Social Media in Neuro-Ophthalmology: Paradigms, Opportunities, and Strategies.

BACKGROUND: Social media (SoMe) is an integral part of life in the 21st century. Its potential for rapid dissemination and amplification of information offers opportunities for neuro-ophthalmologists to have an outsized voice to share expert-level knowledge with the public, other medical professionals, policymakers, and trainees. However, there are also potential pitfalls, because SoMe may spread incorrect or misleading information. Understanding and using SoMe enables neuro-ophthalmologists to influence and educate that would otherwise be limited by workforce shortages. EVIDENCE ACQUISITION: A PubMed search for the terms "social media" AND "neuro-ophthalmology," "social media" AND "ophthalmology," and "social media" AND "neurology" was performed. RESULTS: Seventy-two neurology articles, 70 ophthalmology articles, and 3 neuro-ophthalmology articles were analyzed. A large proportion of the articles were published in the last 3 years (2020, 2021, 2022). Most articles were analyses of SoMe content; other domains included engagement analysis such as Altmetric analysis, utilization survey, advisory opinion/commentary, literature review, and other. SoMe has been used in medicine to share and recruit for scientific research, medical education, advocacy, mentorship and medical professional networking, and branding, marketing, practice building, and influencing. The American Academy of Neurology, American Academy of Ophthalmology, and North American Neuro-Ophthalmology Society have developed guidelines on the use of SoMe. CONCLUSIONS: Neuro-ophthalmologists may benefit greatly from harnessing SoMe for the purposes of academics, advocacy, networking, and marketing. Regularly creating appropriate professional SoMe content can enable the neuro-ophthalmologist to make a global impact.

Gender Authorship Trends in the Ophthalmic Plastic and Reconstructive Surgery Literature.

PURPOSE: Despite increasing numbers of women oculoplastic surgeons, they remain underrepresented within the subspecialty. The purpose of this study was to analyze trends in gender authorship within the field of ophthalmic plastic and reconstructive surgery. METHODS: This retrospective observational study sampled articles published in Ophthalmic Plastic and Reconstructive Surgery (OPRS) and Orbit during the years 1985, 1995, 2005, 2015, and 2020. Data reviewed included article type, total number of authors, and the gender of each article's first and senior author. RESULTS: Nine hundred ninety-nine articles were analyzed, including 701 in OPRS and 298 in Orbit. Of 3,716 total authors, 1,151 (31%) were women, including 297 (29.7%) first authors, and 191 (21.5%) senior authors. Women authorship in OPRS in 1985 (first, 3.9%; senior, 3.3%; all, 3.2%) significantly increased by 2020 (first, 44.6%; senior, 27.9%; all, 42%). Women authorship in Orbit in 1985 (first, 0%; senior, 4.5%; all, 7.4%) also significantly increased by 2020 (first, 43.3%; senior, 34%; all, 42.9%). In a subanalysis of OPRS original investigations alone, women first authorship increased from 3.1% in 1985 to 35.8% in 2020 (p < 0.001) and women senior authorship increased from 4.3% in 1985 to 25% in 2020 (p = 0.001). In a subanalysis of Orbit original investigations alone, women first authorship increased from 0% in 1985 to 65.4% in 2020 (p < 0.001) and women senior authorship increased from 5.3% in 1985 to 42.3% in 2020 (p < 0.001). CONCLUSIONS: Despite a significant increase in women authorship over the past several decades, women remain underrepresented within the oculoplastic literature, particularly in regard to senior authorship. When considering original investigations alone, there has been a significant increase in women first and senior authorship in both OPRS and Orbit.

Impact of COVID-19 on longitudinal ophthalmology authorship gender trends.

