Comprehensive insights into a decade-long journey: The evolution, impact, and human factors of an asynchronous telemedicine program for diabetic retinopathy screening in Pennsylvania, United States.

Diabetic Retinopathy stands as a leading cause of irreversible blindness, necessitating frequent examinations, especially in the early stages where effective treatments are available. However, current examination rates vary widely, ranging from 25-60%. This study scrutinizes the Point-of-Care Diabetic Retinopathy Examination Program at the University of Pittsburgh/UPMC, delving into its composition, evolution, challenges, solutions, and improvement opportunities. Employing a narrative approach, insights are gathered from key stakeholders, including ophthalmologists and staff from primary care clinics. A quantitative analysis from 2008 to 2020 provides a comprehensive overview of program outcomes, covering 94 primary care offices with 51 retinal cameras. Program components feature automated non-mydriatic 45° retinal cameras, a dedicated coordinator, rigorous training, and standardized workflows. Over this period, the program conducted 21,960 exams in 16,458 unique individuals, revealing a diverse population with an average age of 58.5 and a balanced gender distribution. Average body mass index (33.96±8.02 kg/m2) and hemoglobin A1c (7.58%±1.88%) surpassed normal ranges, indicating prevalent risk factors for diabetes-related complications. Notably, 24.2% of patients underwent more than one exam, emphasizing program engagement. Findings indicated that 86.3% of exams were gradable, with 59.0% within normal limits, 12.1% showing some evidence of diabetic retinopathy, and 6.4% exhibiting vision-threatening diabetic retinopathy. Follow-up appointments with ophthalmologists were recommended in 31.5% of exams due to indeterminate results, positive diabetic retinopathy (≥moderate or macular exudate), or other findings like age-related macular degeneration or suspected glaucoma. The program demonstrated high reproducibility across diverse healthcare settings, featuring a sustainable model with minimal camera downtime, standardized workflows, and financial support from grants, health systems, and clinical revenues. Despite COVID-19 pandemic challenges, this research emphasizes the program's reproducibility, user-friendly evolution, and promising outcomes. Beyond technical contributions, it highlights human factors influencing program success. Future research could explore adherence to follow-up ophthalmological recommendations and its associated factors.

Predictors of Clinic Attendance After Community-Based Vision Screening.

Purpose: The purpose of this study was to analyze appointment attendance rates and patient characteristics associated with follow-up adherence after referral from a community vision screening event. Methods: A retrospective chart review of patients who attended a 2021 or 2022 community vision screening event and were referred to the university clinic for further care. Appointments were offered without charge and scheduled at the event. Associations between patients' clinical and demographic characteristics and appointment attendance were assessed by binary logistical regression. Results: A total of 935 patients attended the annual community vision screening events held in 2021 and 2022. Of these patients, 117 (13%) were referred to the clinic for follow-up, of whom 56 (48%) attended their scheduled follow-up appointment. The most common reasons for clinic referral included cataract (12, 10%), diabetic retinopathy (11, 9%), glaucoma (9, 8%), and challenging refractive error (9, 8%). Health insurance and male gender were predictors of follow-up (odds ratio [OR] = 3.08, 95% confidence interval [CI] = 1.19-7.99, P = 0.021 and OR = 2.72, 95% CI = 1.10-6.61, P = 0.035, respectively). Conclusions: Half of the referred patients followed up after vision screening. Providing appointment scheduling at the point of care and offering follow-up care at no cost may help to promote clinic follow-up, but further assessment of barriers to regular eye care is warranted. Health insurance most strongly predicted successful clinic attendance. Translational Relevance: This study emphasizes the enduring impact of health insurance status as a barrier to accessing comprehensive vision care.

Challenges in posterior uveitis-tips and tricks for the retina specialist.

