Gender distribution in publishing in five leading optometry journals.

PURPOSE: To explore gender distribution in authorship and citation parameters of articles published in five optometry journals included in the Ophthalmology category of Journal Citation Reports. METHODS: The Scopus database was used to retrieve all citable articles published in 2011 and 2021 in Optometry and Vision Science, Ophthalmic and Physiological Optics, Clinical Experimental Optometry, Contact Lens and Anterior Eye, and Eye and Contact Lens. Gender of the first, last and single authors of all articles, and citation parameters of articles published in 2011 up to May 2023 were determined. Gender of the editor-in-chief and members of the editorial board of these journals was investigated (May 2023). RESULTS: Only one journal had a female editor-in-chief and three journals had more males than females in their editorial board. In 2011 and 2021, respectively, 40.1% and 48.0% of articles had female as the first authors ( χ 1 , 948 2 = 5.77; p = 0.02), and 32.7% and 39.6% had female as the last authors ( χ 1 , 948 2 = 4.61; p = 0.03). Gender parity was observed in one journal for the first author and none for the last author in 2011, and in three journals for the first author and one for the last author in 2021. Regarding combinations of male (M) and female (F) first and last authorship positions, the authors of articles in 2011 were MM (44.5%), FM (22.8%), FF (17.3%) and MF (15.4%), and MM (34.6%), FM (25.8%), FF (22.1%) and MF (17.5%) in 2021. Differences between 2011 and 2021 were statistically significant ( χ 3 , 948 2 = 9.80; p = 0.02). The proportion of authorship combinations did not show statistically significant differences among journals in 2011 or in 2021. Neither citation nor self-citation were influenced by gender. CONCLUSIONS: Gender disparities persist in optometry journals, with females being under-represented in senior and leadership positions. Increasing the awareness of gender disparity in authorship is a necessary step towards ensuring fairness in science in general, and optometry in particular.

Evaluating patient flow through an emergency ophthalmology consult service in a tertiary care academic centre in Quebec.

OBJECTIVE: This study aims to characterize the epidemiology, common reasons, and diagnostic accuracy of referrals made by emergency departments (EDs) and optometrists to an emergency ophthalmology consultation service as well as to identify opportunities for improvement. DESIGN: Retrospective chart review. PARTICIPANTS: A total of 1249 referrals made to the emergency ophthalmology consultation service at a tertiary care centre between July 2018 and June 2019. METHODS: Patient charts were examined, and clinical variables were extracted. Statistical significance (p < 0.05) was determined via t tests and χ2 tests for continuous and categorical variables, respectively. Diagnostic accuracy of providers and time delay between referral and ophthalmologic encounter also were assessed. RESULTS: Both EDs and optometrists most often referred cases with vitreoretinal (36.48% and 37.19%, respectively) and corneal pathology (21.42% and 20.25%, respectively). Optometrists (n = 240; 52.48%) were significantly more accurate in their diagnoses than EDs (n = 940; 32.45%; p < 0.00001). Specifically, optometrists were significantly more accurate when diagnosing anterior-chamber (n = 29; 58.62%; p = 0.039) and vitreoretinal (n = 89; 60.67%; p < 0.00001) pathology than EDs (anterior chamber, n = 77, 36.36%; vitreoretinal, n = 344, 18.90%). Across all ED referrals (n = 940), 58 (6.17%) had a prolonged delay. Across all optometrist-to-ED referrals (n = 150), 6 (4.00%) had a prolonged delay. Accounting for all cases, the total incidence of prolonged delay was 5.87%. CONCLUSIONS: Our results demonstrate the need for improved communication between optometrists and ophthalmologists to reduce the wait-time burden on EDs. Patients may benefit from direct referral by optometrists to ophthalmologists. Education of allied health professionals on ophthalmic disease also may improve diagnostic accuracy.

Keratoconus Management in the Community: A Survey of Optometrists.

