for prospective applicants. The objective of this study was to assess the research activity of ophthalmology fellows in the year 2023. METHODS: Ophthalmology fellowship programs were compiled using the Association of University Professors of Ophthalmology and the American Society of Ophthalmic Plastic and Reconstructive Surgery websites. Program subspecialties were categorized as: Cornea and External Disease [CED]; Cornea, External Disease, and Refractive Surgery [CEDRS]; Glaucoma; Medical Retina [MR]; Neuro-Ophthalmology [NO]; Oculoplastics; Pediatric Ophthalmology [PO]; Surgical Retina [SR]; Uveitis; and Other. "Other" consisted of Oncology, Pathology, combined Oncology and Pathology fellowships. We identified current fellows using publicly available online information. Programs and fellows that did not have information available were excluded. Total publications, Hirsch index (h-index), and weighted-relative citation ration (w-RCR) were utilized as measures of research output, while total citations and mean-RCR (m-RCR) served as proxies for research impact. Duration of publishing was calculated using the years of the oldest and most recent publications. Statistical analysis was performed using Kruskal-Wallis H tests with an alpha value of .05. RESULTS: A total of 373 fellows from 229 programs met our inclusion criteria. More than half of fellows were men (54.4%), and the most common degree type was MD (93.0%). Across all subspecialties, the median h-index was 3.0 (IQR = 4), m-RCR was .9 (IQR = 1.2) and w-RCR was 3.2 (IQR = 9.8). The median number of publications was six (IQR = 10, with 34 citations (IQR = 110) and 4 years of publishing (IQR = 6). We observed significant differences in h-index (p = .038), total publications (p < .001), and w-RCR (p = .028) by subspecialty. CONCLUSION: We observed significant differences in research output, but no differences in research impact by subspecialty. Overall, Uveitis and Oculoplastics fellows had higher research activity, while Medical Retina and Other fellows had the lowest. This data is pertinent to better understand the landscape of ophthalmology fellowship applications.
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Pesquisa Biomédica , Educação de Pós-Graduação em Medicina , Bolsas de Estudo , Oftalmologia , Oftalmologia/educação , Humanos , Bolsas de Estudo/estatística & dados numéricos , Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Internato e Residência/estatística & dados numéricos , Estados UnidosRESUMO
PURPOSE: To assess patient satisfaction within pediatric ophthalmology and identify trends in patient sentiment. METHODS: Pediatric ophthalmologists in the United States were identified using the American Association for Pediatric Ophthalmology and Strabismus member directory. Demographic data were recorded using publicly available websites. Online written reviews and Stars ratings were obtained from Healthgrades.com. A sentiment analysis package, Valence Aware Dictionary for Sentimental Reasoning (VADER), was used to generate a compound score of reviews, and word frequency analyses were applied. RESULTS: A total of 377 pediatric ophthalmologists (2,640 online reviews) were evaluated. Physicians received an average of 4.22/5 Stars and a compound sentiment score of 0.56, indicating positive sentiment. No differences in scores were observed by gender or location, although physicians with fewer years in practice had higher Stars ratings compared to peers (P < .001). The three most common words in the word frequency analysis of all reviews were "surgery," "staff," and "time," with heavy emphasis on bedside manner and addressing patient concerns. CONCLUSIONS: This study demonstrates overall high patient satisfaction in pediatric ophthalmology care, with differences in sentiment based on physician demographic features. The study highlights that patient perspective is influenced by non-clinical features of care. These data may be used by pediatric ophthalmologists seeking to improve health care delivery. [J Pediatr Ophthalmol Strabismus. 2024;61(3):211-218.].
