Reversible Retinopathy Associated with Fibroblast Growth Factor Receptor Inhibitor.

We present a case of reversible, pseudovitelliform lesions while a patient was taking pembrolizumab (PDL-1 inhibitor) and erdafitinib (pan-fibroblast growth factor receptor inhibitor) outside of clinical trial protocols. A 61-year-old patient with 3 days of metamorphopsia was found to have pseudovitelliform lesions in both eyes 6 weeks after initiation of erdafitinib. After discontinuation of this drug, his visual complaints resolved and his lesions decreased on optical coherence tomography. To our knowledge, this is the first case depicting reversible macular lesions with use of this newly approved medication outside of clinical trial protocols.

Traumatic Optic Nerve Sheath Hematoma.

The aim of this report is to present a patient with traumatic optic nerve sheath hematoma (ONSH), a rare diagnosis with high potential for visual sequelae. This case involves a 41-year-old male who presented promptly following blunt trauma to the right eye and orbit that resulted in acute vision loss. Following computed tomography and ophthalmic examination, a diagnosis of ONSH was made and medical therapy with methylprednisolone was initiated. He reported significant improvements in visual symptoms following intravenous corticosteroid therapy. Although the patient reported significant improvements and had normal Snellen visual acuities in follow-up, he continued to have an inferior visual field defect at 1 week in the affected eye. ONSH causing subsequent localized compression of the optic nerve is a rare mechanism of traumatic optic neuropathy in patients following head trauma. The localized compartment syndrome of the optic nerve and subjective visual symptoms were relieved following corticosteroid therapy with no initial need for surgical decompression. Although central visual acuity returned to baseline, the patient had a persistent visual field defect and relative afferent pupillary defect.

Sex Disparities in Productivity among Oculoplastic Surgeons.

Purpose The aim of the study is to investigate sex differences in academic rank, publication productivity, and National Institute of Health (NIH) funding among oculoplastic surgeons and whether there is an association between American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) membership and scholarly output. Methods Sex, residency graduation year, and academic rank were obtained from institutional websites of 113 U.S. ophthalmology programs. H-indices and m-quotients were obtained from the Scopus database. NIH funding information was obtained from the NIH Research Portfolio Online Reporting Tool. Results Of the 272 surgeons, 74 (30.2%) were females. When adjusted for career duration, differences in female to male proportions were only significant at the rank of assistant professor (assistant: 74.3 vs. 48.5%, p = 0.047; associate: 18.9 vs. 24.6%, p = 0.243; full professor: 13.0 vs. 37.2%, p = 0.114). Women had a shorter career duration than men [10.0 (interquartile range or IQR 12.0) vs. 21.0 (IQR 20.0) years; p < 0.001] and a lower h-index [4.0 (IQR 5.0) vs. 7.0 (IQR 10.0); p < 0.001], but similar m-quotients [0.4 (IQR 0.4) vs. 0.4 (IQR 0.4); p = 0.9890]. Among ASOPRS members, females had a lower h-index than males [5.0 (IQR 6.0) vs. 9.0 (IQR 10.0); p < 0.001] due to career length differences. No difference in productivity between sexes was found among non-ASOPRS members. ASOPRS members from both sexes had higher scholarly output than their non-ASOPRS counterparts. Just 2.7% (2/74) of females compared with 5.3% (9/171) of males received NIH funding ( p = 0.681). Conclusion Sex differences in academic ranks and h-indices are likely due to the smaller proportion of females with long career durations. ASOPRS membership may confer opportunities for increased scholarly output.

Sex Differences in Academic Rank, Scholarly Productivity, National Institutes of Health Funding, and Industry Ties Among Academic Cornea Specialists in the United States.

PURPOSE: This study analyzed sex differences among cornea specialists with regards to academic rank, scholarly productivity, National Institutes of Health (NIH) funding, and industry partnerships. DESIGN: Cross-sectional study. METHODS: This was a study of faculty at 113 US academic programs. Sex, residency graduation year, and academic rank were collected from institutional websites between January and March 2019. H-indices and m-quotients were collected from the Scopus database. The NIH Research Portfolio Online Reporting Tool and Centers for Medicare and Medicaid Services databases were queried for data on NIH funding and industry partnerships. RESULTS: Of the 440 cornea specialists identified, 131 (29.8%) were female. The proportions of females and males at each academic rank (assistant 69.5% vs 41.8%; associate 17.6% vs 21.0%; full professor 13.0% vs 37.2%) were not significant after adjusting for career duration (P = .083, .459, and .113, respectively). Females had significantly lower median h-indices (4.0 [interquartile range {IQR} 7.0] vs 11.0 [IQR 17.0], P < .001) and shorter median career duration (12.0 [IQR 11.0] vs. 25.0 [IQR 20.0] years, P < .001) than males but similar median m-quotients (0.5 [IQR 0.8] vs 0.5 [IQR 0.8], P = 1.00). Sex differences in h-indices were not seen at each academic rank or career duration interval. Among NIH-funded investigators, the median grant funding was $1.6M (IQR $2.2M) for females and $1.2M (IQR $4.6M, P = .853) for males. Overall, 25.5% of females and 58.6% of males (P = .600) had industry partnerships. CONCLUSION: Sex differences within academic ranks and h-indices are likely due to a smaller proportion of females with advanced career duration.