OBJECTIVES: Defining the patterns of practice and referral criteria of optometrists within New Zealand to investigate the diagnosis and management of keratoconus. METHODS: Optometrists recruited through the New Zealand Association of Optometrists, Cornea and Contact Lens Society of New Zealand, and private practices were invited to complete an anonymous survey. RESULTS: Responses were received from 168 optometrists (representing 20.0% of the optometrist population). Half (48%) of optometrists had ≥15 years of experience, and 22% prescribed soft contact lenses daily, whereas only 6.4% prescribed rigid gas-permeable (RGP) lenses daily. The main barriers to prescribing RGPs were experience with fitting, low market demand, and patient discomfort. When referring to an ophthalmologist, 41% reported referring on progression of corneal parameters, 27% on initial diagnosis, 21% at no set time, and 10% with a reduction in visual acuity. Most optometrists (64%) would refer for possible surgery when visual acuity dropped between 6/9 and 6/12. Optometrists with greater experience were more likely to prescribe RGP lenses and co-manage patients with ophthalmologists. Ownership of a corneal imaging unit suggested an increased likelihood of prescribing RGP lenses but did not alter referral patterns. CONCLUSION: This survey provides an overview of current practice and highlights the importance of optometrists in the diagnosis and management of keratoconus. There was a significant discrepancy in keratoconus management, regarding optical correction modality and referral criteria for ophthalmology review. Further interdisciplinary work is required between optometry and ophthalmology to standardize referral guidelines and enhance visual outcomes.

Sistema de competencias laborales para tecnólogos de la salud licenciados en Optometría y Óptica / Job competency system for health technologists licensed in Optometry and Optics

Fundamento: la calidad de un servicio de salud parte del nivel de la competencia y desempeño de sus trabajadores en el cumplimiento de sus funciones laborales y sociales. Objetivo: elaborar un sistema de competencias laborales para tecnólogos de la salud licenciados en Optometría y Óptica. Métodos: se realizó una investigación de desarrollo tecnológico en el campo de la educación médica, durante enero 2021- enero 2022 en instituciones del nivel secundario del municipio Holguín. Se utilizaron métodos teóricos, empíricos y estadísticos que permitieron la triangulación metodológica de los resultados. Se tuvo en cuenta el criterio de especialistas para la valoración del sistema de competencias elaborado. Resultados: se identificaron insuficiencias para ejecutar procederes óptico-optométricos, limitada participación en actividades científico investigativas, baja categorización docente e investigativa, debilidades en la función profesor-tutor y escasa actividad de superación permanente. Se elaboró un sistema de competencias laborales para tecnólogos de la salud licenciados en Optometría y Óptica diseñadas en correspondencia con el ejercicio de sus funciones. Conclusiones: el diagnóstico realizado demostró la necesidad de un sistema de competencias laborales para contribuir al perfeccionamiento del desempeño laboral de estos profesionales, el cual fue valorado como factible, pertinente y útil de ser aplicado.

Background: the quality of a health service is based on the level of competence and performance of its workers in fulfilling their job and social functions. Objective: to develop a system of job skills for health technologists Bachelors in Optometry and Optics. Methods: a technological development investigation was carried out in the field of medical education, from January 2021 to January 2022 in secondary level institutions of the Holguín municipality. Theoretical, empirical and statistical methods were used that allowed the methodological contrast of the results. The criteria of specialists was taken into account for the assessment of the developed competency system. Results: insufficiencies were identified to carry out optical-optometric procedures, limited participation in scientific research activities, low teaching and research ranking, weaknesses in the teacher-tutor function and little permanent improvement activity. A system of job competencies was developed for health technologists with degrees in Optometry and Optics designed in accordance with the exercise of their duties. Conclusions: the diagnosis carried out demonstrated the need for a system of work competencies to contribute to the improvement of the work performance of these professionals, which was valued as feasible, relevant and useful to be applied.

Impact of an email advice service on filtering and refining ophthalmology referrals in England.

PURPOSE: The growing capacity-demand imbalance has necessitated the accelerated digital transformation of eye care services. The role of Oxford Eye Hospital's (OEH) email advice service has become even more relevant in the post-Covid era. We sought to evaluate its impact on referrals to secondary care. METHODS: The consultant-led OEH email advice service primarily targets primary eye care personnel (optometrists and GPs) requiring clinical advice on patient referral. Emails received between September and November 2020 were analysed for demographic data, contents, characteristics, and outcomes. Thematic analysis was performed. A user feedback survey was conducted. RESULTS: A total of 828 emails were received over the 3-month study period (mean 9.1/day). They were predominantly from optometrists (77.9%) and general practitioners (16.1%). Of the 81.0% (671) relating to clinical advice, over half (54.8%) included images from a variety of modalities, and following review, over half (55.5%) were deemed suitable for management in the community, while 36.5% were referred directly to appropriate subspecialty clinics. Only 8.1% required urgent assessment in eye casualty. Thematic analysis showed that this service was most useful for retinal lesions, optical coherence tomography abnormalities, and borderline abnormal optic discs. No adverse events were identified. User feedback was very positive. CONCLUSION: A secure email advice service is a safe and low-maintenance modality that provides direct and efficient two-way communication between primary and secondary eye care professionals. It allows rapid response to clinical queries, referral filtering and refinement, and streamlining of patient referral pathways. Users (predominantly optometrists) were overwhelmingly positive about its usefulness in clinical practice.