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Oftalmologia , Satisfação do Paciente , Humanos , Masculino , Estados Unidos , Feminino , Criança , Pediatria , Oftalmologistas/psicologiaRESUMO
OBJECTIVES: Quantification of academic productivity relies on bibliometric measurements, such as the Hirsch index (h-index). The National Institutes of Health (NIH) recently developed the relative citation ratio (RCR), an article-level, citation-driven metric that compares researchers with others within their respective fields. Our study is the first to compare the usage of RCR in academic otolaryngology. STUDY DESIGN: Retrospective Database Review. METHODS: Academic otolaryngology residency programs were identified using the 2022 Fellowship and Residency Electronic Interactive Database. Demographic and training data were collected for surgeons using institutional websites. RCR was calculated using the NIH iCite tool, and h-index was calculated using Scopus. Mean RCR (m-RCR) is the average score of the author's articles. Weighted RCR (w-RCR) is the sum of all article scores. These derivatives are a measure of impact and output, respectively. The career duration of a physician was categorized into the following cohorts: 0-10, 11-20, 21-30, and 31+ years. RESULTS: A total of 1949 academic otolaryngologists were identified. Men had higher h-indices and w-RCRs than women (both p less than 0.001). m-RCR was not different between genders (p = 0.083). There was a difference in h-index and w-RCR (both p less than 0.001) among the career duration cohorts, but there was no difference in m-RCR among the cohorts (p = 0.416). The faculty rank professor was the greatest for all metrics (p < 0.001). CONCLUSION: Critics of the h-index argue that it is reflective of the time a researcher has spent in the field, instead of impact. The RCR may reduce historic bias against women and younger otolaryngologists. LEVEL OF EVIDENCE: NA Laryngoscope, 134:592-599, 2024.
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Otorrinolaringologistas , Otolaringologia , Estados Unidos , Humanos , Masculino , Feminino , Estudos Retrospectivos , Otolaringologia/educação , Bibliometria , Eficiência , Docentes de MedicinaRESUMO
PURPOSE: Women are underrepresented in several medical specialties, including ophthalmology. Reducing disparities is critical in diversifying perspectives and increasing equity within ophthalmology, both of which can ultimately improve care delivery. We examined ophthalmic fellowship programs directors in the United States to investigate gender disparities by subspecialty. DESIGN: Cross-sectional study. METHODS: This was a retrospective cross-sectional study of ophthalmology fellowship program directors in academic medical centers. The primary outcome measure was a descriptive analysis of current fellowship directors in 2022 when stratified by subspecialty and demographic features. RESULTS: Analysis was conducted on 358 fellowship directors in the United States. Twenty-nine percent of directors were women. Female directors had significantly fewer years since residency graduation compared with male peers (17 vs 24; P < .001); however, no differences were observed by program type (P = .896) or location (P = 0.104). Differences in female director representation were observed by subspecialty (P < .001), with the greatest percentage of women in pediatric ophthalmology (54%), other (oncology and pathology) fellowships (50%), and medical retina (40%). The subspecialties with the lowest percentage of female directors were oculoplastic and reconstructive surgery (13%) surgical retina and vitreous (16%). CONCLUSION: There are disparities in female representation in academic leadership positions across ophthalmic subspecialties. Addressing this difference may have critical impacts on career advancement and opportunities available for marginalized groups in medicine.
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Internato e Residência , Oftalmologia , Criança , Humanos , Masculino , Feminino , Estados Unidos , Bolsas de Estudo , Oftalmologia/educação , Estudos Transversais , Estudos Retrospectivos , Docentes de MedicinaRESUMO
PURPOSE: To characterize demographics, academic characteristics, and research activity of academic glaucoma specialists. METHODS: Faculty demographic and academic data were recorded for glaucoma specialist faculty from 99 United States ophthalmology residency programs using institutional websites, Doximity, and LinkedIn. H-index was calculated using Scopus. Mean and weighted relative citation ratio (RCR), measuring research impact and productivity, respectively, was determined with the National Institute of Health iCite tool. RESULTS: Most academic glaucoma specialists were men (0.61), located in the Southern United States (0.316), and in practice for less than or equal to 10 years in 2023 (0.324). Twenty-six percent had additional professional degrees, and 11% completed fellowship training in addition to clinical glaucoma. Assistant professor was the most common academic appointment (0.479), and almost a quarter (0.23) had additional positions. Mean h-index (13.3), mean-RCR (1.76), and weighted-RCR (84.0) were consistent with high research productivity and impact. Gender comparison found that men had significantly higher h-index (p < .001), m-RCR (p = .007), w-RCR (p < .001) as compared to women. H-index (p < .001; p < .001; p < .001), m-RCR (p = .006; p < .001; p < .001), and w-RCR (p < .001; p < .001; p < .001) also increased with career duration, academic position, and additional academic appointments, respectively. Additional training was associated with higher h-index (p = .023) and w-RCR (p = .012), but not m-RCR (p = .699). CONCLUSION: Higher research activity is significantly associated with higher departmental positions and additional academic appointments. This illustrates the importance of research contributions for academic promotion. Variations in research activity by gender distribution may therefore affect opportunities for career advancement.
