Performance of Automated Machine Learning in Predicting Outcomes of Pneumatic Retinopexy.

Purpose: Automated machine learning (AutoML) has emerged as a novel tool for medical professionals lacking coding experience, enabling them to develop predictive models for treatment outcomes. This study evaluated the performance of AutoML tools in developing models predicting the success of pneumatic retinopexy (PR) in treatment of rhegmatogenous retinal detachment (RRD). These models were then compared with custom models created by machine learning (ML) experts. Design: Retrospective multicenter study. Participants: Five hundred and thirty nine consecutive patients with primary RRD that underwent PR by a vitreoretinal fellow at 6 training hospitals between 2002 and 2022. Methods: We used 2 AutoML platforms: MATLAB Classification Learner and Google Cloud AutoML. Additional models were developed by computer scientists. We included patient demographics and baseline characteristics, including lens and macula status, RRD size, number and location of breaks, presence of vitreous hemorrhage and lattice degeneration, and physicians' experience. The dataset was split into a training (n = 483) and test set (n = 56). The training set, with a 2:1 success-to-failure ratio, was used to train the MATLAB models. Because Google Cloud AutoML requires a minimum of 1000 samples, the training set was tripled to create a new set with 1449 datapoints. Additionally, balanced datasets with a 1:1 success-to-failure ratio were created using Python. Main Outcome Measures: Single-procedure anatomic success rate, as predicted by the ML models. F2 scores and area under the receiver operating curve (AUROC) were used as primary metrics to compare models. Results: The best performing AutoML model (F2 score: 0.85; AUROC: 0.90; MATLAB), showed comparable performance to the custom model (0.92, 0.86) when trained on the balanced datasets. However, training the AutoML model with imbalanced data yielded misleadingly high AUROC (0.81) despite low F2-score (0.2) and sensitivity (0.17). Conclusions: We demonstrated the feasibility of using AutoML as an accessible tool for medical professionals to develop models from clinical data. Such models can ultimately aid in the clinical decision-making, contributing to better patient outcomes. However, outcomes can be misleading or unreliable if used naively. Limitations exist, particularly if datasets contain missing variables or are highly imbalanced. Proper model selection and data preprocessing can improve the reliability of AutoML tools. Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Research on re-searching: interrupted foraging is not disrupted foraging.

In classic visual search, observers typically search for the presence of a target in a scene or display. In foraging tasks, there may be multiple targets in the same display (or "patch"). Observers typically search for and collect these target items in one patch until they decide to leave that patch and move to the next one. This is a highly rule-governed behavior. The current study investigated whether these rules are disrupted when the foraging is interrupted in various manners. In Experiment 1, the foraging was briefly interrupted and then resumed in the same patch. In Experiments 2 and 3, the foraging in each patch either ended voluntarily or compulsorily after a fixed amount of time. In these cases, foraging resumed in a patch only after all patches were visited. Overall, the rules of foraging remained largely intact, though Experiment 2 shows that foraging rules can be overridden by the demand characteristics of the task. The results show that participants tended to perform approximately consistently despite interruptions. The results suggest that foraging behavior in a relatively simple foraging environment is resilient and not easily disrupted by interruption.

Errors in visual search: Are they stochastic or deterministic?

In any visual search task in the lab or in the world, observers will make errors. Those errors can be categorized as "deterministic": If you miss this target in this display once, you will definitely miss it again. Alternatively, errors can be "stochastic", occurring randomly with some probability from trial to trial. Researchers and practitioners have sought to reduce errors in visual search, but different types of errors might require different techniques for mitigation. To empirically categorize errors in a simple search task, our observers searched for the letter "T" among "L" distractors, with each display presented twice. When the letters were clearly visible (white letters on a gray background), the errors were almost completely stochastic (Exp 1). An error made on the first appearance of a display did not predict that an error would be made on the second appearance. When the visibility of the letters was manipulated (letters of different gray levels on a noisy background), the errors became a mix of stochastic and deterministic. Unsurprisingly, lower contrast targets produced more deterministic errors. (Exp 2). Using the stimuli of Exp 2, we tested whether errors could be reduced using cues that guided attention around the display but knew nothing about the content of that display (Exp3a, b). This had no effect, but cueing all item locations did succeed in reducing deterministic errors (Exp3c).

Toward viewing behavior for aerial scene categorization.

