Gender inclusivity of ophthalmology journal submission guidelines and associated research metrics.

PURPOSE: This cross-sectional study evaluated the prevalence of inclusive author submission guidelines across ophthalmology journals. METHODS: Journals were identified from the 2021 Journal Citations Report (Clarivate Analytics). Independent reviewers rated each author submission guideline as "inclusive" for satisfying at-least one of six criteria: i) included examples of gender inclusive language; ii) recommended the use of gender-inclusive language; iii) distinguished between sex and gender; iv) provided educational resources on gender-inclusive language; v) provided a policy permitting name changes (e.g., in case of gender and name transition); and/or vi) provided a statement of commitment to inclusivity. The primary objective was to investigate the proportion of journals with "gender-inclusive" author submission guidelines and the elements of the gender-inclusive content within these guidelines. A secondary objective was to review the association between "gender-inclusivity" in author submission guidelines with publisher, origin country, and journal/source/influence metrics (Clarivate Analytics). RESULTS: Across 94 journals, 29.8% journals were rated as inclusive. Inclusive journals had significantly higher relative impact factor, citations, and article influence scores compared to non-inclusive journals. Of the 29.8% of inclusive journals, the three most common domains were inclusion of an inclusivity statement (71.4% of inclusive journals), distinguishing between sex and gender (67.9%), and provision of additional educational resources on gender reporting for authors (60.7%). CONCLUSION: A minority of ophthalmology journals have gender-inclusive author submission guidelines. Ophthalmology journals should update their submission guidelines to advance gender equity of both authors and study participants and promote the inclusion of gender-diverse communities.

Diagnostic Yield of Investigations in Symmetric Optic Neuropathy.

BACKGROUND: Symmetric optic neuropathy (SON) is commonly seen in neuro-ophthalmic practice and is often discovered incidentally. Although multiple investigations might be performed to discover the underlying cause, they are not always indicated. The aim of this study was to report a clinically reasonable and cost-effective approach to investigating patients with SON. METHODS: SON was defined as bilateral optic neuropathy with normal and/or symmetrically decreased central visual acuity, absence of relative afferent pupillary defect, presence of symmetric optic disc pallor, symmetric thinning of peripapillary retinal nerve fiber layer on optical coherence tomography, and absence of other identifiable causes of optic neuropathy. Records of all patients diagnosed with SON seen at a tertiary university-affiliated neuro-ophthalmology practice from 2016 to 2022 were reviewed to identify the yield of various investigations. Clinical data from the initial and last follow-up visit were obtained. Subgroup analysis was performed to ascertain whether diagnostic yield is higher in patients with severe visual loss (central acuity worse than 20/40) compared with those with mild visual loss (acuity 20/40 or better). RESULTS: One hundred thirty-six patients met inclusion criteria. Testing for OPA1 and OPA2 mutations had the highest diagnostic yield (16.0%), followed by mitochondrial genome sequencing (13.6%), serum vitamin B12 (6.1%), and serum folate (1.6%). MRI brain was performed in 54.4% of patients and had a diagnostic yield of only 5%. Both patients who had abnormal MRI had symptoms of demyelination at presentation. Patients were followed for a mean of 15.0 (SD 21.3) months. The most frequently identified etiologies of SON were Leber hereditary optic neuropathy (8.1%), alcohol/tobacco amblyopia (7.4%), vitamin B12 deficiency (5.9%), and dominant optic atrophy (2.9%). Patients with severe visual impairment were more likely to have a final diagnosis compared with those with milder visual impairment (63.9% vs 12.0%, P < 0.001). CONCLUSIONS: The diagnostic yield of investigating SON in patients with preserved visual function, normal diet, and absence of other neurological symptoms is very low. It is reasonable to observe patients with SON with mild visual impairment, reserving costly investigations for those with the visual acuity worse than 20/40 or progressive course.

Neuro-ophthalmology output in high-impact clinical ophthalmology and neurology journals.