Who cites optometry journals?

PURPOSE: This work seeks to identify the most impactful journals, papers, authors, institutions, and countries that cite optometry journal articles. METHODS: The Scopus database was searched for papers citing at least one article published in any of the 18 optometry journals included in that database (i.e. 'optometry articles'). The 10 most highly cited papers that cite optometry journal articles were determined from 82,830 papers found. A h-index for "optometry journal citations" (the hOJC-index) was derived for each entity in the categories of journals, papers, authors, institutions and countries to serve as a measure of impact. RESULTS: The hOJC-index of the body of papers citing optometry journal articles is 370. Papers citing optometry journal articles have themselves been cited 2,054,816 times. Investigative Ophthalmology & Visual Science (hOJC = 154) is the most impactful journal citing optometry articles and Optometry and Vision Science the most prolific (5310 papers). The most impactful paper citing optometry journal articles (5725 citations) was published in Journal of Clinical Epidemiology. Ophthalmologist Seang Mei Saw (hOJC = 69) is the most impactful author and optometrist Nathan Efron is the most prolific (288 papers). Harvard University (hOJC = 127) is the most impactful and UNSW Sydney is the most prolific institution (1761 papers). The United States is the most impactful and prolific nation (hOJC = 313; 28,485 papers). CONCLUSIONS: Optometry journal articles are cited extensively by optometrists, ophthalmologists, and vision scientists world-wide, as well as authors from a broad spectrum of non-ophthalmic research domains. This work confirms the utility and influence of optometry journals.

Level of Eye Care Among Eye Care Providers Themselves.

OBJECTIVES: To assess the prevalence of eye disease and frequency of eye examinations among eye care providers themselves. METHODS: In this cross-sectional study, an anonymous questionnaire was used to evaluate occurrence of eye disease and frequency of eye examinations among eye care providers including the clinicians (ophthalmologists, ophthalmology residents, and optometrists) as well as the support staff (ophthalmic technicians and eye clinic administrative staff). RESULTS: The survey response rate was 98 of 173 (56.6%) including 50 ophthalmic technicians, 27 ophthalmologists, 7 ophthalmology residents, 6 optometrists, and 8 eye clinic administrative staff members. The most common reported ocular condition was dry eye disease (36.7%). Myopia and hyperopia were present in 60 (61.2%) and 13 (13.3%), respectively. Myopia was significantly more prevalent among the clinicians (75.0%) than in the support staff (51.7%, P =0.02). The most recent eye examination was within the past year in 42 (42.9%), 1 to 2 years in 28 (28.6%), 3 to 5 years in 14 (14.3%), and over 5 years in 10 (10.2%). Four (4.1%) had never had an eye examination before. The number of eye examinations received was significantly higher in the support staff compared with the clinicians for the past one year (0.86±0.74 vs 0.43±0.59, respectively, P =0.003) and the past five years (2.81±2.08 vs 1.75±1.78, respectively, P =0.01). CONCLUSIONS: Dry eye disease and myopia are common among eye care providers. A significant portion of eye care providers do not have regular eye examinations for themselves.

Private equity in ophthalmology and optometry: a time series analysis from 2012 to 2021.