PURPOSE: Posterior uveitis is a common chorioretinal pathology affecting all ages worldwide and is a frequent reason for referral to the retina clinic. The spectrum of etiologies for uveitis is very broad and includes infectious and auto-immune diseases. Inflammation can be confined to the eye or may be a part of systemic disease. A useful outline is therefore proposed to aid in the correct diagnosis of these challenging entities. The situation is further complicated by the fact that many neoplastic conditions resemble features of posterior uveitis; they are known as "masqueraders of uveitis". Here, we summarize different posterior uveitides that present with rare findings, along with masqueraders that can be difficult to distinguish. These conditions pose a diagnostic dilemma resulting in delay in treatment because of diagnostic uncertainty. METHODS: An extensive literature search was performed on the MEDLINE/PUBMED, EBSCO and Cochrane CENTRAL databases from January 1985 to January 2022 for original studies and reviews of predetermined diagnoses that include posterior uveitic entities, panuveitis and masquerade syndromes. RESULTS: We described conditions that can present as mimickers of posterior uveitis (i.e., immune check-points inhibitors and Vogt-Koyanagi-Harada-like uveitis; leukemia and lymphoma associated posterior uveitis), inflammatory conditions that present as mimickers of retinal diseases (i.e., Purtscher-like retinopathy as a presentation of systemic lupus erythematosus; central serous chorioretinopathy masquerading inflammatory exudative retinal detachment), and uveitic conditions with rare and diagnostically challenging etiologies (i.e., paradoxical inflammatory effects of anti-TNF-α; post vaccination uveitis; ocular inflammation after intravitreal injection of antiangiogenic drugs). CONCLUSION: This review of unique posterior uveitis cases highlights the overlapping features of posterior uveitis (paradoxical inflammatory effects of anti -TNF α and uveitis; Purtscher-like retinopathy as a presentation of systemic lupus erythematosus, …) and the nature of retinal conditions (ischemic ocular syndrome, or central retinal vein occlusion, amyloidosis, inherited conditions like retinitis pigmentosa, autosomal dominant neovascular inflammatory vitreoretinopathy (ADNIV), etc.…) that may mimic them is represented. Careful review of past uveitis history, current medications and recent vaccinations, detailed examination of signs of past or present inflammation, eventually genetic testing and/ or multimodal retinal imaging (like fluorescein angiography, EDI-OCT, OCT-angiography for lupus Purtscher-like retinopathy evaluation, or ICG for central serous retinopathy, or retinal amyloid angiopathy) may aid in correct diagnosis.

Choroidal Mass in a Patient with Undiagnosed Pulmonary Langerhans' Cell Histiocytosis.

BACKGROUND: Langerhan cell histiocytosis (LCH), although not a common cause, should be kept in the differential diagnosis for a patient that presents with a choroidal mass. CASE PRESENTATION: A 28-year-old female presented with a 4-day history of vision loss and associated pain in her right eye. EXAMINATION AND INVESTIGATIONS: A dilated fundus examination revealed a deep subretinal, orange, mottled lesion with associated serous retinal detachment. Ultrasonography demonstrated a solid mass at the posterior pole. Fluorescein angiography revealed corresponding, small, punctate, hyperfluorescent areas with leakage and pooling in the late phase outlining the subretinal fluid. Optical coherence tomography confirmed the choroidal elevation and subretinal fluid. In addition to starting oral steroids for addressing the patient's acute symptoms, a metastatic workup was ordered due to the lesion's appearance. Diagnosis: Computed tomography (CT) of the chest showed nodular lesions and subsequent lung biopsy was S-100 and CD1a positive, diagnostic of Langerhan's cell histiocytosis (LCH). TREATMENT AND OUTCOME: The patient was treated with six cycles of vinblastine and prednisolone therapy followed with a subsequent taper of steroids. Complete resolution of signs and symptoms was noted. DISCUSSION: A review of all reported cases of ophthalmic LCH with or without choroidal involvement was conducted. Diagnostic and therapeutic approaches described in these reportshave been summarized in the current manuscript. This case highlights the importance of pursuing a systemic workup in patients with uveal mass lesions. LCH should be considered in the differential of every choroidal mass.

Association Between Parental Leave and Ophthalmology Resident Physician Performance.