BACKGROUND: The COVID-19 pandemic increased the gender gap in academic publishing. This study assesses COVID-19's impact on ophthalmology gender authorship distribution and compares the gender authorship proportion of COVID-19 ophthalmology-related articles to previous ophthalmology articles. METHODS: This cohort study includes authors listed in all publications related to ophthalmology in the COVID-19 Open Research Dataset and CDC COVID-19 research database. Articles from 65 ophthalmology journals from January to July 2020 were selected. All previous articles published in the same journals were extracted from PubMed. Gender-API determined authors' gender. RESULTS: Out of 119,457 COVID-19-related articles, we analyzed 528 ophthalmology-related articles written by 2518 authors. Women did not exceed 40% in any authorship positions and were most likely to be middle, first, and finally, last authors. The proportions of women in all authorship positions from the 2020 COVID-19 group (29.6% first, 31.5% middle, 22.1% last) are significantly lower compared to the predicted 2020 data points (37.4% first, 37.0% middle, 27.6% last) (p < .01). The gap between the proportion of female authors in COVID-19 ophthalmology research and the 2020 ophthalmology-predicted proportion (based on 2002-2019 data) is 6.1% for overall authors, 7.8% for first authors, and 5.5% for last and middle authors. The 2020 COVID-19 authorship group (1925 authors) was also compared to the 2019 group (33,049 authors) based on journal category (clinical/basic science research, general/subspecialty ophthalmology, journal impact factor). CONCLUSIONS: COVID-19 amplified the authorship gender gap in ophthalmology. When compared to previous years, there was a greater decrease in women's than men's academic productivity.

Association between cannabis and the eyelids: A comprehensive review.

Cannabis is the most consumed illicit drug worldwide. As more countries consider bills that would legalize adult use of cannabis, health care providers, including eye care professionals (ophthalmologists, optometrists), will need to recognize ocular effects of cannabis consumption in patients. There are only 20 studies on the eyelid effects of cannabis usage as a medical treatment or a recreational drug. These include ptosis induction, an "eyelid tremor" appearance and blepharospasm attenuation. Six articles describe how adequately dosed cannabis regimens could be promising medical treatments for blepharospasm induced by psychogenic factors. Fourteen articles report eyelid tremors in intoxicated drivers and ptosis as a secondary effect in cannabinoid animal experimental models. The exact mechanism of cannabinoids connecting cannabis to the eyelids is unclear. Further studies should be conducted to better understand the cannabinoid system in relation to the eyelid and eventually develop new, effective and safe therapeutic targets derived from cannabis.

COVID-19 Recommendations From Ophthalmic and Plastic Reconstructive Surgery Societies Worldwide.

PURPOSE: The COVID-19 pandemic has brought unprecedented challenges for oculoplastic surgeons worldwide, in terms of care delivery, medical equipment and at-risk patient management. To date, there are no centralized or compiled international COVID-19 guidelines for oculoplastic surgeons. METHODS: We examined COVID-19 guidelines published by oculoplastic societies worldwide. All countries around the world were initially considered in this study, but only 9 oculoplastic societies met the inclusion criteria: (1) publicly available guidelines displayed on the oculoplastic society's website, or (2) guidelines received from the oculoplastic society after contacting them twice using the contact information on their website. RESULTS: The 9 oculoplastic societies examined include: the American Society of Ophthalmic Plastic and Reconstructive Surgery, the British Oculoplastic Surgery Society, the Canadian Society of Oculoplastic Surgery, the European Society of Ophthalmic Plastic and Reconstructive Surgery, la Sociedad Española de Cirugía Plástica Ocular y Orbitaria, la Asociación Colombiana de Cirugía Plastica Ocular, the Asia Pacific Society of Ophthalmic Plastic & Reconstructive Surgery, the Oculoplastics Association of India, and the Philippine Society of Ophthalmic Plastic and Reconstructive Surgery. They all agree that urgent procedures should not be delayed, while non-necessary procedures (including all elective clinic services) should be postponed. When adequate protective equipment is available, oculoplastic surgeons must treat urgent cases. Eight out of 9 societies have provided recommendations on personal protective equipment use in order to prevent the spread of COVID-19 and to adequately protect mucous membranes. Other recommendations provided by certain societies are related to shelter in place measures, hand hygiene and surface disinfection protocols, patient triage, and thyroid eye disease management. CONCLUSIONS: All 9 societies with published recommendations have provided valuable recommendations to their members, regarding urgency of care and infection control solutions (personal protective equipment, hand hygiene, telemedicine, and social isolation).

Perspectives on a virtual student-led research conference in ophthalmology.

We share our experience of organizing a one-day virtual educational event, the first Canadian national student ophthalmology conference, in response to the need for ophthalmology career exploration. The conference included mentorship with residents, research presentations, keynote speakers, and more. Following the event, students expressed some improvement in accessing ophthalmology mentorship and research opportunities, along with a modest enhancement in their understanding of the specialty. We provide insights into the organizational framework and quality improvement results, aiming to assist students in adapting similar events for various specialities.