Previous work has demonstrated similarities and differences between aerial and terrestrial image viewing. Aerial scene categorization, a pivotal visual processing task for gathering geoinformation, heavily depends on rotation-invariant information. Aerial image-centered research has revealed effects of low-level features on performance of various aerial image interpretation tasks. However, there are fewer studies of viewing behavior for aerial scene categorization and of higher-level factors that might influence that categorization. In this paper, experienced subjects' eye movements were recorded while they were asked to categorize aerial scenes. A typical viewing center bias was observed. Eye movement patterns varied among categories. We explored the relationship of nine image statistics to observers' eye movements. Results showed that if the images were less homogeneous, and/or if they contained fewer or no salient diagnostic objects, viewing behavior became more exploratory. Higher- and object-level image statistics were predictive at both the image and scene category levels. Scanpaths were generally organized and small differences in scanpath randomness could be roughly captured by critical object saliency. Participants tended to fixate on critical objects. Image statistics included in this study showed rotational invariance. The results supported our hypothesis that the availability of diagnostic objects strongly influences eye movements in this task. In addition, this study provides supporting evidence for Loschky et al.'s (Journal of Vision, 15(6), 11, 2015) speculation that aerial scenes are categorized on the basis of image parts and individual objects. The findings were discussed in relation to theories of scene perception and their implications for automation development.

What is the basis of ensemble subset selection?

The visual system can rapidly calculate the ensemble statistics of a set of objects; for example, people can easily estimate an average size of apples on a tree. To accomplish this, it is not always useful to summarize all the visual information. If there are various types of objects, the visual system should select a relevant subset: only apples, not leaves and branches. Here, we ask what kind of visual information makes a "good" ensemble that can be selectively attended to provide an accurate summary estimate. We tested three candidate representations: basic features, preattentive object files, and full-fledged bound objects. In four experiments, we presented a target and several distractors' sets of differently colored objects. We found that conditions where a target ensemble had at least one unique color (basic feature) provided ensemble averaging performance comparable to the baseline displays without distractors. When the target subset was defined as a conjunction of two colors or color-shape partly shared with distractors (so that they could be differentiated only as preattentive object files), subset averaging was also possible but less accurate than in the baseline and feature conditions. Finally, performance was very poor when the target subset was defined by an exact feature relationship, such as in the spatial conjunction of two colors (spatially bound object). Overall, these results suggest that distinguishable features and, to a lesser degree, preattentive object files can serve as the representational basis of ensemble selection, while bound objects cannot.

Terms of debate: Consensus definitions to guide the scientific discourse on visual distraction.

Hypothesis-driven research rests on clearly articulated scientific theories. The building blocks for communicating these theories are scientific terms. Obviously, communication - and thus, scientific progress - is hampered if the meaning of these terms varies idiosyncratically across (sub)fields and even across individual researchers within the same subfield. We have formed an international group of experts representing various theoretical stances with the goal to homogenize the use of the terms that are most relevant to fundamental research on visual distraction in visual search. Our discussions revealed striking heterogeneity and we had to invest much time and effort to increase our mutual understanding of each other's use of central terms, which turned out to be strongly related to our respective theoretical positions. We present the outcomes of these discussions in a glossary and provide some context in several essays. Specifically, we explicate how central terms are used in the distraction literature and consensually sharpen their definitions in order to enable communication across theoretical standpoints. Where applicable, we also explain how the respective constructs can be measured. We believe that this novel type of adversarial collaboration can serve as a model for other fields of psychological research that strive to build a solid groundwork for theorizing and communicating by establishing a common language. For the field of visual distraction, the present paper should facilitate communication across theoretical standpoints and may serve as an introduction and reference text for newcomers.

Hybrid visual and memory search for scenes and objects with variable viewpoints.

In hybrid search, observers search visual arrays for any of several target types held in memory. The key finding in hybrid search is that response times (RTs) increase as a linear function of the number of items in a display (visual set size), but RTs increase linearly with the log of the memory set size. Previous experiments have shown this result for specific targets (find exactly this picture of a boot on a blank background) and for broad categorical targets (find any animal). Arguably, these are rather unnatural situations. In the real world, objects are parts of scenes and are seen from multiple viewpoints. The present experiments generalize the hybrid search findings to scenes (Experiment 1) and multiple viewpoints (Experiment 2). The results replicated the basic pattern of hybrid search results: RTs increased logarithmically with the number of scene photos/categories held in memory. Experiment 3 controls the experiment for which viewpoints were seen in an initial learning phase. The results replicate the findings of Experiment 2. Experiment 4 compares hybrid search for specific viewpoints, variable viewpoints, and categorical targets. Search difficulty increases from specific viewpoints to variable viewpoints and then to categorical targets. The results of the four experiments show the generality of logarithmic search through memory in hybrid search.