Purpose: To identify temporal and geographic trends in private equity (PE)-backed acquisitions of ophthalmology and optometry practices in the United States from 2012 to 2021. Methods: In this cross-sectional time series, acquisition data from 10/21/2019 to 9/1/2021 and previously published data from 1/1/2012 to 10/20/2019 were analyzed. Acquisition data were compiled from 6 financial databases, 5 industry news outlets, and publicly available press releases. Linear regression models were used to compare rates of acquisition. Outcomes included number of total acquisitions, practice type, locations, provider details, and geographic footprint. Results: A total of 245 practices associated with 614 clinical locations and 948 ophthalmologists or optometrists were acquired by 30 PE-backed platform companies between 10/21/2019 and 9/1/2021. Of 30 platform companies, 18 were new vis-à-vis our prior study. Of these acquisitions, 127 were comprehensive practices, 29 were retina practices, and 89 were optometry practices. From 2012 to 2021, monthly acquisitions increased by 0.947 acquisitions per year (P < 0.001*). Texas, Florida, Michigan, and New Jersey were the states with the greatest number of PE acquisitions, with 55, 48, 29, and 28 clinic acquisitions, respectively. Average monthly PE acquisitions were 5.71 per month from 1/1/2019 to 2/29/2020 (pre-COVID), 5.30 per month from 3/1/2020 to 12/31/2020 (COVID pre-vaccine [P = 0.81]), and 8.78 per month from 1/1/2021 to 9/1/2021 (COVID post-vaccine [P = 0.20]). Conclusions: PE acquisitions increased during the period 2012-2021 as companies continue to utilize regionally focused strategies for acquisitions.

Survey of the Faculty Status of Optometrists at Academic Medical Centers in the United States.

SIGNIFICANCE: This is the first study of the prevalence and faculty status of optometrists practicing at academic medical centers in the United States. PURPOSE: This study aimed to quantify the number of optometrists at academic medical centers, along with faculty rank and post-doctoral training programs. METHODS: The official Web sites of academic medical centers and schools of medicine in the United States were examined during the 2021 to 2022 academic year to identify departments of ophthalmology and collect faculty profiles of employed optometrists. Institutional data were cross-referenced and analyzed by geographic distribution. Data were gathered from the Association of Schools and Colleges of Optometry and Accreditation Council on Optometry Education to identify post-graduate training programs in optometry. RESULTS: A total of 192 academic medical centers were identified, of which 121 (63.02%) had a residency or fellowship program in ophthalmology and/or optometry. One hundred twenty-five (65.10%) of these institutions had at least one staff optometrist. Seven hundred eighteen optometrists were found at these institutions, representing 1.83% of the 39,205 practicing optometrists estimated in the United States. Of the 718 optometrists, 369 (51.39%) held an academic appointment at a medical school. The most common academic rank was assistant professor (184 [25.63%]), followed by instructor (138 [19.22%]), associate professor (34 [4.74%]), and full professor (13 [1.81%]). The distribution of academic rank was similar across all regions but varied between institutions as to whether all, some, or none of the optometric faculty were appointed by a medical school. Of 296 optometry residency programs in the United States, 21 (7.09%) were at an academic medical center. Of 15 optometric fellowship programs in the United States, 3 (20%) were at an academic medical center. Of the 192 institutions in this study, 22 (11.46%) had a post-doctoral optometric training program. CONCLUSIONS: This study shows the distribution of academic rank and post-doctoral training programs for optometrists at academic medical centers.

Feasibility of providing collaborative glaucoma care from a community optometry perspective: a mixed-methods assessment.

CLINICAL RELEVANCE: Despite evidence showing that optometry-led collaborative glaucoma care can be delivered at reduced cost compared to ophthalmology-based care without compromising patient outcomes, such models of care are not widely practiced in Australia. Ensuring glaucoma patients have equitable access to effective and cost-effective care is a matter of public health importance. BACKGROUND: This study examined the feasibility and business case assessment for providing glaucoma care from a community optometry perspective. METHODS: Nine optometrists were interviewed in a semi-structured format, focusing on the economic feasibility, barriers, and benefits of collaborative glaucoma care. The Consolidated Framework for Intervention Research was used for thematic data analysis. Costs and revenues associated with providing glaucoma care were sourced from the literature and interviews. A business case model assessing the profitability of glaucoma care in optometric practice was developed. RESULTS: Thematic analysis revealed concerns over financial viability such that current Medicare Benefits Schedule fees are not sufficient to justify the cost of running a community optometry glaucoma clinic. All participants received a supplementary source of revenue. This finding was confirmed by the business case assessment. Inter-professional trust was perceived to be a key barrier to initiation of collaborative care however was able to be overcome quickly upon commencement of a collaborative care relationship. Optometrists perceived that collaborative care was beneficial to all involved, including patients, ophthalmologists, optometrists, and health payers. There was a perception of a growing divide between clinical and retail optometry, which was thought by most participants to be appropriate. CONCLUSION: This study is the first to explore the feasibility and business case for community-based optometrists to provide collaborative glaucoma care in Australia. Our findings show that current public funding is insufficient to justify the business case to private optometry practice, despite being perceived by optometrists as beneficial to all involved.

