Analysis of Sex Diversity Trends Among Ophthalmology Match Applicants, Residents, and Clinical Faculty.

IMPORTANCE: The proportion of women in the field of ophthalmology in the US trails the proportion of women in the general population. Sex diversity trends have been studied in other specialties, but there is a dearth of such literature in ophthalmology. OBJECTIVE: To investigate trends in the proportion of female ophthalmology match applicants, residents, and clinical faculty. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study examined data from the San Francisco Match, the Association of University Professors of Ophthalmology, Accreditation Council for Graduate Medical Education, Association of American Medical Colleges, and American Academy of Ophthalmology (AAO) from January 1, 2011, to December 31, 2019. Data from ophthalmology match applicants, residents, clinical faculty at US medical schools, and AAO members were collected. MAIN OUTCOMES AND MEASURES: The proportion of female applicants, residents, and medical school clinical faculty in ophthalmology. RESULTS: Data were obtained from a total of 2807 ophthalmology applicants (35.3% female), 1 004 563 residents (43.8% female), 463 079 clinical faculty members (42.5% female), and 78 968 AAO members (26.1% female). Male ophthalmology residency applicants outnumbered female applicants by a ratio of 1.6:1 from 2016 to 2019. The percentage of female matched applicants in 2016 (41% [168/406]) and 2019 (42% [184/436]) differed by 1% (percent change, 0.99; 95% CI, -1.12 to 3.1; P = .36). There was a 2.3% increase (percent change, 0.34; 95% CI, 0.24-0.43; P < .001) in the percentage of female residents across all surgical specialties from 2011 (39.7% [8710/21 985]) to 2019 (42% [10 951/26 082]) but a 2.5% decrease (percent change, -0.45; 95% CI, -0.84 to -0.06; P = .02) in the percentage of female residents in ophthalmology from 2011 (41.5% [589/1419]) to 2019 (39% [575/1473]). The percentage of female ophthalmology clinical faculty differed by 2% (percent change, 1.02; 95% CI, -0.21 to 2.24; P = .10) from 2017 (38% [1179/3102]) to 2019 (40% [1225/3060]). From 2016 to 2019, male practicing ophthalmologists in the AAO outnumbered female practicing ophthalmologists by a ratio of 3:1. CONCLUSIONS AND RELEVANCE: This study found that the percentage of women in the field of ophthalmology remains lower than percentages in other specialties, and the percentage of female ophthalmology residents has decreased in recent years. More efforts are needed to improve female representation in ophthalmology.

Progress Towards Parity: Female Representation in the American Society of Ophthalmic Plastic and Reconstructive Surgery.

PURPOSE: To report female representation within the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) at all levels of career achievement over 50 years. METHODS: Data were extrapolated from published ASOPRS directories and the 50th anniversary booklet. Fellowship, membership, leadership, and awards data were evaluated over 5 decades. Comparisons were made between the first and second 25 years, proportions of early and late career achievements, and time to career progression between males and females. RESULTS: During the first decade, 5.6% of ASOPRS fellows were female (n = 2), which rose to 6.6% (n = 8), 17.6% (n = 32), 22.4% (n = 35), and 39.4% (n = 97) in the second, third, fourth, and fifth decades, respectively. These patterns were echoed in ASOPRS membership. When comparing the first half (1969-1994) to the second half (1995-2018), fellowship (10.5% vs. 30.0%, p < 0.001), membership (8.0% vs. 30.3%, p < 0.001), early career awards (5.6% vs. 28.9%, p = 0.047), program directorship (0.0% vs. 15.7%, p = 0.017), and executive committee female representation (4.5% vs. 16.8%, p < 0.001) increased significantly. However, females were proportionally underrepresented as program directors (p = 0.003), late career award winners (p = 0.001), executive committee members (p < 0.001), and presidents (p = 0.020). Among those reaching leadership positions, females took longer than males to become program directors by a median of 4 years (p = 0.025). CONCLUSIONS: There has been a steady increase in female representation in ASOPRS fellowship training and membership. While significant progress has been made, growth in female leadership and award recognition is still needed.

Ophthalmic malpractice and physician gender: a claims data analysis (an American Ophthalmological Society thesis).

