Neovascular Age-Related Macular Degeneration in a Predominantly Black Population.

BACKGROUND AND OBJECTIVE: We intend to study the characteristics and outcomes of an understudied patient population with neovascular age-related macular degeneration (nAMD). PATIENTS AND METHODS: This retrospective study evaluated presenting features and outcomes in a predominantly Black patient population with nAMD. A multivariate regression explored baseline characteristics predictive of 1-year vision. RESULTS: Sixty-three eyes were included. The median (interquartile range) baseline vision was 20/300 (20/80 to counting fingers). Patients' baseline optical coherence tomography findings showed a mean central subfield thickness of 336 µm; 80% (n = 35) and 41% (n = 18) had fluid and central scarring, respectively. The primary predictor for vision at year-one was baseline vision (P = 0.03, 95% CI: 0.04 to 0.91). All of those who gained ≥ 3 lines of vision lacked central scarring at baseline. CONCLUSION: Further studies are needed to investigate how to improve earlier detection and treatment of nAMD in this patient population. [Ophthalmic Surg Lasers Imaging Retina 2023;54:580-584.].

Impact of Gap Years Following Medical School Graduation on Resident Research Productivity in Ophthalmology.

Background Gap years following medical school graduation have become more common, but research into their tangible career benefit is lacking. Examining the impact of gap years on resident scholarly productivity in ophthalmology may provide insight generalizable to all specialties. Objective To evaluate whether a gap year following medical school graduation significantly predicts scholarly productivity during ophthalmology residency. Methods In December 2021, residents were recorded from 110 publicly available American ophthalmology residency program webpages. They were included if educational history was listed on publicly accessible academic and social media profiles. Residents were then stratified into gap year and nongap year cohorts. Publication data were recorded from Scopus and PubMed. Pearson's chi-square, independent sample t -tests, and multivariable regression were performed. Results A total of 1,206 residents were analyzed, with 1,036 (85.9%) residents taking no gap year and 170 (14.1%) residents with at least one gap year. Gap year residents were predicted to have increase in the likelihoods of publishing at least one, two, or five total articles during residency, in addition to at least one article in a high-impact journal. There was no significant relationship between gap years and publications with senior authors affiliated with either the resident's medical school or residency program. Conclusion Residents taking gap years following graduation may publish more during residency, but these publications are not associated with senior authors at their institutions. Future investigations should continue to evaluate the significance of gap years in medical education.

TEMPORAL EFFICACY AND STERILITY TESTING OF POVIDONE-IODINE FROM AN OPEN BOTTLE.

PURPOSE: To investigate the temporal efficacy and sterility of povidone-iodine (PI) against bacteria associated with postinjection endophthalmitis in an in vitro study. METHODS: A single PI bottle was opened and tested for sterility and antibacterial efficacy. Povidone-iodine from the open bottle was inoculated onto a blood agar plate and evaluated for growth 24 hours later to test sterility; this was repeated for five consecutive days. To test for antibacterial efficacy, PI was instilled onto the surface of plates of Staphylococcus , Streptococcus , Enterococcus , Pseudomonas , and Haemophilus species. The plates were then evaluated 24 hours later for a clear zone of inhibition (i.e., no growth) where the PI was placed. This process was repeated for five consecutive days. RESULTS: Sterility testing showed no growth of organisms on the blood agar plates for each of the five days of testing. For antibacterial efficacy testing, zones of inhibition of growth were seen on each plate of bacterial colonies only where PI was placed, for each of the five days of testing. CONCLUSION: In this study, PI from an open bottle maintained its sterility and antibacterial efficacy for five days. These data could help support repeated use of the same bottle, reducing waste and costs for retina practices.

Erratum: Virtual Ophthalmology Rotation for Visiting Medical Students: An Opportunity to Enhance Diversity in the Workforce.

[This corrects the article DOI: 10.1055/s-0043-1760831.].

Virtual Ophthalmology Rotation for Visiting Medical Students: An Opportunity to Enhance Diversity in the Workforce.