LONG-TERM USE OF ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION.

PURPOSE: Although pivotal trials have demonstrated efficacy of anti-vascular endothelial growth factor therapy in neovascular age-related macular degeneration, there is a paucity of clinical data about the long-term (>5 years) treatment. METHODS: Retrospective analysis of all patients with neovascular age-related macular degeneration who were actively treated, had received >40 anti-vascular endothelial growth factor injections, and were followed for ≥5 years. Snellen-corrected visual acuity, initial drug choice, and times elapsed between treatments were collected. Rates of endophthalmitis and outcomes of submacular hemorrhage were also evaluated. RESULTS: A total of 88 patients (162 eyes) met the inclusion criteria: the average patient age was 86.3 years with an average follow-up period of 7.6 years. The average total number of injections per eye was 69 (18.0 SD); a total of 11,208 injections were given throughout the study period, and 6 cases (0.05%) of endophthalmitis were observed. Overall, there was a clinical and statistical difference in average Snellen-corrected visual acuity at Injections #2,#3, #4, #5, #6, #10, and #20, as compared with baseline ( P = 0.03, P < 0.01, P = 0.02, P < 0.01, P = 0.01, P = 0.01, P < 0.01, respectively). Patients in the Snellen-corrected visual acuity subgroup 20/20 to 20/40 maintained vision until injection #30. Seven eyes experienced a visually significant submacular hemorrhage. CONCLUSION: This neovascular age-related macular degeneration cohort received on average eight anti-vascular endothelial growth factor injections per year for approximately 8 years; eyes with good (≥20/40) initial baseline vision maintained their visual acuity, whereas those with worse Snellen-corrected visual acuity (≤20/50) had a robust initial improvement that diminished with time. Most patients were maintained on the same initial drug of choice and the rate of endophthalmitis was low.

Surgical Management of Full-Thickness Macular Holes in Macular Telangiectasia Type 2: A Global Multicenter Study.

PURPOSE: To report on macular hole repair in macular telangiectasia type 2 (MacTel2). DESIGN: Global, multicenter, retrospective case series. PARTICIPANTS: Patients undergoing surgery for MacTel2-associated full-thickness macular hole (MTMH). METHODS: Standardized data collection sheet distributed to all surgeons. MAIN OUTCOME MEASURES: Anatomic closure and visual outcomes of MTMH. RESULTS: Sixty-three surgeries in 47 patients with MTMH were included from 30 surgeons. Mean age was 68.1 years, with 62% female, 72% White, 21% East or South Asian, 2% African American, and 2% Hispanic or Latino. Procedures included 34 internal limiting membrane (ILM) peeling alone, 22 ILM flaps, 5 autologous retinal transplantations (ARTs), 1 retinotomy, and 1 subretinal bleb. For ILM peeling, preoperative visual acuity (VA) was 0.667 ± 0.423 logarithm of the minimum angle of resolution (logMAR). Minimum hole diameter (MHD) was 305.5 ± 159.4 µm (range, 34-573 µm). Sixteen of 34 ILM peels (47%) resulted in MTMH closure. At postoperative month 6, VA was stable at 0.602 ± 0.516 logMAR (P = 0.65). VA improved by at least 2 lines in 43% and at least 4 lines in 24%. For ILM flaps, preoperative VA was 0.878 ± 0.552 logMAR. MHD was 440.8 ± 175.5 µm (range, 97-697 µm), which was significantly larger than for ILM peels (P < 0.01). Twenty of 22 ILM flaps (90%) resulted in MTMH closure, which was significantly higher than for ILM peels (P < 0.01). At postoperative month 6, VA improved to 0.555 ± 0.405 logMAR (P < 0.05). VA improved by at least 2 lines in 56% and at least 4 lines in 28%. For ARTs, preoperative VA was 1.460 ± 0.391 logMAR. MHD was 390.2 ± 203.7 µm (range, 132-687 µm). All 5 ARTs (100%) resulted in MTMH closure. At postoperative month 6, VA was stable at 1.000 ± 0.246 logMAR (P = 0.08). Visual acuity improved at least 2 lines in 25%. CONCLUSIONS: Surgical closure of macular holes improved VA in 57% of MTMHs. Internal limiting membrane flaps achieved better anatomic and functional outcomes than ILM peeling alone. Autologous retinal transplantation may be an option for refractory MTMHs. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

The real-world efficacy and safety of faricimab in neovascular age-related macular degeneration: the TRUCKEE study - 6 month results.