Importance: Although parental leave is essential in enhancing resident wellness and fostering inclusive workplace environments, residents may often feel discouraged from using parental leave owing to perceived stigma and concerns about possible negative effects on their training. Objective: To examine parental leave usage across multiple institutions and compare residency performance metrics between residents who took parental leave vs their peers who did not take leave. Design, Setting, and Participants: This was a retrospective cross-sectional analysis conducted from April 1, 2020, to July 28, 2022, of educational records. Multicenter data were obtained from 10 Accreditation Council for Graduate Medical Education (ACGME)-accredited ophthalmology programs across the US. Included ophthalmology residents graduated between 2015 and 2019. Data were analyzed from August 15, 2021, to July 25, 2022. Exposures: Performance metrics of residents who used parental leave during residency were compared with those of residents who did not take parental leave. Main Outcomes and Measures: Measures of performance included the Ophthalmic Knowledge Assessment Program (OKAP) scores, ACGME milestones scores, board examination pass rates, research activity, and surgical volumes. Results: Of the 283 ophthalmology residents (149 male [52.7%]) included in the study, 44 (15.5%) took a median (IQR) parental leave of 4.5 (2-6) weeks. There were no differences in average OKAP percentiles, research activity, average ACGME milestones scores, or surgical volume between residents who took parental leave and those who did not. Residents who pursued fellowship were less likely to have taken parental leave (odds ratio [OR], 0.43; 95% CI, 0.27-0.68; P < .001), and residents who practiced in private settings after residency were more likely to have taken parental leave (OR, 3.56; 95% CI, 1.79-7.08; P < .001). When stratified by sex, no differences were identified in performance between female residents who took parental leave compared with residents who did not take leave, except a mild surgical number difference in 1 subspecialty category of keratorefractive procedures (difference in median values, -2; 95% CI, -3.7 to -0.3; P = .03). Conclusions and Relevance: In this multicenter cross-sectional study, no differences in performance metrics were identified between residents taking parental leave compared with their peers. These findings may provide reassurance to trainees and program directors regarding the unlikelihood, on average, that taking adequate parental leave will affect performance metrics adversely.

Characteristics associated with barriers to eye care: A cross-sectional survey at a free vision screening event.

INTRODUCTION: Social determinants of health can limit access to regular eye care, but their role in ophthalmology is underexamined. The purpose of this study is to assess the relationship between patient characteristics and self-reported barriers to eye care. METHODS: This anonymous, cross-sectional survey was conducted at a two-day free eye clinic event in Pittsburgh, Pennsylvania. Adult patients presenting for vision screening were eligible to participate. Patient characteristics (demographics, health status) and self-reported barriers to eye care were collected. Predictors of barriers to eye care were analyzed using binary logistic regression. RESULTS: Of 269 eligible, consecutive patients approached for survey completion, 183 comprised the volunteer sample. The 183 participants (105 female patients [59%]) had a mean (standard deviation) age of 53 (15) years, and generally self-identified as Black (74, 46%) or White (67, 41%). While a third reported having no health insurance (60, 34%), the remaining two-thirds of participants had public (84, 48%) or private coverage (34, 19%). Three-quarters of respondents reported at least one barrier to receiving regular eye care (136, 76%), most commonly medical costs (89, 50%) and insurance issues (73, 41%). Not having health insurance or vision insurance was strongly associated with reporting at least one barrier to care (OR 5.00, p=0.002, and OR 7.46, p<0.001, respectively). Those with self-reported eye disease were more likely to report transportation difficulties (OR 4.45, p=0.013), and employed participants reported difficulty getting time off work to attend eye exams (OR 7.73, p=0.002). Finally, compared to Black race, White race was associated with a higher likelihood of reporting any barrier to care (OR 2.79, p=0.013). CONCLUSION: Three-quarters of vision screening attendees reported at least one barrier to regular eye care, most commonly medical costs and insurance.

A Novel Approach to Teaching Fundoscopy Using a Virtual Format.

Introduction: Ophthalmology education has been underemphasized in medical school curricula despite the fact that patient eye-related complaints are commonplace across primary care specialties. Although previous curricula used direct ophthalmoscopy to teach medical students the fundamentals of ophthalmic examination, there has been a growing call to teach these fundamentals through reading fundus photos due to the increasing prevalence and decreased costs of fundus cameras in primary care settings. We developed a virtual workshop to teach ophthalmoscopy to medical students using fundus photography. Methods: First-year medical students were enrolled in a 2-hour, synchronous, virtual ophthalmoscopy workshop as part of an advanced physical exam curriculum at the University of Pittsburgh School of Medicine. Students participated in a pretest, introductory lecture, interactive small-group session, and posttest. Breakout groups were led by senior medical students or residents. We compared pre- and posttest results for improved understanding of concepts covered in the workshop. Results: Of 147 students, the average scores on the pretest and posttest were 39% and 75%, respectively (p < .01). Students were significantly more confident in their ability to identify various pathologies on fundus photography. After the workshop, the student preceptors indicated increased comfort in a teaching role and greater interest in medical education. The preceptors were also more confident in their own ability to interpret fundus photography and in their understanding of various ocular pathologies. Discussion: Our virtual, interactive workshop is effective in teaching medical students a systematic approach to the interpretation of fundus photographs.