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Eficiência , Internato e Residência , Masculino , Humanos , Feminino , Estados Unidos , Bibliometria , Pesquisa , DemografiaRESUMO
PURPOSE: Patients utilize online physician reviews to decide between and rate ophthalmologists. Sentiment analysis allows for better understanding of patient experiences. In this study, Valence Aware Dictionary sEntiment Reasoner (VADER) and word frequency analysis of glaucoma specialist Healthgrades reviews were used to determine factors prioritized by patients. DESIGN: Retrospective cross-sectional analysis. PARTICIPANTS: N/A. METHODS: Written reviews and Star ratings of glaucoma specialists listed under the Physicians Payments Sunshine Acts were obtained, and demographic information was collected. Valence Aware Dictionary sEntiment Reasoner produced Negative, Neutral, Positive, and Compound scores of reviews, and these were stratified by demographic variables. Word frequency review was applied to determine popular words and phrases. MAIN OUTCOME MEASURES: Star ratings, VADER Compound score of written reviews, and highest word frequencies. RESULTS: A total of 203 glaucoma specialists and 3531 written reviews were assessed. Glaucoma specialists had an average of 4.26/5 stars, with a mean of 30 ratings per physician on Healthgrades. Most physicians (86%) had overall Positive written reviews (VADER = 0.74), indicating high patient satisfaction. Specialists who were women or had fewer years of practice had higher Compound and Star scores than their respective male and senior counterparts, with statistical significance observed between junior and senior physician Stars (P < 0.001). Repeated words pertaining to the surgery, staff, wait times, and questions were common overall and among the most positive and most negative reviews. CONCLUSIONS: Glaucoma specialist patients value nonclinical factors, such as appointment setting and nonphysician health-care staff members, in their written reviews. Thus, factors beyond clinical outcomes are influential in the overall patient experience and should be considered to improve health-care delivery. These results can also advise ophthalmologists on factors that patients prioritize when evaluating physicians, which influences the decisions of other patients seeking glaucoma care. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Glaucoma , Satisfação do Paciente , Humanos , Glaucoma/fisiopatologia , Glaucoma/terapia , Estudos Retrospectivos , Estudos Transversais , Masculino , Feminino , Oftalmologistas , Pessoa de Meia-Idade , Relações Médico-Paciente , AdultoRESUMO
BACKGROUND: The ACS-NSQIP Surgical Risk Calculator (SRC) is used to predict surgical outcomes, but its accuracy in gastrectomy has been questioned.1,2 We investigated if adding hypoalbuminemia enhances its predictive ability in gastrectomy. METHODS: We identified gastrectomy patients from the ACS-NSQIP database from 2005 to 2019. We constructed pairs of logistic regression models: one with the existing 21 preoperative risk factors from the SRC and another with the addition of hypoalbuminemia. We evaluated improvement using Likelihood Ratio Test (LRT), Brier scores, and c-statistics. RESULTS: Of 18,070 gastrectomy patients, 34.5 â% had hypoalbuminemia. Hypoalbuminemia patients had 2.34 higher odds of mortality and 1.79 higher odds of morbidity. Adding hypoalbuminemia to the RC model statistically improved predictions for mortality, cumulative morbidity, pulmonary, renal, and wound complications (LRT p â< â0.001). It did not improve predictions for cardiac complications (LRT p â= â0.11) CONCLUSION: Hypoalbuminemia should be considered as an additional variable to the ACS-NSQIP SRC for gastrectomy.
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Hipoalbuminemia , Complicações Pós-Operatórias , Humanos , Medição de Risco , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Hipoalbuminemia/complicações , Fatores de Risco , Melhoria de Qualidade , Gastrectomia/efeitos adversos , Estudos RetrospectivosRESUMO
PURPOSE: Vision-threatening diseases (VTDs) are the leading causes of vision loss and blindness. Use of deep learning artificial intelligence (DLAI) in early detection and subspecialty referral is critical to saving vision years and maintaining quality of life. To address this, we propose a comprehensive community-based screening retinal approach that incorporates DLAI to mitigate disparities and address need in an underserved urban community. METHODS: We evaluated two DLAI software designed for 45° retinal image analysis. DLAI was deployed in clinical settings to triage cases for ophthalmic referrals. Functionality was evaluated to propose implementation in a community screening. RESULTS: Our community screenings have incorporated various imaging modalities to improve VTD pick up rate: nonmydriatic color retinal imaging (18%), fundus autofluorescence (AF) (23%), and ocular coherence tomography B and angiography scans (35%). Robotic teleconsultation increased follow-up reached 100%. In clinical settings, DLAI reduced image analysis time (EyeArt™ = under 38 s, SELENA+™ =10.6 s) and highlighted multiple VTDs. High concordance was observed between human graders and DLAI (k = 0.68 in the department of endocrinology and k = 1 in the emergency department). CONCLUSION: Integration of DLAI in our ocular screening protocol can be used to reach underserved communities, especially when traditional health-care access is limited.