Introduction We created a virtual rotation to facilitate the exposure of ophthalmology to medical students and serve as a pilot program to help attract students from under-represented in medicine (URM) backgrounds. In addition to the rotation eliminating the financial burdens associated with in-person away rotations, we offered a not-for-credit (i.e., drop-in) option that included sessions outside the typical clinic hours. This option reduced scheduling conflicts as a barrier to enrollment and allowed junior medical students and postgraduates to participate and hopefully further develop an interest in ophthalmology. Methods Before the rotation, participants completed a pre-test and a survey to collect data on learners' backgrounds and interest in applying for ophthalmology residency. The rotation included live lectures, case-based discussions, chart reviews, and guided self-study. Following the rotation, participants completed a post-test and a survey to query applicants on the online rotation's utility and delivery. Results Eleven learners enrolled in the course and completed the prerotation survey and test. Approximately one-third (4/11; 36%) were URM students and two-thirds (7/11; 64%) were female. All responded they were planning to apply for ophthalmology residency. All responded they strongly agreed that the rotation increased their general knowledge in ophthalmology, and 89% (9/11) strongly agreed that it improved their ability to diagnose and manage actual patients. Nearly all (7/8; 87.5%) strongly agreed the rotation provided the opportunity to seek support for the residency application process, and all found the online platform reliable and easy to access. Exam scores improved significantly from pre- to post-tests (60 vs. 79%; p < 0.01). Conclusions The rotation attracted a substantial proportion of URM students. Learners reported that the virtual rotation effectively taught and supported their endeavors to become ophthalmologists. Virtual rotations for visiting students can reduce barriers such as travel, financial costs, and time constraints that might otherwise hinder exposure to specialty training that is not offered or is underrepresented at students' home institutions. Increasing exposure and offering mentorship through this novel platform deserves further study to enhance diversity and inclusion in medicine.

Emergency Department Presentation of Retinal Artery Occlusion.

PURPOSE: To determine how frequently patients who present to an emergency department (ED) with a retinal artery occlusion (RAO) undergo brain imaging and cardiovascular testing and are hospitalized. DESIGN: Retrospective cross-sectional study. PARTICIPANTS: Patients who presented to an ED with an RAO in the National Emergency Department Sample (NEDS), a nationally representative United States database. METHODS: The NEDS was queried to identify patients who presented to an ED with the primary diagnosis of RAO between 2006 and 2014. Patient and hospital characteristics were evaluated, and a multivariable regression was performed to determine predictors of hospitalization. Testing was categorized into 3 groups: (1) brain imaging performed using computed tomography or magnetic resonance; (2) carotid imaging performed using ultrasound, computed tomography, or magnetic resonance; and (3) cardiac testing performed using electrocardiogram or echocardiogram. The number of tests performed for each category was recorded. MAIN OUTCOME MEASURES: Proportions of patients undergoing brain imaging, carotid imaging, or cardiac testing. Rate and predictors of hospitalization. RESULTS: Among 259 343 582 ED visits, 2802 had a primary diagnosis of RAO. Patients were mostly aged ≥65 years (59%) and male (54%). Hypertension (59%), dyslipidemia (36%), and diabetes (20%) were the most common preexisting cardiovascular diseases. Brain imaging, carotid imaging, and cardiac testing were performed in 20.3%, 7.1%, and 23.8% of the patients, respectively; at least 1 test from each of these 3 categories was performed in 4.1% of the patients. Half of the patients were hospitalized. Factors that increased the chances of hospitalization included the following (P < 0.05): age of <45 years; female sex; a history of smoking; presenting to a metropolitan hospital and having giant cell arteritis, carotid artery disease, atrial fibrillation, cardiac valve disease, obesity, dyslipidemia, hypertension, diabetes, and chronic ischemic heart disease. CONCLUSIONS: Most patients who presented to an ED with an RAO did not receive emergency brain imaging, carotid imaging, or basic cardiac testing. A multidisciplinary approach is needed to raise awareness that RAOs should be treated as a precursor of stroke or a stroke equivalent.

Applicants' choice of an ophthalmology residency program.