Prevalence of diabetic retinopathy and self-reported barriers to eye care among patients with diabetes in the emergency department: the diabetic retinopathy screening in the emergency department (DRS-ED) study.

BACKGROUND: Screening for diabetic retinopathy (DR) is suboptimal, and patients with diabetes who present to the emergency department (ED) may be at particularly high risk of undiagnosed DR. The purpose of this study is to determine the prevalence of DR among diabetic patients who present to the ED of our tertiary medical center using teleophthalmology and to assess self-reported barriers to eye care. METHODS: This cross-sectional, single-institution study recruited clinically stable diabetic patients who presented to the ED during daytime hours over 29 total weekdays across 2 months in 2018 and 2019. Participants had nonmydriatic, 45-degree, single-field digital retinal photographs taken on site (Digital Retinal System, Centervue). Following retinal imaging, participants then completed a survey about barriers to regular eye care and their acceptance of potential interventions to promote screening. Digital retinal photographs were interpreted remotely by a board-certified ophthalmologist and communicated to participants' primary care physician and/or endocrinologist. RESULTS: Over the study period, 275 ED patients had a documented diagnosis of diabetes, of whom 167 were deemed clinically stable for the study and 141 were invited to participate. Sixty-four were enrolled, of whom 50 had gradable-quality fundus images (78%). Of these 50 patients, almost all had type 2 diabetes (47, 94%), with an average disease duration of 12 ± 9 years and mean hemoglobin A1c of 8.1 ± 2.0% (mmol/mol). Based on fundus photography, 14 patients (28%) were diagnosed with DR, which was newly diagnosed for 10 (20% of the total study population). Severity was most commonly mild or moderate (12/14, 86%), with 1 case of severe nonproliferative DR and 1 proliferative DR. The majority (26, 52%) reported at least one barrier to routine eye care in our self-administered survey, of which having too many appointments (6, 12%) and cost (5, 10%) were frequently cited as most important. The majority were receptive to interventions to promote DR screening, including reminder phone calls (29, 58%) and text messages (28, 56%). CONCLUSIONS: Digital fundus photography in the ED detected a high rate of undiagnosed DR. Half of participants reported barriers to routine care, and most were receptive to messaging interventions to schedule an eye exam. Future studies are warranted to assess scalability of ED-based screening programs and their follow-through rates.

Screening for Ocular Candidiasis Among Patients With Candidemia: Is It Time to Change Practice?

Ocular candidiasis (OC) complicates approximately 10% of candidemia and carries potentially severe morbidity. There are conflicting recommendations about the need for routine funduscopic examinations of candidemic patients. Indirect funduscopy is accurate and safe in diagnosing OC, and positive findings change recommended treatment. However, conclusive evidence that treatment changes improve outcomes is lacking. Bringing perspectives as infectious diseases physicians and ophthalmologists, we review controversies about OC and endorse routine screening during candidemia. We acknowledge difficulties in obtaining inpatient ophthalmologic consults and recommend studies to evaluate digital fundus photography and teleophthalmology as an alternative to funduscopic examinations by ophthalmologists in asymptomatic patients.

Accuracy Assessment of Outpatient Telemedicine Encounters at an Academic Ophthalmology Department.