Choroidal Thickness Correlates with Clinical and Imaging Metrics of Parkinson's Disease: A Pilot Study.

BACKGROUND: Parkinson's disease (PD) is marked clinically by motor symptoms and pathologically by Lewy bodies and dopamine neuron loss in the substantia nigra pars compacta (SNc). Higher iron accumulation, assessed by susceptibility MRI, also is observed as PD progresses. Recently, evidence has suggested that PD affects the retina. OBJECTIVE: To better understand retinal alterations in PD and their association to clinical and SNc iron-related imaging metrics. METHODS: Ten PD and 12 control participants (2 eyes each) from an ongoing PD imaging biomarker study underwent enhanced depth imaging optical coherence tomography evaluation. Choroidal (vascular) thickness and nerve layers were measured in 4 subregions [superior, temporal, inferior, and nasal] and at 3 foveal distances (1, 1.5, and 3 mm). These metrics were compared between PD and control groups. For significantly different metrics, their associations with clinical [levodopa equivalent daily dosage (LEDD), motor and visuospatial function] and SNc susceptibility MRI metrics [R2* and quantitative susceptibility mapping (QSM)] were explored. RESULTS: Compared to control participants, PD participants had a thicker choroid (p = 0.005), but no changes in nerve layers. Higher mean choroidal thickness was associated with lower LEDD (p < 0.01) and better visuospatial function (p < 0.05). Subregion analyses revealed higher choroidal thickness correlated with lower LEDD and better motor and visuospatial measures. Higher mean choroidal thickness also was associated with lower nigral iron MRI (p < 0.05). CONCLUSION: A small cohort of PD research participants displayed higher choroidal thickness that was related to better clinical performance and less nigral pathology. These intriguing findings warrant further investigation.

Gender disparities among United States academic pediatric ophthalmologists: an analysis of publication productivity, academic rank, and NIH funding.

PURPOSE: To investigate gender disparitie among pediatric ophthalmologists in academic rank, publication productivity, and National Institutes of Health (NIH) funding. METHODS: In this cross-sectional analysis of pediatric ophthalmologists at 113 US academic programs, data on gender, residency graduation year, and academic rank were obtained from institutional websites between January 2019 and March 2019. The Scopus database was used to calculate h-indices and m-quotients. The NIH Research Portfolio Online Reporting Tool was used to determine NIH funding. RESULTS: We identified 389 pediatric ophthalmologists: 194 women (49.9%) and 195 men (50.1%). A binomial logistic regression model, which included career length as an independent variable, showed proportions of women to men were similar across all academic ranks (assistant professor, 64.4% vs 46.2% [P = 0.738]; associate professor, 21.7% vs 19.0% [P = 0.357]; full professor, 13.9 vs 34.9% [P = 0.119]). Women had a lower median h-index (5.0 vs 8.0 [P = 0.008]) and a shorter median career duration (12.5 vs 25.0 years [P < 0.001]), but a similar median m-quotient (0.5 vs. 0.5; P = 0.525). Among pediatric ophthalmologists who received NIH funding (20 women vs. 27 men; P = 0.826), the overall median grant-funding total for women was $804K (interquartile range (IQR) 5.0M, mean $3.8M) compared to men, $2.2M (IQR, 4.0M; mean, $3.7M; P = 0.328). CONCLUSIONS: The shorter career duration for women likely contributes to the difference in overall h-indices between genders, as m-quotients were similar. The m-quotient should be used over the h-index when comparing academic productivity across genders when disparities in career length exist.

Association Between Sex Composition and Publication Productivity of Journal Editorial and Professional Society Board Members in Ophthalmology.