Nous partageons notre expérience portant sur l'organisation d'un événement éducatif virtuel d'une journée: la première conférence nationale canadienne des étudiants en ophtalmologie. Cette initiative a été prise en réponse au besoin d'exploration des carrières en ophtalmologie. La conférence comprenait des séances de mentorat avec des résidents, des présentations de recherche, des conférenciers d'honneur, entre autres. Suite à cet événement, les étudiants ont exprimé une amélioration dans l'accès au mentorat et aux opportunités de recherche en ophtalmologie, ainsi qu'une modeste amélioration de leur compréhension de la spécialité. Nous offrons un aperçu du cadre organisationnel et des résultats de l'amélioration de la qualité, dans le but d'aider d'autres étudiants à organiser des événements similaires pour diverses spécialités.

Creation and cost-evaluation of a student-run podcast in ophthalmology.

Podcasts are an increasingly popular medical education modality, especially in surgical fields. However, the cost of developing a high-quality medical education podcast presents a barrier to many content creators. The authors developed the podcast series 'The Lenspod,' designed to be a cost-efficient but high-quality education resource in ophthalmology. The REC financial framework has been previously used to estimate the financial costs of technology-based medical education. Using this framework, costs were competitive with other medical education podcasts. It is our hope that similar methodology may be used to create and disseminate future podcasts for medical education.

Les balados sont une modalité d'enseignement médical de plus en plus populaire, en particulier dans les domaines chirurgicaux. Cependant, le coût de création d'un balado éducatif de qualité en médecine constitue un obstacle pour de nombreux créateurs de contenu. Les auteurs sont les créateurs de la série de balados The Lenspod, qui se veut une ressource éducative à la fois rentable et de qualité en ophtalmologie. Appliquant le cadre financier REC, déjà utilisé pour estimer les coûts financiers de modes d'enseignement médical basés sur la technologie, nous avons constaté que les coûts de notre balado sont compétitifs par rapport à d'autres en éducation médicale. Nous espérons qu'une méthode similaire sera utilisée pour créer et diffuser davantage de balados éducatifs en médecine.

Development of a Cloud-Based Clinical Decision Support System for Ophthalmology Triage Using Decision Tree Artificial Intelligence.

Purpose: Clinical decision support systems (CDSS) are an emerging frontier in teleophthalmology, drawing on heuristic decision making to augment processes such as triage and referral. We describe the development and implementation of a novel cloud-based decision tree CDSS for on-call ophthalmology consults. The objective was to standardize the triage and referral process while providing a more accurate provisional diagnosis and urgency. Design: Prospective comparative cohort study. Subjects: On-call referrals to a Canadian community ophthalmology clinic. Methods: A web-based decision tree algorithm was developed using current guidelines and expert opinion. The algorithm collected tailored information on the patient's ophthalmic concern, and outputted a provisional diagnosis and urgency before sending an electronic referral to the on-call ophthalmology clinic. Data were described using descriptive statistics. Spearman-rho correlations and Cohen's kappa coefficient were used to characterize the observed relationships. Post hoc analysis was conducted using analysis of contingency tables and adjusted residuals. Main Outcome Measures: Diagnostic category, provisional diagnosis, and urgency for the referring provider, CDSS, and ophthalmologist. Results: Ninety-six referrals were processed. Referring providers included medical doctors (76.0%, n = 73), optometrists (20.8%, n = 20), and nurse practitioners (3.1%, n = 3). The CDSS (κ = 0.5898; 95% confidence interval [CI], 0.4868-0.6928; P < 0.0001) performed equally well with 66.7% agreement in determining category when compared with referring providers (κ = 0.5880; 95% CI, 0.4798-0.6961; P < 0.0001). The CDSS (agreement = 53.1%; κ = 0.4999; 95% CI, 0.4021-0.5978; P < 0.0001) performed better than referring providers (agreement = 43.8%; κ = 0.4191; 95% CI, 0.3194-0.5188; P < 0.0001) in determining a diagnosis. The CDSS (ρ = 0.5014; 95% CI, 0.3092-0.6935; P < 0.0001) also performed better than referring providers (ρ = 0.4035; 95% CI, 0.2406-0.5665; P < 0.0001) in determining urgency. The CDSS assigned a lower level of urgency in 22 cases (22.9%) compared with referring providers in 6 cases (6.3%). Conclusions: To our knowledge, this is the first cloud-based CDSS in ophthalmology designed to augment the triage and referral process. The CDSS achieves a more accurate diagnosis and urgency, standardizes information collection, and overcomes antiquated paper-based consults. Future directions include developing a random forest model or integrating convolutional neural network-based machine learning to refine the speed and accuracy of triage and referral processes, with emphasis on increasing sensitivity of the CDSS.