BACKGROUND/OBJECTIVE: Investigate real-world patients receiving faricimab for the treatment of neovascular age-related macular degeneration (nAMD). SUBJECTS/METHODS: Multicenter, retrospective chart review was conducted on patients treated with faricimab for nAMD from February 2022 to September 2022. Collected data includes background demographics, treatment history, best-corrected visual acuity (BCVA), anatomic changes, and adverse events as safety markers. The main outcome measures are changes in BCVA, changes in central subfield thickness (CST) and adverse events. Secondary outcome measures included treatment intervals and presence of retinal fluid. RESULTS: After one injection of faricimab, all eyes (n = 376), previously-treated (n = 337) and treatment-naïve (n = 39) eyes demonstrated a + 1.1 letter (p = 0.035), a + 0.7 letter (p = 0.196) and a + 4.9 letter (p = 0.076) improvement in BCVA, respectively, and a - 31.3 µM (p < 0.001), a - 25.3 µM (p < 0.001) and a - 84.5 µM (p < 0.001) reduction in CST, respectively. After three injections of faricimab, all eyes (n = 94), previously-treated (n = 81) and treatment-naïve (n = 13) eyes demonstrated a + 3.4 letter (p = 0.03), a + 2.7 letter (p = 0.045) and a + 8.1 letter (p = 0.437) improvement in BCVA, and a - 43.4 µM (p < 0.001), a - 38.1 µM (p < 0.001) and a - 80.1 µM (p < 0.204) reduction in CST, respectively. One case of intraocular inflammation was observed after four injections of faricimab and resolved with topical steroids. One case of infectious endophthalmitis was treated with intravitreal antibiotics and resolved. CONCLUSIONS: Faricimab has demonstrated improvement or maintenance of visual acuity for patients with nAMD, along with rapid improvement of anatomical parameters. It has been well-tolerated with low incidence of treatable intraocular inflammation. Future data will continue to investigate faricimab for real-world patients with nAMD.

Reliability of radiologists' first impression when interpreting a screening mammogram.

Previous studies showed that radiologists can detect the gist of an abnormality in a mammogram based on a half-second image presentation through global processing of screening mammograms. This study investigated the intra- and inter-observer reliability of the radiologists' initial impressions about the abnormality (or "gist signal"). It also examined if a subset of radiologists produced more reliable and accurate gist signals. Thirty-nine radiologists provided their initial impressions on two separate occasions, viewing each mammogram for half a second each time. The intra-class correlation (ICC) values showed poor to moderate intra-reader reliability. Only 13 radiologists had an ICC of 0.6 or above, which is considered the minimum standard for reliability, and only three radiologists had an ICC exceeding 0.7. The median value for the weighted Cohen's Kappa was 0.478 (interquartile range = 0.419-0.555). The Mann-Whitney U-test showed that the "Gist Experts", defined as those who outperformed others, had significantly higher ICC values (p = 0.002) and weighted Cohen's Kappa scores (p = 0.026). However, even for these experts, the intra-radiologist agreements were not strong, as an ICC of at least 0.75 indicates good reliability and the signal from none of the readers reached this level of reliability as determined by ICC values. The inter-reader reliability of the gist signal was poor, with an ICC score of 0.31 (CI = 0.26-0.37). The Fleiss Kappa score of 0.106 (CI = 0.105-0.106), indicating only slight inter-reader agreement, confirms the findings from the ICC analysis. The intra- and inter-reader reliability analysis showed that the radiologists' initial impressions are not reliable signals. In particular, the absence of an abnormal gist does not reliably signal a normal case, so radiologists should keep searching. This highlights the importance of "discovery scanning," or coarse screening to detect potential targets before ending the visual search.

How do people find pairs?

Humans continuously scan their visual environment for relevant information. Such visual search behavior has typically been studied with tasks in which the search goal is constant and well-defined, requiring relatively little interplay between memory and orienting. Here we studied a situation in which the target is not known in advance, and instead, memory needs to be dynamically updated during the actual search. Observers compared two simultaneously presented arrays of objects for any matching pair of items-a task that requires continuous comparisons between what is seen now and what was seen a few moments ago. To manipulate the balance between memorizing and scanning, we ran two versions of the task. In an eye-tracking version, the objects were continuously available and could be scanned with relative ease. The results suggested that observers preferred scanning over memorizing. In a mouse-tracking version, perceptual availability was limited, and scanning was slowed. Now observers substantially increased their memory use. Thus, the results revealed a flexible and dynamic interplay between memory and perception. The findings aid in further bridging the research fields of attention and memory. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Mirror blindness: Our failure to recognize the target in search for mirror-reversed shapes.