Purpose We assess the clinical accuracy of direct-to-patient real-time outpatient video visit encounters at our eye center. Design This was a retrospective longitudinal study. Subjects and Methods Patients who completed a video visit over a 3-week period between March and April 2020 were included. Accuracy assessment was determined by comparing diagnosis and management from the video visit with subsequent in-person follow-up over the next year. Results A total of 210 patients (mean age 55±18 years) were included, of whom 172 (82%) were recommended a scheduled in-person follow-up encounter after their video visit. Among the 141 total patients who completed in-person follow-up, 137 (97%) had a diagnostic agreement between telemedicine and in-person evaluation. Management plan agreed for 116 (82%), with the remainder of visits either escalating or deescalating treatment upon in-person follow-up with little substantive change. Compared with established patients, new patients had higher diagnostic disagreement following video visits (12 vs. 1%, p =0.014). Acute visits trended toward more diagnostic disagreement compared with routine visits (6 vs. 1%, p =0.28) but had a similar rate of management change on follow-up (21 vs. 16%, p =0.48). New patients were more likely to have early unplanned follow-up than established patients (17 vs. 5%, p =0.029), and acute video visits were associated with unplanned early in-person assessments compared with routine video visits (13 vs. 3%, p =0.027). There were no serious adverse events associated with the use of our telemedicine program in the outpatient setting. Conclusions Video visits had high diagnostic and management agreement with subsequent in-person follow-up encounters.

Predictive Factors of Research Productivity among Ophthalmology Residents: A Benchmark Analysis.

Introduction Positive and negative associations between prior publications and future research productivity is described in other fields, but no such analysis exists for ophthalmology. We conducted a study to determine characteristics of residents exhibiting research productivity during residency. Methods Using San Francisco Match and Program Web sites, a roster of ophthalmology residents in 2019 to 2020 was compiled, and publication data was collected via PubMed and Google Scholar on a random sample of 100 third-year residents. Results The median number of publications generated by ophthalmology residents before residency is 2 (range 0-13). Thirty-seven, 23, and 40 residents had zero, one, and two or more papers published during residency, respectively, with a median of 1 (range 0-14). On univariate analysis, compared with residents who published zero or one paper, those who published ≥ 2 were more likely to have more preresidency publications (odds ratio [OR] 1.30; p = 0.005), attend a top-25 ranked residency program by multiple metrics including Doximity reputation (OR 4.92; p < 0.001), and have attended a top-25 ranked medical school program by U.S. News and World Report (OR 3.24; p = 0.03). However, on adjusted analyses, the only factor that remained significant for predicting publications in residency was whether the residency program attended was top 25 ranked (OR 3.54; p = 0.009). Discussion/Conclusion With the advent of the United States Medical Licensing Examination Step 1 pass/fail system, greater emphasis will be placed on other metrics, including research. This is the first benchmark analysis examining factors predictive of publication productivity in ophthalmology residents. Our study suggests that the residency program attended, not the medical school attended or prior publication history, plays an influential role in the number of publications produced during residency, highlighting the importance of factors to support research on the institutional level, such as mentorship and funding, rather than historical factors in research productivity by the resident.

Look beyond the retinopathy: The incidental finding of a brain tumour.

We report the case of a 33-year-old woman who was found to have optic-nerve head swelling on fundus photographs obtained for telemedicine diabetic retinopathy screening. The patient was found to have a large vestibular schwannoma on brain imaging. This case shows the added benefit of implementing timely changes in management in response to significant incidental findings on tele-ophthalmology diabetic retinopathy screening, which can lead to potentially life- and vision-saving interventions.

Review of the Current Literature and Our Experience on the Value of OCT-angiography in White Dot Syndromes.

PURPOSE: To describe the application of OCT-A in various posterior uveitis disorders in our experience and to compare it with the available literature. METHODS: Eighteen eyes with the diagnoses of multifocal choroiditis (MFC), multifocal placoid pigment epitheliopathy (APMPPE), multiple evanescent white dot syndrome (MEWDS), tuberculous serpiginous-like choroiditis (SLC), serpiginous choroiditis (SC), and birdshot chorioretinopathy (BSCR) were studied. RESULTS: We found flow void of the choriocapillaris in patients with APMPPE, SC, MFC, BSCR, and in SLC. In contrast, perfusion of the choriocapillaris seemed normal in patients with MEWDS. CONCLUSIONS: We confirmed that OCT-A contributes new information on the physiopathology of white dot syndromes and inflammatory chorioretinopathies, notably on whether or not the choriocapillaris is involved. Comparing the OCT-A features allowed us to suggest that both APMPPE and SLC might be part of the same spectrum of inflammatory disease with primary involvement at the level of the choriocapillaris and secondary RPE damage.

The Use of Mobile Messaging for Telecommunications with Patients in Ophthalmology: A Systematic Review.