OBJECTIVE: To characterize the neuro-ophthalmology publishing trends of the top general clinical ophthalmology and neurology journals and to report (i) the proportion of articles that are neuro-ophthalmology focused and (ii) the correlation between annual proportion of neuro-ophthalmology-focused articles and annual proportion of neuro-ophthalmologist journal editors. DESIGN: Retrospective database review. MATERIALS: Articles in the top 5 general clinical ophthalmology and neurology journals. METHODS: Publications from 2012 through 2021 were retrieved from Embase and classified as teaching or nonteaching articles based on journal indexing. Duplicate screening was conducted to further categorize articles as either focused or not focused on neuro-ophthalmology. RESULTS: The titles, abstracts, and (or) full texts of 34,660 articles were reviewed. The total proportions of nonteaching articles and teaching articles focused on neuro-ophthalmology were 3.4% and 13.8%, respectively. Neuro-ophthalmology contributions to nonteaching and teaching publications were greater among the ophthalmology journals (4.0% and 15.2%) than among the neurology journals (2.6% and 13.3%). There were no clear trends in the annual proportion of neuro-ophthalmology-focused articles across the 10-year period. The annual proportion of neuro-ophthalmologist journal editors was positively correlated with annual neuro-ophthalmology output for teaching articles (Pearson's r = 0.541; p < 0.001) but not articles unrelated to teaching (Pearson's r = 0.067; p = 0.598). CONCLUSIONS: Our study found that there was a lower prevalence of neuro-ophthalmology papers in high-impact-factor general clinical ophthalmology and neurology journals over the last 10 years. It is important to have good representation of neuro-ophthalmology studies in such journals to promote best neuro-ophthalmic practices among all clinicians.

Role of Positioning after Full-Thickness Macular Hole Surgery: A Systematic Review and Meta-Analysis.

TOPIC: The importance of postoperative face-down positioning (FDP) to achieve anatomic and functional success after full-thickness macular hole (FTMH) surgery is explored in this meta-analysis of randomized controlled trials (RCTs). CLINICAL RELEVANCE: There is considerable variability in clinical practices regarding the need and length of FDP recommended to patients after FTMH surgery. There is also a lack of robust clinical guidelines on the topic. As such, an updated estimate of the effect size of FDP on clinically important outcomes is critical to inform practice. METHODS: Ovid MEDLINE, EMBASE, CENTRAL, and SCOPUS databases were searched from inception to October 3, 2021, for RCTs evaluating FDP versus non-FDP (nFDP). Data were collected for 7 clinically important outcomes after macular hole surgery: closure rate, visual acuity (VA) improvement, recurrence of FTMH, visual function, quality of life, patient satisfaction, and complication rates. We used the Cochrane risk-of-bias tool for randomized trials (RoB 2) to assess the risk of bias and followed the Grade of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to assess the certainty in the evidence across outcomes. We conducted meta-analyses using random-effects modeling. Subgroup analyses were carried out based on hole size, type of gas, and duration of FDP. RESULTS: Eight RCTs of 709 eyes were included. The relative risk (RR) of FTMH closure rate comparing FDP versus nFDP was RR 1.05 (95% confidence interval [CI]: 0.99, 1.12, P = 0.09, I2 = 44%, GRADE rating: LOW). The mean difference (MD) regarding VA improvement comparing FDP and nFDP was MD -0.07 (95% CI: -0.12 to 0.01, P = 0.03, I2 = 16%, GRADE rating: LOW). CONCLUSION: The current review did not demonstrate a difference between FDP and nFDP with respect to FTMH closure, although the CIs were wide. There was a visual benefit to FDP; however, the CIs included values of trivial clinical significance. Subgroup analyses demonstrated that the VA benefit observed was driven by large holes. Limited data precluded analysis regarding the rate of FTMH recurrence, measures of visual function, quality of life measures, and patient satisfaction metrics. Further prospective trials are required to assess the gaps in the literature and improve the certainty of evidence for the outcomes examined.

The 100 Most-Cited Papers on Giant Cell Arteritis: A Bibliometric Analysis.