OBJECTIVE: To determine the factors most important to applicants when selecting an ophthalmology residency program. DESIGN: Cross-sectional survey. PARTICIPANTS: All 595 applicants who submitted a rank list to the Ophthalmology Residency Matching Program for the 2012 match. METHODS: Participants anonymously completed a 25-item questionnaire after the submission of their rank lists. A multiple-choice format and ordinal scale were used to query applicants on demographics, career plans, and the importance of factors related to program characteristics. One question allowed a free text response to identify factors that caused the applicant to rank a program lower than other programs or not at all (i.e., "red flag"). MAIN OUTCOME MEASURES: Factors important to applicants when creating their rank lists. RESULTS: The response rate was 37% (218/595). The 3 most important factors affecting rank lists were resident-faculty relationships, clinical and surgical volume, and diversity of training. The fourth most important was the interview experience with faculty; poor interview experience was the most frequently cited "red flag." Age, gender, and marital status did not affect how applicants rated factors. Applicants planning a post-residency fellowship or an academic career placed greater importance on opportunities for resident research and a program's prestige (P<0.0001). Female and ethnic minority applicants placed greater importance on the diversity of faculty and residents by gender or ethnicity (P<0.0001). CONCLUSIONS: Applicants rated educational and interpersonal factors as more important than geographic factors when selecting an ophthalmology residency program. Future career plans and demographic factors influenced the rating of specific factors. The results of this study provide a useful resource to programs preparing for the match.

Enucleation and evisceration: 20 years of experience.

OBJECTIVE: To determine the indications, relative frequencies, surgical times, and complications for enucleation and evisceration performed at a single academic center. METHODS: Medical records of all patients who underwent an enucleation or evisceration between January 1st, 1990 and December 31st, 2009 at a single academic center were reviewed. Patient demographics and surgical indications, times, and complications were recorded. RESULTS: A total of 85 eyes in 85 patients underwent enucleation (n = 31; 36%) or evisceration (n = 54; 64%) during the study period. Almost all patients were of African descent (96%). The most common underlying cause leading to eye removal was trauma. On average, eviscerations (47.3 ± 10.3 minutes) took significantly less time to perform than enucleations (89.6 ± 10.1 minutes; p < 0.01). Complications included implant exposure, infection, lower lid laxity, fornix insufficiency, and need for subsequent surgery; the occurrence of these complications was found to be similar between the two groups (p = 0.77). No case of sympathetic ophthalmia or inadvertent evisceration of an eye with an occult intraocular malignancy was noted. From the first decade for which data were available (1990- 1999) to the second decade (2000- 2009), the average number of enucleations decreased (p = 0.02) and the average number of eviscerations (p = 0.04) increased. CONCLUSION: Evisceration was found to be a safe and quicker alternative to enucleation in our study. A change in surgical preference from enucleation to evisceration was seen during the 20-year study period.

Ophthalmology Residency Match outcomes for 2011.

PURPOSE: To determine the match rate and predictors of matching into an ophthalmology residency. DESIGN: Population-based, cross-sectional study. PARTICIPANTS: All 746 candidates who submitted an application for the 2011 ophthalmology residency match. METHODS: The Ophthalmology Residency Matching Program applicant database was reviewed to determine applicant characteristics and match outcomes. For US seniors, multivariate regression analysis was performed to determine predictors of matching. MAIN OUTCOME MEASURES: Match rate and predictors of US seniors matching. RESULTS: Rank lists were submitted by 622 applicants, among whom 458 (74%) matched. The match rate was higher for US seniors (83%) than for independent applicants (41%; P < 0.001). US seniors who matched were more likely to be Alpha Omega Alpha medical honor society members (odds ratio [OR], 2.94; 95% confidence interval [CI], 1.16-7.29), to attend medical schools ranked in the top 40 according to National Institutes of Health funding (OR, 2.25; CI, 1.14-4.43), and to have ranked more programs (OR, 1.44; CI, 1.29-1.60). Those ranking 6 to 10 programs had an 80% to 90% chance of matching, and those ranking more than 10 programs had a greater than 90% chance of matching. No clear benefit was observed by ranking additional programs once 11 had already been ranked. Average US Medical Licensing Examination Step 1 scores were 239 ± 14 and 223 ± 18 for applicants who were matched and unmatched, respectively; this difference was significant by univariate analysis (P < 0.001) but not by multivariate regression (P = 0.163). CONCLUSIONS: Ophthalmology ranks among the most competitive specialties in medicine. Those most likely to match were US seniors who maintained academic excellence beginning in their preclinical years. A finite relationship exists between ranking a greater number of programs and having a greater chance of matching.