Comparison of the influence of alcohol and cannabis on the dynamics of the accommodative response.

PURPOSE: To assess and compare the changes produced by the two most commonly used substances, alcohol and cannabis, on accommodation dynamics. METHODS: A total of 38 young participants (19 females) were enrolled in the study. They were assigned to two groups: a cannabis group (N = 19) and an alcohol group. Participants in the cannabis group underwent two randomized sessions: a baseline session and a session after smoking a cigarette. Participants in the alcohol group underwent three randomized sessions: a baseline session, a session after the intake of 300 ml of red wine (Alcohol 1), and other after the ingestion of 450 ml of wine (Alcohol 2). For the accommodation assessment, the open-field autorefractor WAM-5500 was used. RESULTS: The decrease of the mean velocity of the accommodative response produced by Alcohol 2 condition was significantly greater than that observed for Alcohol 1 and Cannabis (p = 0.046). The direction of the accommodation (near-distance and distance-near) had no effect on the deterioration of the accommodation dynamics following substance use. The target distance had a significant effect on the decrease of the mean velocity following substance use (p = 0.002). The decrease of the amplitude of the accommodative response was associated with a decrease of the peak velocity (p = 0.004) and the increase of the accommodative lag (p < 0.001). CONCLUSIONS: A moderate-high dose of alcohol impairs accommodation dynamics to a greater extent that lower dose of alcohol or smoked cannabis. The deterioration of the accommodation mean speed was higher for a shorter target distance.

Virtual Reality for Vision Science.

Virtual reality (VR) allows us to create visual stimuli that are both immersive and reactive. VR provides many new opportunities in vision science. In particular, it allows us to present wide field-of-view, immersive visual stimuli; for observers to actively explore the environments that we create; and for us to understand how visual information is used in the control of behaviour. In contrast with traditional psychophysical experiments, VR provides much greater flexibility in creating environments and tasks that are more closely aligned with our everyday experience. These benefits of VR are of particular value in developing our theories of the behavioural goals of the visual system and explaining how visual information is processed to achieve these goals. The use of VR in vision science presents a number of technical challenges, relating to how the available software and hardware limit our ability to accurately specify the visual information that defines our virtual environments and the interpretation of data gathered in experiments with a freely moving observer in a responsive environment.

Geographic access to eye health services in Aotearoa New Zealand: which communities are being left behind?

CLINICAL RELEVANCE: Efforts to provide accessible eye care must consider the extent to which travel-distance may be a barrier for some communities. BACKGROUND: This study aimed to determine the distribution of - and geographic access to - eye health services in Aotearoa New Zealand. We further sought to identify communities who might benefit from provision of eye health services that were more geographically accessible. METHODS: We obtained addresses of optometry and ophthalmology clinics from regulatory bodies and augmented this with online searches. Address locators were created using a Land Information dataset and geocoded using ArcGIS 10.6. A national population was derived using Statistics New Zealand's Integrated Data Infrastructure. We generated population-weighted centroids of each of New Zealand's 50,938 meshblocks and calculated the travel distance along the road network between each clinic and population (meshblock centroid). The proportion of the population living >50 km from each clinic type was calculated; as was the median, inter-quartile range and maximum distance across area-level deprivation quintiles in each district. RESULTS: A national population of 4.88 million was identified, as were addresses for 344 optometry, 46 public ophthalmology and 90 private ophthalmology clinics. Nationally and within each district, travel distance to optometry was shorter than to either type of ophthalmology clinic. The region of Northland - with a high proportion of the population Maori and in the highest quintile of area-level deprivation - had the furthest average distance to travel to optometry and public ophthalmology, while the West Coast region on the South Island had the farthest to travel to private ophthalmology. Several communities were identified where longer distances intersected with higher area-level deprivation. CONCLUSION: Most New Zealanders live within 10 km of eye health services. However, to achieve equitable eye health, strategies are required that make affordable eye health services accessible to communities for whom large travel distances intersect with high deprivation.