Importance: Because women remain underrepresented in leadership positions in medicine, including ophthalmology, knowledge of sex composition of ophthalmic journal editorial and professional society boards seems warranted. Objectives: To investigate the sex composition of ophthalmic journal editorial and professional society boards and compare the publication productivity and number of citations of male vs female board members. Design, Setting, and Participants: In this cross-sectional study, the SCImago Journal Rank indicator was used to identify the 20 highest-ranked ophthalmology journals. Faculty members from each ophthalmic subspecialty were surveyed within a US academic ophthalmology department to identify 15 influential ophthalmology societies. The 2018 board members of each journal and society were identified from the journals' and societies' official websites, and the sex of each individual was recorded. Information regarding journals and societies was collected from October 1 to December 31, 2018. The Scopus database was accessed in January 2019 and then used to find each member's h-index and m-quotient. Main Outcomes and Measures: The h-index, defined as the highest number of an author's publications that received at least h number of citations, was calculated for each board member. The m-quotient, which accounts for varying lengths of academic careers, was calculated by dividing the h-index by the number of years since first publication. Results: Of the 1077 members of ophthalmic journal editorial and society leadership boards, 797 (74.0%) were men and 280 (26.0%) were women. Among the 24 editors in chief of the 20 journals investigated, 23 (95.8%) were male. Thirteen of the 15 professional society presidents (86.7%) were men. Male board members had significantly higher median h-indexes (male vs female journals: 34 [interquartile range {IQR}, 23-47] vs 28 [IQR, 19-40], P < .001; male vs female societies: 27 [IQR, 15-41] vs 17 [IQR, 8-32], P = .006), median publication numbers (male vs female journal board members: 157 [IQR, 88-254] vs 109 [IQR, 66-188], P < .001; male vs female society board members: 109 [IQR, 57-190] vs 58 [IQR, 28-139, P = .001), and median citations (male vs female journal board members: 4027 [IQR, 1897-8005] vs 2871 [IQR, 1344-5852], P < .001; male vs female society board members: 2228 [IQR, 1005-5069] vs 1090 [IQR, 410-2527], P = .003). However, the median m-quotients for male and female board members were comparable (male vs female journal board members: 1.2 [IQR, 0.8-1.6] vs 1.1 [IQR, 0.8-1.5], P = .54; male vs female society board members: 1.0 [IQR, 0.7-1.4] vs 0.9 [IQR, 0.6-1.3], P = .32). Conclusions and Relevance: The findings suggest that the sex composition on journal editorial and professional society boards in ophthalmology is consistent with the sex composition of ophthalmologists in the US, as reported by the Association of American Colleges, but that editor in chief and society president positions are male dominated despite the apparent equality in academic productivity.

International experiences during United States ophthalmology residency training: Current structure of international experiences and perspectives of faculty mentors at United States training institutions.

BACKGROUND: There is a high level of interest in international experiences during United States (U.S.) ophthalmology residency training among both program directors and trainees. METHODS: An electronic invitation to a 26-question survey was sent to all 114 U.S. ophthalmology residency program directors. The invitation requested that the survey be completed by the one faculty member who was most involved in overseeing the international experiences for the residents. The survey consisted of multiple choice and Likert-type scale questions. The Mann-Whitney U test was used for analysis of demographic data and Friedman's test and Wilcoxon-Signed Rank test were used to analyze ranked responses. RESULTS: Responses were obtained from 70 faculty mentors representing unique programs, yielding a response rate of 61.4%. The majority of programs that responded (88.6%, n = 62) either offered international ophthalmology experiences for residents or supported residents finding their own experiences to go abroad. International experience participation rate among residents correlated with the number of years the experiences had been offered by the programs (p = 0.001). More than half of the respondents (55.0%, n = 33) felt that the residents benefited more than the hosts during these international experiences. Approximately half of the respondents (51.6%, n = 32) believed that additional training beyond what is covered in the standard curriculum to practice ophthalmology in the U.S. is necessary for practicing ophthalmology in an international setting. CONCLUSIONS: There is high interest and participation in international experiences within U.S. ophthalmology residency programs. This high participation warrants further investigation into the long-term impact of these international experiences and how U.S. residency programs can structure these experiences to maximize the benefits to both the residents and the international host communities.

Severe Human Granulocytic Anaplasmosis With Significantly Elevated Ferritin Levels in an Immunocompetent Host in Pennsylvania: A Case Report.

Human granulocytic anaplasmosis (HGA) is a tick-borne, infectious disease caused by Anaplasma phagocytophilum that generally presents with nonspecific symptoms such as fever, chills, headache, malaise, and myalgia. If not treated immediately, HGA can cause hemophagocytic lymphohistiocytosis (HLH), a well-documented but underrecognized sequela of severe HGA. In this article, we report a case of severe HGA with hyperferritinemia in a 74-year-old male from Central Pennsylvania who initially presented with recurrent fevers, nausea, and malaise to our emergency department and was subsequently discharged home that same day. Ten days later, the patient returned with acute kidney injury, elevated liver transaminases, and profound hyperferritinemia to 5130 ng/mL. Empiric doxycycline was administered for suspected tick-borne disease and serologies eventually came back positive for anti-Anaplasma phagocytophilum antibodies. The patient returned to baseline status 15 days after discharge. Our case shows the challenges in the timely diagnosis of HGA and highlights the role of serum ferritin in aiding this diagnosis. Although our patient did not fulfill the HLH diagnostic criteria, our report demonstrates the importance of recognizing HGA as a reversible cause of HLH.