PURPOSE: To analyze and compare malpractice claims rates between male and female ophthalmologists and test the hypothesis that claims rates are equal between the two sexes. METHODS: A retrospective, cohort study review was made of all claims reported to the Ophthalmic Mutual Insurance Company from January 1990 through December 2008 in which an expense (including indemnity and/or legal defense costs) was paid or reserved. A total of 2,251 claims were examined. Frequency (claims per physician) and severity (indemnity payment, associated expenses and reserves per claim) were analyzed for both male and female ophthalmologists. Frequency and severity data were further stratified by allegation, type of treatment, and injury severity category. RESULTS: Men were sued 54% more often than females over the period studied (P<.001). Women had lower claims frequencies across all allegations and within the treatment areas of cataract, cornea, and retinal procedures (P<.7). Men had more claims associated with severe injury, including permanent major injury and death (P<.001). The average amount paid in indemnity and expenses was 7% higher for claims against women ($115,303 compared to $107,354 against men). CONCLUSIONS: Nearly 20 years of closed claim data reveal male ophthalmologists are significantly more likely than women to have reported malpractice activity. Claims against men were associated with more severe injury to the patient but were slightly less costly overall compared to claims against women. Further study is necessary to understand the reasons underlying gender disparities in malpractice claims rates and whether the observed past differences are predictive of future results.

Castleman's disease in the orbit of a 17-year-old girl: a case report.

Castleman's disease is an atypical lympho proliferative disorder comprising hyaline vascular elements, plasma cells, or a mixture of both, which can present in unicentric or multicentric fashion. Resection of unicentric lesions is typically curative, but multicentric disease, also characterized by constitutional symptoms and a poorer prognosis, often requires treatment with chemotherapy, radiation, steroids, or immune modulators. Castleman's disease is rarely diagnosed in the orbit. The authors present the clinical and histopathological findings of a 17-year-old who was found to have a focal lesion in her orbit. She was successfully treated with surgical resection and was free of disease recurrence or other sequelae at 10-months follow up.

Eyelid eversion for visualisation of the upper eyelid lamellae: an anatomical cadaver study.

Controversy persists in surgical eyelid anatomy despite the routine use of microanatomical examination in modern eyelid research. The aim of our study was to facilitate visualisation of upper eyelid anatomy by optimising the orientation of cadaveric specimens. We studied the anatomy of everted eyelids, providing an excellent histological view of the posterior approach to the eyelid commonly used in surgery. Non-traumatic separation of the eyelid lamellae provides a new view of the eyelid's lamellar nature. Further application of this model may enhance understanding of the multilayered aspect of the levator aponeurosis. The technique may improve intraoperative understanding of critical eyelid anatomy and promote safer and more effective eyelid surgery.

Müller muscle conjunctival resection for blepharoptosis in patients with poor to fair levator function.

It has been suggested that Müller muscle conjunctival resection might not be a good procedure for the treatment of blepharoptosis in patients with less than optimal levator function. This case series includes four eyelids (three patients) that had fair preoperative levator function (4 to 8 mm) and good response to phenylephrine. The mean preoperative levator function was 6.25 mm and the mean amount of resection was 10.25 mm. The mean preoperative marginal reflex distance was -0.50 mm and the mean postoperative marginal reflex distance was 3.38 mm. Müller muscle conjunctival resection may be effective for treating patients with fair levator function and satisfactory response to phenylephrine.

Müller muscle-conjunctiva resection for blepharoptosis in patients with glaucoma filtering blebs.

PURPOSE: To study the safety and efficacy of Müller muscle-conjunctiva resection (MMCR) for blepharoptosis in patients with functional glaucoma-filtering blebs. METHODS: Retrospective chart review of patients who underwent MMCR in the presence of a functioning filtering bleb. Patients offered MMCR all responded satisfactorily to preoperative topical phenylephrine hydrochloride testing. Using a similar technique, MMCR was performed by 6 surgeons at 6 different centers. Two patients had simultaneous upper blepharoplasty. Postoperative slit lamp examination was performed to assess for bleb injury or infection. In addition, all patients had routine glaucoma follow-up visits to assess for bleb functioning. RESULTS: Nine patients with functional filtering blebs tolerated MMCR well and had no bleb complications. All blebs remained functional after surgery. One patient had anterior chamber reaction for 10 days and another patient had foreign body sensation for 6 weeks. At 9.2-months mean follow-up time, the mean change in margin reflex distance-1 was 2.9 mm. CONCLUSION: MMCR may be safe and effective in the setting of a glaucoma-filtering bleb.