The paediatric optometry alignment program - a model of interprofessional collaborative eyecare.

CLINICAL RELEVANCE: Collaboration  between hospital-based ophthalmology and community-based optometry could pave the way to improve access to paediatric eyecare services. BACKGROUND: The Paediatric Optometry Alignment Program (POAP) began in 2016 as a proof-of-concept pilot project that aimed to improve access to specialist paediatric ophthalmology services. If found to be effective at improving patient access, and the quality of care acceptable to patients and professionals then the strategic intent was to upscale the programme to  serve as a model for paediatric eye care in the community. METHODS: Temporal observational trend analysis was used to review ophthalmology clinic appointment waitlists prior and post POAP pilot project commencement. Family satisfaction with post-discharge care was surveyed in a purposive sample of 30 patients.  Aligned optometrists in the program pilot (n = 97) were invited to complete an online survey (response rate 46%; n = 45). RESULTS: The percentage of children waiting longer than clinically recommended fell from 72% to 36%. Sixty-seven percent  of surveyed families had attended a community optometrist as recommended, and all rated the optometry experience from good to excellent.  Participating optometrists reported high levels of satisfaction with involvement in the program, and increased confidence and involvement in paediatric eye care delivery. The need to improve formal transfer  of clinical information was identified. CONCLUSION: Facilitated integrated care between community-based optometrists and a hospital-based ophthalmology department can improve access for tertiary care services, with high satisfaction for families and participating community-based optometrists.

Expanding the scope of an eConsult service: acceptability and feasibility of an optometry-ophthalmology pilot project.

OBJECTIVE: To determine the feasibility and acceptability of connecting optometrists to ophthalmologists on an eConsult service. DESIGN: Descriptive analysis of utilization data and an anonymous survey. PARTICIPANTS: All eConsult cases sent by optometrists between March 2019 and February 2020 (utilization data); optometrists and ophthalmologists participating in the eConsult Vision Pilot Project (survey). METHODS: Utilization data for the study period were collected automatically and underwent descriptive analysis. Participating optometrists and ophthalmologists received an email invitation to a survey assessing the project. RESULTS: Thirteen optometrists from 5 clinics in the southeast region and 7 ophthalmologists were recruited to participate in the pilot project. Optometrists sent 109 eConsults in a 13-month period, representing 33% of all cases submitted to ophthalmology through the eConsult service provincially (March 2019-March 2020). Sixty-eight percent of respondents to an anonymous online survey valued the recruitment and engagement of eye care professionals from the same health region. The influence of the eConsult service was reported to have a "somewhat positive" (27%) to "very positive" (50%) influence on the relationship between the two professional groups. CONCLUSION: The eConsult Vision Pilot Project fills a gap in service and provides an opportunity for patients to get access to specialty advice. We demonstrated that allowing optometrists to solicit specialist advice from ophthalmologists was acceptable and feasible.

Optometry research in Spain: Topics of interest, institutions and investigators.

PURPOSE: To determine the institutions, journals of choice and topics of investigation of the most prolific and highly cited Spanish optometrist researchers. METHODS: As a primary search strategy, the Scopus database (Elsevier) was queried with the terms (optometr* OR "contact lens*" OR refracti* OR *ocular) and the affiliation country filter "Spain". The list of authors returned by the primary search was used in a secondary manual search based on co-authors and institutions. Authors were included in the analysis if they had an h-index > 10, were of Spanish nationality, were affiliated to Spanish institutions, and possessed an optometry degree. Authors were ranked by h-index, number of publications and number of citations. Topics of research interest and target journals were determined by analyzing the 10 most highly cited papers of each author. RESULTS: A total of 32 authors with an h-index > 10 were identified, of whom 14 (43.7%) were female. Only one author had an h-index > 40, and 7 (21.9%) authors had an h-index over 20. The Journal of Cataract and Refractive Surgery was the first journal of choice (19.1% of highest cited papers), followed by Optometry and Vision Science (10.3%). The Universidad Complutense de Madrid hosted the largest percentage of authors (18.7%), followed by the Universitat de València (15.6%). Main topics of research interest were topography (6.5% of papers), cornea (6.2%) and contact lens (5.0%). CONCLUSION: Optometry in Spain is a fertile field of research, with an increasing number of highly cited authors publishing in high impact journals.