Ocular Symptoms in Adolescents and Young Adults With Electronic Cigarette, Cigarette, and Dual Use.

Importance: Despite increasing use of cigarettes and electronic cigarettes (e-cigarettes) and related health effects among youth, few studies have reported their effects on eyes. Objective: To examine the frequency and severity of ocular symptoms (ocular discomfort, pain, burning, itching, redness, dryness, glare, blurriness, strain, and headaches) in young e-cigarette and cigarette users. Design, Setting, and Participants: In an observational cross-sectional study, a survey conducted in May 6 to 14, 2020, asked participants about use (ever, past 30 days, and past 7 days) of e-cigarettes and cigarettes. The participants included US individuals aged 13 to 24 years. Main Outcomes and Measures: Associations between vision-related outcomes (general vision, severity/frequency of ocular symptoms) and tobacco use were analyzed using weighted multivariable logistic regressions, adjusting for sociodemographic factors, contact lens use, and other combustible use. Results: There were 2168 never users, 2183 ever users, 1092 past 30-day users, and 919 past 7-day users of e-cigarettes; 55.9% of e-cigarette ever users also used cigarettes (dual users). Of the 4351 respondents, 63.8% identified as female, and mean (SD) age was 19.1 (2.9) years. Between 1.1% and 3.9% of ever dual users reported severe to very severe ocular symptoms; between 0.9% and 4.3% reported daily symptoms, which was higher than the proportion of symptoms in e-cigarette- or cigarette-only users. Past 7-day dual users had more severe itching (adjusted odds ratio [AOR], 2.37; 95% CI, 1.36-4.13; P = .002), redness (AOR, 2.58; 95% CI, 1.50-4.46; P = .001), dryness (AOR, 2.89; 95% CI, 1.64-5.08; P < .001), glare (AOR, 2.56; 95% CI, 1.50-4.35; P = .001), blurriness (AOR, 2.47; 95% CI, 1.36-4.50; P = .003), headaches (AOR, 2.31; 95% CI, 1.34-4.00; P = .003); and more frequent pain (AOR, 3.45; 95% CI, 2.09-5.68; P < .001), burning (AOR, 3.08; 95% CI, 1.86-5.09; P < .001), and redness (AOR, 2.72; 95% CI, 1.69-4.36; P < .001) than all other participants. Past 30-day dual users had more severe dryness (AOR, 2.65; 95% CI, 1.61-4.36; P < .001) and more frequent pain (AOR, 3.33; 95% CI, 2.12-5.21; P < .001) than all other participants. Ever dual users experienced more severe dryness (AOR, 1.60; 95% CI, 1.05-2.43; P = .03) and blurriness (AOR, 1.79; 95% CI, 1.21-2.64; P = .003) and more frequent pain (AOR, 1.69; 95% CI, 1.13-2.53; P = .01) and blurriness (AOR, 1.63; 95% CI, 1.13-2.36; P = .009) than never users. Conclusions and Relevance: In this cross-sectional US study, adolescents and young adult users of both e-cigarettes and cigarettes had a higher likelihood of experiencing severe and frequent ocular symptoms, with past 7-day users reporting more symptoms than past 30-day users or ever users. These findings provide additional reasons for users of e-cigarettes and cigarettes to reduce their tobacco use to possibly prevent or minimize ocular symptoms.

Public perception of laser-assisted blepharoplasty versus blade-assisted blepharoplasty.