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PURPOSE: Early detection and treatment of diabetic retinopathy (DR) are critical for decreasing the risk of vision loss and preventing blindness. Community vision screenings may play an important role, especially in communities at higher risk for diabetes. To address the need for increased DR detection and referrals, we evaluated the use of artificial intelligence (AI) for screening DR. METHODS: Patient images of 124 eyes were obtained using a 45° Canon Non-Mydriatic CR-2 Plus AF retinal camera in the Department of Endocrinology Clinic (Newark, NJ) and in a community screening event (Newark, NJ). Images were initially classified by an onsite grader and uploaded for analysis by EyeArt, a cloud-based AI software developed by Eyenuk (California, USA). The images were also graded by an off-site retina specialist. Using Fleiss kappa analysis, a correlation was investigated between the three grading systems, the AI, onsite grader, and a US board-certified retina specialist, for a diagnosis of DR and referral pattern. RESULTS: The EyeArt results, onsite grader, and the retina specialist had a 79% overall agreement on the diagnosis of DR: 86 eyes with full agreement, 37 eyes with agreement between two graders, 1 eye with full disagreement. The kappa value for concordance on a diagnosis was 0.69 (95% CI 0.61-0.77), indicating substantial agreement. Referral patterns by EyeArt, the onsite grader, and the ophthalmologist had an 85% overall agreement: 96 eyes with full agreement, 28 eyes with disagreement. The kappa value for concordance on "whether to refer" was 0.70 (95% CI 0.60-0.80), indicating substantial agreement. Using the board-certified retina specialist as the gold standard, EyeArt had an 81% accuracy (101/124 eyes) for diagnosis and 83% accuracy (103/124 eyes) in referrals. For referrals, the sensitivity of EyeArt was 74%, specificity was 87%, positive predictive value was 72%, and negative predictive value was 88%. CONCLUSIONS: This retrospective cross-sectional analysis offers insights into use of AI in diabetic screenings and the significant role it will play in automated detection of DR. The EyeArt readings were beneficial with some limitations in a community screening environment. These limitations included a decreased accuracy in the presence of cataracts and the functional cost of EyeArt uploads in a community setting.
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Diabetes Mellitus , Retinopatia Diabética , Humanos , Retinopatia Diabética/diagnóstico , Inteligência Artificial , Estudos Transversais , Estudos Retrospectivos , Programas de Rastreamento/métodos , Fotografação/métodosRESUMO
PURPOSE: To evaluate the utility of EQIP as a novel tool for determining the quality of patient information on YouTube regarding refractive eye surgery. METHODS: Three searches were conducted on YouTube using "PRK eye surgery", "LASIK eye surgery", and "SMILE eye surgery". 110 relevant videos were evaluated using the Ensuring Quality Information for Patients (EQIP) criteria. RESULTS: The average EQIP score was 15.1 (moderate quality). On average, physician-authored videos scored significantly higher on questions 17 (p = .01), 18 (p = .001), 26 (p = .008), relating to author transparency and use of graphs/figures. Patient-authored videos scored significantly higher on questions 8 (p < .001), 9 (p < .001), 12 (p = .008), 16 (p = .02), and 21 (p = .0350). These questions addressed risks/benefits, quality of life and alert signs, date and video revisions, and personally addressing viewers. CONCLUSION: EQIP was useful in identifying specific strengths and deficits in online refractive surgery patient education resources that were not evident from other screening tools. The quality of information on YouTube videos on refractive surgeries is average. Physician-authored videos could be improved by clarifying risks and quality of life issues. Quality evaluation of medical information is important for comprehensive online surgical education.