Introduction: Communication and concordance between patients and providers are crucial for improved outcomes and disease prevention. Mobile health strategies have been shown to improve patient accessibility and convenience. Mobile messaging is one strategy that has demonstrated varying degrees of effectiveness in patient care. The aim of this review is to investigate methods, outcomes, and conclusions of studies that have assessed mobile messaging interventions in ophthalmology. Methods: A qualitative systematic review of PubMed, Scopus, Web of Science, and Embase databases was conducted to identify studies that investigated the implementation and efficacy of mobile messaging services in ophthalmology practice. Included articles were categorized based on study content: appointment attendance, patient preference and willingness, education, concordance, and other clinical outcomes. Three tools were used to assess for potential bias. Results: Out of a total of 3,655 unique titles retrieved, 15 articles were included in the final qualitative synthesis after abstract and full-text screening. Included studies were published between 2008 and 2020 from seven different countries and across various contexts. All but one study found that the use of mobile messaging in ophthalmology care led to improved process measures or patient outcomes. Evidence for a positive effect was the strongest for appointment follow-up. Survey and feedback data suggest that patients, more so younger patients, are open to mobile message interventions. Conclusion: Mobile messaging interventions can play a role in improving appointment attendance, patient education, and patient practices for ophthalmology patients. Further study is necessary to determine the effectiveness of this tool across various groups and settings.

Initial Results and Patient Survey of Virtual Inpatient Ophthalmology Consultations During the COVID-19 Pandemic.

Purpose: To examine the uptake, results, and patient assessment of virtual inpatient ophthalmology consultations at our academic medical center during the COVID-19 pandemic.Design: Retrospective review, pre and post COVID analysis, and teleophthalmology patient survey in the inpatient and emergency setting.Participants: Adult patients at our medical center for whom ophthalmology consultation was requested from February 24 through April 19, 2020.Methods: Patient encounters were retrieved and coded for all inpatient and emergency room ophthalmology consultations over a 4-week period before and a 4-week period after our department first offered virtual ophthalmology consultations. Theseconsultations took place over real-time video, audio, or photography between the on-call ophthalmologist and the patient and/or patient's primary physician. A four-item questionnaire was offered to patients who completed a virtual consultation.Main Outcome Measures: Virtual consultation diagnoses and management outcomes; patient assessment of virtual inpatient and emergent ophthalmic care.Results: Of all 423 included encounters, 258 (61%) occurred during the 4 weeks before offering virtual consultations and 165 (39%) encounters occurred during the subsequent 4-week period, indicating a 36% decrease in ophthalmology consultations over this pandemic period. A total of 120 (28%) encounters were conducted remotely during the 8-week period. In-person emergency department (ED) encounters (as percent of total encounters) decreased from 60% to 36% (p < .01) between the first and eighth weeks of the study period. In the 4 weeks since their implementation, virtual inpatient ophthalmology consultations were utilized in 34 of 165 (21%) consultations. Of those, 20 (59%) were high acuity and 1 (3%) was escalated to the ED for in-person evaluation. Most common management decisions made included medication prescription in 46 (55%) patients and scheduling follow-up for 44 (30%) patients. In a survey administered to all 120 patients who were managed over phone or video, 56 (47%) responded. Respondents were in general agreement (Cronbach's alpha = 0.92) and expressed satisfaction with phone and virtual encounters. Specifically, 42 (49%) of 86 patients who had phone encounters noted a mean weighted satisfaction score of 4.6 out of 5 and 14 (41%) responders of 34 virtual consultation encounters noted a mean weighted satisfaction score of 4.9 out of 5. The difference between the average weighted satisfaction scores favored virtual consultation over telephone encounters (p < .01).Conclusions: Virtual inpatient ophthalmology consultations are feasible and have reported high patient satisfaction. Implementing video-based technologies to deliver high-acuity ophthalmic triage and management may help to promote patient and provider safety. In our experience, patients favored virtual consultation over telephone encounters.

A Required Ophthalmology Rotation: Providing Medical Students with a Foundation in Eye-Related Diagnoses and Management.