It is well known that visual search for a mirror target (i.e., a horizontally flipped item) is more difficult than search for other-oriented items (e.g., vertically flipped items). Previous studies have typically attributed costs of mirror search to early, attention-guiding processes but could not rule out contributions from later processes. In the present study we used eye tracking to distinguish between early, attention-guiding processes and later target identification processes. The results of four experiments revealed a marked human weakness in identifying mirror targets: Observers appear to frequently fail to classify a mirror target as a target on first fixation and to continue with search even after having directly looked at the target. Awareness measures corroborated that the location of a mirror target could not be reported above chance level after it had been fixated once. This mirror blindness effect explained a large proportion (45-87%) of the overall costs of mirror search, suggesting that part of the difficulties with mirror search are rooted in later, object identification processes (not attentional guidance). Mirror blindness was significantly reduced but not completely eliminated when both the target and non-targets were held constant, which shows that perfect top-down knowledge can reduce mirror blindness, without completely eliminating it. The finding that non-target certainty reduced mirror blindness suggests that object identification is not solely achieved by comparing a selected item to a target template. These results demonstrate that templates that guide search toward targets are not identical to the templates used to conclusively identify those targets.

Spatial and temporal massive memory in humans.

It is well known that humans have a massive memory for pictures and scenes.1,2,3,4 They show an ability to encode thousands of images with only a few seconds of exposure to each. In addition to this massive memory for "what" observers have seen, three experiments reported here show that observers have a "spatial massive memory" (SMM) for "where" stimuli have been seen and a "temporal massive memory" (TMM) for "when" stimuli have been seen. The positions in time and space for at least dozens of items can be reported with good, if not perfect accuracy. Previous work has suggested that there might be good memory for stimulus location,5,6 but there do not seem to have been concerted efforts to measure the extent of this memory. Moreover, in our method, observers are recalling where items were located and not merely recognizing the correct location. This is interesting because massive memory is sometimes thought to be limited to recognition tasks based on sense of familiarity.

27-GAUGE PARS PLANA/PLICATA VITRECTOMY FOR PEDIATRIC VITREORETINAL SURGERY.

PURPOSE: To report on the feasibility of 27-gauge (G) vitrectomy for pediatric patients. METHODS: This study is an international, multicenter, retrospective, interventional case series. Participants were patients 17 years or younger who underwent 27-G vitrectomy for various indications. RESULTS: The records of 56 eyes from 47 patients were reviewed. Mean age was 5.7 ± 5.2 years. Diagnoses included retinopathy of prematurity (Stages 3 with vitreous hemorrhage, 4A, 4B, and 5), Terson's syndrome, traumatic macular hole, posterior capsular opacification, endophthalmitis, and others. Instruments used were the 27-G infusion, 27-G vitreous cutter, 27-G light pipe, and 27-G internal limiting membrane forceps. Instrument bending was noted in one (1.8%) case. There were no cases with intraoperative complications, infusion issues, or postoperative endophthalmitis. There were 67/145 (46%) sclerotomies that required suturing, of which most (51/145) were sutured out of precaution. There were four cases (7.1%) that required conversion to a larger gauge and three cases (5.3%) that developed postoperative hypotony. Mean visual acuity improved from logarithm of the minimum angle of resolution 1.32 (20/420) to 0.72 (20/105), after a mean follow-up of 125.1 days (P = 0.01). Anatomic success was achieved in 96.4% of eyes after a single surgery. CONCLUSION: Twenty-seven-gauge vitrectomy was safe and feasible in selected pediatric vitreoretinopathies. Further studies are warranted to examine indications and outcomes.

INFUSION-ASSISTED EVACUATION OF SUBMACULAR HEMORRHAGE.