OBJECTIVE: To evaluate perceptions of blade- versus laser-based blepharoplasty before and after being provided educational information. METHODS: This interventional pre-post study included 145 randomly selected participants (Maisonneuve-Rosemont Hospital, Montreal, Canada, August 2020) who were asked about their perceptions surrounding blepharoplasty. Participants then received information about the techniques before answering final questions. RESULTS: Participants perceived no difference in outcomes for blade (37%) versus laser (40%) blepharoplasty precounselling. This increased to laser blepharoplasty postintervention (56%, p < 0.001) despite being told that there was no difference in outcomes. The higher the level of education among participants, the more likely they were to correctly believe that both techniques had similar outcomes (p = 0.049). Most participants would choose laser blepharoplasty initially (64%), and this percentage increased postintervention (81%, p < 0.001). The preintervention perception of blade blepharoplasty recovery time (20.1 ± 32.6 days) was longer than that for laser blepharoplasty (13.5 ± 32.0 days, p = 0.01) and increased for both techniques postintervention (p < 0.001). Perceived pain was lower for laser blepharoplasty. Postintervention, participants responded that additional costs of ($975 ± $1,091) would justify laser over blade blepharoplasty. CONCLUSION: Elucidating patient perceptions and preferences for blade- versus laser-based blepharoplasty provides surgeons with perspective on how to tailor preoperative counselling. Before and after the intervention, participants had a bias toward choosing laser blepharoplasty. The intervention seems to falsely convince people that laser blepharoplasty leads to better outcomes. Because the doctor's advice can greatly impact patients' decisions, physicians have to be careful not to give false expectations when counselling patients. Inaccurate recall of key educational takeaways suggests that information should be vulgarized and delivered actively to patients.

Influence of Age, Sex, and Wait Times on Public Online Ratings of Glaucoma Physicians in the United States.

PRCIS: Glaucoma surgeons are highly rated by the general public. Physicians with shorter wait times and who are younger are more likely to have higher ratings. Female glaucoma physicians are less likely to have higher ratings. PURPOSE: Find what characteristics of glaucoma physicians are associated with higher online ratings. METHODS: All American members of the American Glaucoma Society were queried on Healthgrades, Vitals, and Yelp. Ratings, medical school ranking, region of practice, sex, age, and wait times were recorded. RESULTS: One thousand one hundred six (78.2%) of American Glaucoma Society members had at least 1 review across the 3 platforms. The average score among glaucoma surgeons was 4.160 (0.898 SD). Female physicians were associated with lower online ratings [adjusted odds ratio (aOR): 0.536; 95% CI 0.354-0.808]. Physicians with <30 minutes of wait time had higher ratings: 15-30 minutes wait time (aOR: 2.273; 95% CI: 1.430-3.636) and <15 minutes wait time (aOR: 3.102; 95% CI: 1.888-5.146). Older physicians had lower ratings (aOR: 0.384; 95% CI: 0.255-0.572). CONCLUSIONS: Public online ratings of glaucoma specialists in the United States seem to favor those of younger age, men, and those with shorter wait times.

Cannabis and the Cornea.

Purpose: While cannabis has the potential to reduce corneal pain, cannabinoids might induce side effects. This review article examines the effects of cannabinoids on the cornea. As more states and countries consider the legalization of adult cannabis use, health-care providers will need to identify ocular effects of cannabis consumption.Methods: Studies included in this review examined the connection between cannabis and the cornea, more specifically anti-nociceptive and anti-inflammatory actions of cannabinoids. NCBI Databases from 1781 up to December 2019 were consulted.Results: Five studies examined corneal dysfunctions caused by cannabis consumption (opacification, decreased endothelial cell density). Twelve studies observed a reduction in corneal pain and inflammation (less lymphocytes, decreased corneal neovascularization, increased cell proliferation and migration).Conclusion: More than half of the studies examined the therapeutic effects of cannabinoids on the cornea. As the field is still young, more studies should be conducted to develop safe cannabinoid treatments for corneal diseases.

The Lens: Can a Weekly Newsletter Improve Medical Student Knowledge of the Ophthalmology Literature?