Introduction: Current ophthalmologic training in medical school is inadequate in preparing medical students to handle basic eye complaints as nonophthalmology residents. Most medical students are uncomfortable performing eye examinations, but increased ophthalmology training improves confidence in this area. The University of Pittsburgh School of Medicine (UPSOM) teaches students the basics of ophthalmology with a required 1-week rotation during the 1-month specialty care clerkship (SCC), providing students with skills to perform rudimentary eye examinations as nonophthalmology providers. Methods: Within a 1-week ophthalmology rotation, we developed a series of interactive case-based teaching sessions, handouts, and homework that accompanied clinical instruction to familiarize third- and fourth-year medical students with ophthalmic equipment, terminology, diagnosis, and management. Of learners, 67 (roughly 11 per cohort) rotated on six consecutive SCCs beginning in May 2019. All learners completed an in-house exam and received resident clinical evaluations at the end of their rotation. Results: Of the 64 participants who responded to the survey, 100% rated the quality of teaching sessions outstanding or good, and 83% of students strongly agreed or agreed with the statement, "I believe the overall teaching in the ophthalmology clinical settings was good quality." The average clinical and exam score for ophthalmology over 6 months was 4.5 out of 5, and 83% respectively. Discussion: Generally positive student feedback as well as high clinical and exam scores suggested that the required UPSOM ophthalmology clerkship was both engaging and effective. This course can be easily adapted to teach students at other medical institutions.

Crowdsourced Assessment of Surgical Skill Proficiency in Cataract Surgery.

OBJECTIVE: To test whether crowdsourced lay raters can accurately assess cataract surgical skills. DESIGN: Two-armed study: independent cross-sectional and longitudinal cohorts. SETTING: Washington University Department of Ophthalmology. PARTICIPANTS AND METHODS: Sixteen cataract surgeons with varying experience levels submitted cataract surgery videos to be graded by 5 experts and 300+ crowdworkers masked to surgeon experience. Cross-sectional study: 50 videos from surgeons ranging from first-year resident to attending physician, pooled by years of training. Longitudinal study: 28 videos obtained at regular intervals as residents progressed through 180 cases. Surgical skill was graded using the modified Objective Structured Assessment of Technical Skill (mOSATS). Main outcome measures were overall technical performance, reliability indices, and correlation between expert and crowd mean scores. RESULTS: Experts demonstrated high interrater reliability and accurately predicted training level, establishing construct validity for the modified OSATS. Crowd scores were correlated with (r = 0.865, p < 0.0001) but consistently higher than expert scores for first, second, and third-year residents (p < 0.0001, paired t-test). Longer surgery duration negatively correlated with training level (r = -0.855, p < 0.0001) and expert score (r = -0.927, p < 0.0001). The longitudinal dataset reproduced cross-sectional study findings for crowd and expert comparisons. A regression equation transforming crowd score plus video length into expert score was derived from the cross-sectional dataset (r2 = 0.92) and demonstrated excellent predictive modeling when applied to the independent longitudinal dataset (r2 = 0.80). A group of student raters who had edited the cataract videos also graded them, producing scores that more closely approximated experts than the crowd. CONCLUSIONS: Crowdsourced rankings correlated with expert scores, but were not equivalent; crowd scores overestimated technical competency, especially for novice surgeons. A novel approach of adjusting crowd scores with surgery duration generated a more accurate predictive model for surgical skill. More studies are needed before crowdsourcing can be reliably used for assessing surgical proficiency.

The Ophthalmology Mini-Elective Gives Vision to Preclinical Medical Students.

Introduction: Ophthalmology education during medical school is often very limited. To provide exposure to areas beyond its standard curriculum, the University of Pittsburgh School of Medicine offers mini-elective courses in various disciplines. We developed such a course to provide instruction in the basics of clinical ophthalmology to interested preclinical medical students. Methods: First- and second-year medical students electively enrolled in our course (mean number of students per year = 12), which included four sessions combining didactics and hands-on learning. Additionally, each student individually spent time with an ophthalmologist in the operating room. Our course was held each year from 2015 to 2019. Results: Participants completed pre- (n = 25) and postsurveys (n = 20), reflecting increased comfort with the ophthalmologic history and physical examination. In 2019, participants also completed pre- and posttests, demonstrating increased knowledge of ophthalmology. Discussion: The Ophthalmology Mini-Elective is a unique educational tool that introduces the principles of ophthalmology to preclinical medical students, addressing an area of medicine that is generally minimally included in the required curriculum.