BACKGROUND: Giant cell arteritis (GCA) carries a significant risk of vascular and visual morbidity. Given its clinical importance, the 100 most frequently cited articles on GCA were systematically identified and bibliometrically analyzed. METHODS: All databases belonging to the Web of Science platform were searched for research articles with no restriction on publication date. The distribution of papers among journals, countries of origin, and publication types were evaluated. The correlations between the year of publication with total number of citations and annual citation rate were also assessed. RESULTS: The top 100 articles on GCA were published between 1946 and 2018 and were cited a median (range) of 229 (153-1751) times. The papers were published in 30 journals, including nine rheumatology journals (n= 45), seven general medical journals (n= 21), three ophthalmology journals (n= 8), and eleven journals from other fields of research (n= 26). Based on corresponding author affiliation, the articles originated from 13 countries, led by the US (n= 55), Spain (n= 12), and the UK (n= 11). Clinical studies (n= 73) and non-systematic reviews (n= 11) were the most common publication types. The median (range) number of authors per article was 5 (1-44), and 73 individuals had more than one authorship. Year of publication was significantly correlated with the annual citation rate (P<0.001) but not with the total number of citations (P= 0.487). CONCLUSION: This bibliometric analysis provides insight into the history and evolution of GCA research, highlighting some of the most influential contributions to the field. The latest landmark papers may not have been identified due to temporal constraints on citation accumulation.

The use of optical coherence tomography in neurology: a review.

Optical coherence tomography is a non-invasive, cost-efficient technique that provides high-resolution in vivo imaging of retinal tissue. The peripapillary retinal nerve fibre layer and macular ganglion cell complex are surrogate markers of neuroaxonal integrity in not only the eye, but also the CNS. Retinal atrophy may occur in tandem with CNS pathologies as a result of injury to ganglion cells, direct degeneration of the pregeniculate pathway, or retrograde trans-synaptic degeneration secondary to postgeniculate lesions. In this review, we outline the basic principles of optical coherence tomography and discuss its application to managing patients with demyelinating disorders, idiopathic intracranial hypertension, stroke, neurodegenerative conditions, and mitochondrial disorders. We demonstrate that measurements of peripapillary retinal nerve fibre layer and macular ganglion cell complex thickness are paramount in diagnosing and monitoring neurological disorders, including those with subclinical disease progression.

Publication trends in telemedicine research originating from Canada.

Telemedicine modalities for patient care have seen significant global uptake during the COVID-19 pandemic. This study aimed to bibliometrically evaluate the evolution and current landscape of telemedicine literature in Canada. The Scopus database was searched to identify telemedicine publications for which the first or last author had a Canadian institutional affiliation. Study selection and data abstraction were conducted by two pairs of independent reviewers. Between 1976 and January 2021, 810 of 3,620 retrieved citations were telemedicine publications originating from Canada, including 29 randomized controlled trials and 6 systematic reviews. The annual publication output increased substantially from 1/year in 1976 to 80/year in 2020. Based on author keyword analysis, the most frequently investigated disciplines or disease entities were primary care, COVID-19, telepsychiatry, heart failure, and mental health. The insights this study provides will aid scientists, policy makers, and other stakeholders in identifying opportunities for future investigation and clinical application.

Treat-and-extend regimens of anti-vascular endothelial growth factor therapy for retinal vein occlusions: a systematic review and meta-analysis.

OBJECTIVE: To investigate treat-and-extend (T&E) regimens of anti-vascular endothelial growth factor (anti-VEGF) therapy for the treatment of macular oedema secondary to retinal vein occlusions (RVOs). METHODS: Ovid MEDLINE, Ovid EMBASE and CENTRAL were searched on 25 February 2021. Randomized controlled trials, cohort studies, case-control studies and case series were included. The primary outcome was the change in Early Treatment Diabetic Retinopathy Score (ETDRS) letters from baseline. Conversions from Snellen to ETDRS letters were performed utilizing a published protocol. Secondary outcomes included improvement in retinal thickness from baseline, number of anti-VEGF injections and frequency of adverse events. Outcomes were examined at 12 and 24 months. Certainty of evidence was assessed utilizing GRADE (Grading of Recommendations Assessments, Development and Evaluations) guidelines. RESULTS: Seven hundred eighty-six eyes from 16 studies were included. Meta-analysis demonstrated a mean improvement of 15.7 (95% CI: 13.3-18.0) ETDRS letters at 12 months. Central retinal thickness improved 269.7 µm (95% CI: 233.64-305.90) at 12 months. Injections were performed 8.1 (95% CI: 7.4-8.7) and 13.1 (95% CI: 9.4-16.8) times at 12 and 24 months respectively. Adverse events were infrequent across all studies. Grading of Recommendations Assessments, Development and Evaluations (GRADE) certainty of evidence was very low across all outcomes. CONCLUSIONS: The results support the viability of T&E regimens for the treatment of macular oedema secondary to RVOs.