Rapidly fatal nasal natural killer/T-cell lymphoma: orbital and ocular adnexal presentations.

Nasal natural killer/T-cell lymphoma (NKTL) is an aggressive malignancy that may initially present with orbital and/or ocular adnexal symptoms. We describe the case of a 27-year-old female with nasal NKTL, who initially presented with epiphora and died 4 months thereafter.

Adherence to topical glaucoma medication during hospitalization.

PURPOSE: To describe the patterns and predictors of adherence to topical glaucoma medication during hospitalization for medical disease. DESIGN: Retrospective, nonrandomized, and comparative case-series. METHODS: Medical records of all the patients hospitalized with a secondary diagnosis of glaucoma between January 2006 and March 2009 were reviewed. Baseline characteristics of all patients were recorded including sex, ethnicity, age, primary medical diagnosis, and the length of stay. The outpatient topical glaucoma medications known on admission and prescribed at the time of admission were recorded, and the numbers of outpatient and inpatient systemic medications were tracked. Adherence was defined as receiving more than 75% of the expected doses. The patient discharge instructions were also reviewed. RESULTS: Of the 184 patients included, 98 (53%) were female, 102 (55%) were African-American, and the mean age was 78.3 (±11.7) years old. The most common reason for hospitalization was cardiovascular disease and the median length of stay was 9.5 days. Adherence was achieved in 51.6% of patients. Knowing (P<0.01) and prescribing (P<0.01) the complete outpatient regimen upon admission was associated with adherence. Neither class of topical glaucoma medication nor the number of medications was associated with adherence. Doses were most commonly omitted owing to the failure to prescribe (72.3%). Discharge instructions correctly listed the outpatient regimen 54.3% of the time. CONCLUSION: Adherence to the topical glaucoma medications was suboptimal during hospitalization; this is likely related to the poor reporting of outpatient regimen upon admission. The effect of hospitalization may be a factor to consider in future studies of adherence and when evaluating glaucoma patients after hospitalization.

A ChIP-cloning approach linking SIRT1 to transcriptional modificationof DNA targets.

The mammalian protein deacetylase SIRT1 (sirtuin1) is widely recognized for its link to calorie restriction and longevity. SIRT1 not only modulates the function of protein targets such as p53 or NFkappaB, but it also affects gene transcription by causing hypoacetylation of associated nucleosomal histones. However, the identification of SIRT1-specific DNA targets that confer chromosomal stability and cell longevity have remained elusive. Here, we report the usefulness of a ChIP-cloning approach for the identification of an endogenous DNA target intimately linked with SIRT1 activity. Using the aforementioned technique, we identified a gene encoding the neuro-oncological ventral antigen2 (nova2) as a SIRT1 target. Nova2 regulates the alternative splicing of scn1a, which encodes the alpha-subunit of a neuronal sodium channel targeted by antiepileptic drugs. This finding demonstrates that ChIP-cloning is an innovative approach for the identification of SIRT1-specific DNA targets.

Presenting features suggestive for later recurrence of idiopathic sixth nerve paresis in children.

BACKGROUND: Although idiopathic sixth (abducens) nerve paresis of childhood typically resolves within a few months, the paresis recurs in a minority of cases. The purpose of this study is to describe clinical features at presentation that are associated with later recurrence. METHODS: Retrospective literature review and novel case report. RESULTS: Thirty-five articles were reviewed, revealing 54 nonrecurrent and 41 recurrent cases. One previously unreported recurrent case is also included in our review. Patients with recurrence were typically girls (p < 0.05) and were typically affected in the left eye (p < 0.05). All children who initially presented under 14 months of age and/or whose initial presentation was associated with vaccination developed recurrence. Seventy-three percent of second episodes occurred within one year of initial presentation. No children who initially presented after 12 years of age developed recurrence. CONCLUSIONS: When an otherwise normal child is diagnosed with idiopathic sixth nerve paresis, clinical features suggestive of later recurrence are female gender, left eye involvement, younger age, and recent vaccination. Recurrence is less likely if it has not occurred within one year of the initial event.