PURPOSE: To report a novel surgical technique for evacuating submacular hemorrhage using the infusion stream of a 25-gauge vitrectomy system. METHODS: Surgical case and video. RESULTS: A 54-year-old man was taken to the operating room for a total hyphema, nonclearing vitreous hemorrhage, and elevated intraocular pressure after multiple tractional retinal detachment repairs by an outside surgeon. Intraoperatively, the hyphema and vitreous hemorrhage were cleared, and the source of bleeding was discovered to be an avulsed vessel through a pre-existing retinal break just superior to the optic nerve. A large submacular hemorrhage was also present that was unable to be drained through the break by aspiration alone. With the vitreous cavity under fluid, the infusion cannula was manipulated to guide the infusion stream onto the macula. The stream was directed in a distal to proximal manner toward the retinal break, and the submacular blood was successfully expressed out through the break. Postoperatively, the retina remained attached with almost complete resolution of the submacular hemorrhage. CONCLUSION: Using the mechanical pressure of the infusion stream can be an effective method for evacuating large subretinal hemorrhages.

Taking prevalence effects on the road: Rare hazards are often missed.

Previous work has shown that, in many visual search and detection tasks, observers frequently miss rare but important targets, like weapons in bags or abnormalities in radiological images. These prior studies of the low-prevalence effect (LPE) use static stimuli and typically permitted observers to search at will. In contrast, many real-world tasks, like looking for dangerous behavior on the road, only afford observers a brief glimpse of a complex, changing scene before they must make a decision. Can the LPE be a factor in in dynamic, time-limited moments of real driving? To test this, we developed a novel hazard-detection task that preserves much of the perceptual richness and complexity of hazard detection in the real world, while allowing for experimental control over event prevalence. Observers viewed brief video clips of road scenes recorded from dashboard cameras and reported whether they saw a hazardous event. In separate sessions, the prevalence of these events was either high (50% of videos) or low (4%). Under low prevalence, observers missed hazards at more than twice the rate observed in the high-prevalence condition. Follow-up experiments demonstrate that this elevation of miss rate at low prevalence persists when participants were allowed to correct their responses, increases as hazards become increasingly rare (down to 1% prevalence) and is resistant to simple cognitive intervention (participant prebriefing). Together, our results demonstrate that the LPE generalizes to complex perceptual decisions in dynamic natural scenes, such as driving, where observers must monitor and respond to rare hazards.

What eye tracking can tell us about how radiologists use automated breast ultrasound.

Purpose: Automated breast ultrasound (ABUS) presents three-dimensional (3D) representations of the breast in the form of stacks of coronal and transverse plane images. ABUS is especially useful for the assessment of dense breasts. Here, we present the first eye tracking data showing how radiologists search and evaluate ABUS cases. Approach: Twelve readers evaluated single-breast cases in 20-min sessions. Positive findings were present in 56% of the evaluated cases. Eye position and the currently visible coronal and transverse slice were tracked, allowing for reconstruction of 3D "scanpaths." Results: Individual readers had consistent search strategies. Most readers had strategies that involved examination of all available images. Overall accuracy was 0.74 (sensitivity = 0.66 and specificity = 0.84). The 20 false negative errors across all readers can be classified using Kundel's (1978) taxonomy: 17 are "decision" errors (readers found the target but misclassified it as normal or benign). There was one recognition error and two "search" errors. This is an unusually high proportion of decision errors. Readers spent essentially the same proportion of time viewing coronal and transverse images, regardless of whether the case was positive or negative, correct or incorrect. Readers tended to use a "scanner" strategy when viewing coronal images and a "driller" strategy when viewing transverse images. Conclusions: These results suggest that ABUS errors are more likely to be errors of interpretation than of search. Further research could determine if readers' exploration of all images is useful or if, in some negative cases, search of transverse images is redundant following a search of coronal images.

How private equity achieves return on investment in ophthalmology.

PURPOSE OF REVIEW: To review how private equity entities generate profit for investors and ophthalmologists. RECENT FINDINGS: There is a preponderance of private equity acquisitions and consolidation in ophthalmology. These private equity entities generate revenue by growth, profit improvement, and efficient use of capital structure. Physician partners sell their revenue and assets to a private equity entity while retaining a percentage of future profit. In general, a greater percentage going forward, will result in a smaller initial buyout. Partners typically receive payment in the form of cash and stock in the private equity entity, aligning incentives of both parties to grow and succeed. Junior associates and future partners typically do not benefit from the cash buyout but might have opportunity to buy shares in the private equity entity. SUMMARY: The ophthalmology job market has changed significantly with the rise in private equity. Private equity investors profit from organic growth, economies of scale, and future revenue of ophthalmology practices. Ophthalmology partners benefit from often sizeable buyouts and potentially profitable shares in the private equity entity. Junior and future ophthalmologist may be less likely to succeed financially compared with their contemporaries. Some private equity entities will thrive and other may fail, particularly if they are unable to attract talented new ophthalmologists.