Optimizing topical drop efficacy with proper eyelid positioning.

Purpose: To report the observation that the efficacy of topical glaucoma treatment improved after surgical correction of ectropion in a 71-year-old male with a known history of glaucoma. Observations: The patient initially presented for tearing and lid malposition and was found to have bilateral elevated intraocular pressures (IOP) in addition to bilateral lower eyelid ectropion. IOP control was initially prioritized over ectropion repair, with IOP remaining elevated despite topical glaucoma treatment and selective laser trabeculoplasty. Sequential unilateral ectropion repair was then carried out, with topical glaucoma treatment resumed after the first repair. It was observed that the IOP improved with topical glaucoma treatment on each side after ectropion repair, despite no changes to medications nor dosing. Conclusions and importance: The efficacy of topical glaucoma treatment is dependent on drop availability and absorption. While recent efforts to increase drop efficacy have been focused on engineering formulations that increase retention or corneal penetration, our case highlights that in selected glaucoma patients, correction of lid malposition may serve as an effective way to improve drop efficacy.

Craniofacial Surgery Fellowship Selection Criteria: A National Program Director Survey.

BACKGROUND: Candidate characteristics for craniofacial fellowship training still remain unknown, as no data are available in the literature. This study aims to provide information on the criteria that are used to select and rank applicants for the craniofacial surgery fellowship match. METHOD: A 38-question survey was sent in April 2015 to all craniofacial surgery fellowship program directors (n = 29) involved in the US match using QuestionPro Survey Software. The survey investigated factors used for selection of applicants, including medical school, residency training, research experience, fellowship interview, and candidate characteristics. A 5-point Likert scale was used to grade 33 factors from "not at all important" (1) to "essential in making my decision" (5); or for 5 controversial factors from "very negative impact" (1) to "very positive impact in making my decision" (5). RESULTS: A total of 62% (18 out of 29) of responses were received from craniofacial surgery program directors. The most important factors were professionalism and ethics (4.7 ±â€Š0.5), perceived commitment to craniofacial surgery (4.6 ±â€Š0.8), interactions with faculty and staff (4.5 ±â€Š0.5), interpersonal skills (4.5 ±â€Š0.5), and overall interview performance (4.4 ±â€Š0.6). Factors that have a negative impact on the selection process include graduation from a nonplastic surgery residency program (1.9 ±â€Š0.7) or a non-US plastic surgery residency program (2.2 ±â€Š0.6), and visa requirement (2.2 ±â€Š0.5). CONCLUSION: This study provides data on craniofacial surgery program directors' perception on the criteria important for fellowship applicant selection. It is our hope that program directors, residency programs, and applicants find this data useful as they prepare for the craniofacial fellowship match.

Microsurgery Fellowship Selection Criteria: A National Program Director Survey.

Background Desirable candidate characteristics for microsurgery fellowship applicants still remain unclear, as no data are available in the literature. This study aims to provide information on the criteria that are used to select and rank applicants for the microsurgery fellowship match. Methods A 38-question survey was sent in April 2015 to all microsurgery fellowship directors (n = 36) involved in the U.S. match, using QuestionPro Software. The survey investigated various factors used for selection of applicants, including medical school, residency training, research experience, fellowship interview, and candidate characteristics. A 5-point Likert scale was used to grade 33 influential factors from 1 ("not at all important in making my decision") to 5 ("essential in making my decision"), or for 5 controversial factors from 1 ("very negative impact in making my decision") to 5 ("very positive impact in making my decision"). Results A total of 53% (19 out of 36) of responses were received from microsurgery fellowship directors. The most important factors included letters of recommendations by microsurgeons (4.6 ± 0.5), interactions with faculty (4.6 ± 0.5), overall interview performance in the selection process (4.6 ± 0.5), and professionalism and ethics (4.4 ± 0.7). Factors that had a negative impact on the selection process included graduate from a non-U.S. plastic surgery residency program (2.1 ± 0.9), graduate needing a visa (2.3 ± 0.8), and graduate from a foreign medical school (2.4 ± 1.0). Conclusion This study provides data on the microsurgery fellowship directors' perception of the criteria important for applicant selection and shows that the most valued criteria are letters of recommendation, interactions with faculty, and interview performance.