OBJECTIVE: Medical trainees often report barriers to their active engagement with academic medical literature. We assessed whether subscription to The Lens, a weekly newsletter summarizing recent ophthalmology literature, improved readers' knowledge of the literature. DESIGN: The implementation, uptake, and feasibility of The Lens are described. To assess newsletter efficacy, a 14 question multiple-choice quiz was designed with seven questions based on research articles featured in The Lens and seven based on articles published in high impact ophthalmology journals that were not featured in The Lens. The quiz was statistically validated in a sub-sample of non-subscribers to confirm similar difficulty between Lens and non-Lens quiz items. Among subscribers, within-participant scores on each subsection were compared using paired t-tests. Linear regression was used to determine if participation-adjusted subscription length was associated with quiz scores, after covariate adjustment. SETTING AND PARTICIPANTS: Medical student subscribers of The Lens. RESULTS: Over 12 months, The Lens attained 352 subscribers and summarized 410 research articles in 40 newsletters, at a monetary cost of <$5 per issue. The survey sample comprises 59 medical students who subscribed to The Lens. Subjectively, 83.1% of subscribers reported that The Lens helped them learn about the ophthalmology literature. Among non-subscribers, scores on the Lens and non-Lens quiz subsections were similar (median paired difference = 0%), indicating that subsections were similar in difficulty. Lens subscribers correctly answered 51.1% of Lens items, compared to 42.9% of non-Lens items (mean paired difference, 8.2%; p=0.022), indicating that readers retained information presented in The Lens. In an adjusted linear regression model, each additional participation-adjusted month of subscription to The Lens was associated with a 2.7% improvement in Lens item quiz score (p=0.022). CONCLUSION: Weekly newsletters can help trainees across medical specialties overcome barriers to engagement with the academic literature and improve their knowledge of recently published studies.

Gender Gap in Neurology Research Authorship (1946-2020).

Gender disparity in the field of neurology impedes scientific advancements and innovations. In 2018, 45.0% of neurology and neurological subspecialty residents were women. Despite a notable rise in the proportion of women neurologists over the past decades, inequalities regarding publication proportions between men and women persist in the field. This cohort study examines authorship trends in articles published in 155 international neurology journals, identified as those listed in the annual Journal Citation Reports' "Clinical Neurology" section. Authors' names, authorship positions and countries of affiliation were extracted from PubMed for indexed articles published from 1946 to 2020. Gender-API (a validated and highly accurate application program interface) assigned binary genders to authors. Author gender proportions were compared across subspecialties, authorship position and years. In 303,385 unique articles, 1,663,036 total authors were identified of which 34.1% were women. Neuroradiology demonstrated the lowest proportion of women authors (21.3%), while neurogenetics displayed the highest (44.5%). In articles with multiple authors, both men and women last authors were more likely to publish with a male first author, though this was significantly more pronounced for men last authors (1.86 vs. 1.08; p < 0.001). From 2002 to 2020, women remained in the minority of last (24.6%), first (36.2%), and middle author positions (35.8%). The authorship gender distribution in neurological journals neither reflects the gender proportion of neurologists in the field overall nor in any subspecialty examined. We also find a tendency for senior and junior authors of the same gender to publish together which perpetuates authorship inequity. Further work is needed to identify underlying causes so that interventions might be developed to improve authorship diversity.

Differences in SARS-CoV-2 recommendations from major ophthalmology societies worldwide.

OBJECTIVE: Since the WHO declared the COVID-19 outbreak as a public health emergency, medical societies around the world published COVID-19 recommendations to physicians to ensure patient care and physician safety. During this pandemic, ophthalmologists around the world adapted their clinical and surgical practice following such guidelines. This original research examines all publicly available COVID-19 recommendations from twelve major ophthalmology societies around the world. METHODS AND ANALYSIS: Twelve ophthalmology societies recognised by the International Council of Ophthalmology were included in this study. One society per each WHO region was included: the society selected was the one who had the highest number of national COVID-19 confirmed cases on 11 May 2020. In addition to these countries, the major ophthalmology society in each G7 country was included. RESULTS: Ten out of 12 major international ophthalmology societies from countries covering all six WHO regions have given recommendations regarding urgent patient care, social distancing, telemedicine and personal protective equipment when caring for ophthalmic patients during the COVID-19 pandemic. While all guidelines emphasise the importance of postponing non-urgent care and taking necessary safety measures, specific recommendations differ between countries. CONCLUSIONS: As there is no clear consensus on ophthalmology guidelines across countries, this paper highlights the differences in international ophthalmic care recommendations during the COVID-19 pandemic. Knowledge of the differences in ophthalmic management plans will allow ophthalmologists and all eye care providers to consider the variety of international approaches and apply best practices following evidence-based recommendations during pandemics.