Academic Ophthalmology Department Research Articles

The Effect of Sleep Position Preference on Eyelid and Eyebrow Symmetry.

To investigate the relationship between sleep position preference and eyebrow and eyelid position and degree of upper eyelid dermatochalasis. A prospective study evaluating the impact of sleep position on facial asymmetry was conducted at an academic ophthalmology department. Eligibility criteria included the absence of periocular-altering trauma or surgery, contact lens use, or other periorbital disease processes. Patients reported their sleep position preference on a questionnaire. Standardized digital photographs of patients were obtained, and Image J software was used for measurements and converted into millimeters based on a standard corneal limbus-to-limbus ratio. Upper and lower eyelid position, upper eyelid dermatochalasis, and eyebrow position were assessed by the following image-derived measurements: marginal reflex distance 1 (iMRD1), marginal reflex distance 2 (iMRD2), tarsal platform show (iTPS), and central brow position (iBP). These results were compared with the patient reported sleep position preference to determine correlation. Seventy-one patients were enrolled and reported the following sleep position preferences: 28 (right), 24 (left), 13 (both), and 6 (supine). Patients with a right- or left-sided preference demonstrated lower iMRD1 measurements for the preferred sleep side (p < 0.0004) with no other significant difference in periorbital measurements. A larger degree of upper eyelid height (iMRD1) asymmetry was observed among patients with a sleep side preference. Patients with a predominant sleep side preference demonstrate a significant increase in ipsilateral upper eyelid asymmetry and an inferior upper eyelid position on the sleep side. There were no differences noted in lower eyelid position, central eyebrow position, or amount of upper eyelid dermatochalasis.

Virtual learning solutions in COVID-19 era: University Italian Ophthalmology department perspective.

Introduction:Few months after the COVID-19 pandemic burst, many aspects of the human life, including education, dramatically changed. Because of the lockdown measures taken to limit the virus spread in Italy, in-person teaching and learning have been interrupted in all health care disciplines and readapted in virtual formulae.Methods:As academic ophthalmology departments, we had to maintain the educational needs of medical and orthoptic students, internships, surgical training of residents, as well as to cover the scientific update of health care personnel (HCPs), and the continuation of research and academic activities. To assure these needs we ideated an educational strategy and a team, which was then translated on a multichannel virtual platform created with Microsoft Teams.Results:In this platform there were 21 channels organized in a public view mode, open to all Team members, or in private view mode to separate non-permanent HCPs, internships, residents, and students’ tasks, from permanent HCPs tasks. Virtual channels were dedicated to provide theoretical lessons, clinical cases, surgical video, internal meetings and webinar, to offer news from scientific societies, requests of appointments from biomedical companies, links with ophthalmological websites, to move forward research projects, to participate at institutional academic duties, and to obtain feedbacks from users. Residents continued their training on surgery using a surgical simulator, after consulting an agenda uploaded into the dedicated virtual channel.Conclusion:These positive initial results should represent a boost to rapidly proceed with the development of even more versatile virtual learning solutions, given that the forecasts for the duration of the COVID-19 pandemic are not encouraging.

Characteristics Associated With New Patient Appointment No-Shows at an Academic Ophthalmology Department in the United States

This study aimed to identify patient and appointment characteristics associated with no-shows to new patient appointments at a US academic ophthalmology department. Cross-sectional study. This was a study of all adult patients with new patient appointments scheduled with an attending ophthalmologist at Penn State Eye Center between January 1st and December 31st of 2019. A multiple logistic regression model was used to assess the association between characteristics and no-show status. Of 4,628 patients, 759 (16.4%) were no-shows. From the multiple logistic regression model, characteristics associated with no-shows were age (Odds Ratio (OR) for 18-40 years vs. >60 years: 3.41, 95% Confidence Interval (CI) 2.57, 4.51, p <0.001 and OR for 41-60 years vs. >60 years: 2.14, 95% CI 1.67, 2.74, p<0.001), median household income (OR for <$35,667 vs. >$59,445: 1.59, 95% CI 1.08, 2.34, p<0.001), insurance (OR for None vs. Medicare: 6.92, 95% CI 4.41, 10.86, p<0.001 and OR for Medicaid vs. Medicare: 1.54, 95% CI 1.18, 2.01, p=0.002), race (OR for Black vs. White: 2.62, 95% CI 2.00, 3.43, p<0.001 and OR for Other vs. White: 2.02, 95% CI 1.58, 2.59, p<0.001), and commute distance (OR for 5-10 mi vs. ≤5 mi: 1.73, 95% CI 1.17, 2.55, p=0.006). Appointments with longer lead times and scheduled with glaucoma or retina specialists were also significantly associated with greater no-shows. Certain patient and appointment characteristics were associated with no-show status. These findings may assist in the development of targeted interventions at the patient, practice, and health system levels to improve appointment attendance.

Cost Analysis of Routine Vitrectomy Surgery

To use electronic health record (EHR) time logs to calculate the complete cost profiles of routine pars plana vitrectomy surgery. Economic analysis. Patients undergoing elective vitrectomy procedures (Current Procedural Terminology codes 67040, 67041, and 67042) at Vanderbilt University Medical Center in fiscal year2019. Process flow mapping for routine vitrectomy surgery was used to define the operative episode. De-identified time logs were sourced from an internal perioperative data warehouse to calculate procedure-level durations. The costs of materials and overhead were calculated from internal financial management software. Costs per minute for space, equipment, and personnel were based on internal figures. These inputs were used for a time-driven activity-based costing (TDABC) analysis. Complete cost profile of routine pars plana vitrectomy surgery. Cost analysis of routine vitrectomy surgery resulted in a total cost of $7169.79 per patient, which was $2053.85 more than the maximum Medicare reimbursement for the equivalent episode, $5115.93. Vitrectomy cases do not break even unless the case duration is fewer than 26.81 minutes, overhead is reduced by 53.78%, or reimbursement is increased by 40.15%. Reimbursement does not compensate for variable costs alone for cases lasting longer than 55.09 minutes. In the cohort used here, 68% of cases are completely unprofitable, with increasing losses directly proportional to the length of the case. This analysis showed that true costs for routine vitrectomy procedures are significantly more than the maximum allowable Medicare reimbursement. Academic ophthalmology departments may benefit from more accurate costing approaches using existing EHR data. These approaches may be informative for policy discussion regarding appropriate reimbursement.

Utilizing a Professionalism Mentor to Address Sexual Harassment in Academic Ophthalmology.

Objective This study assesses a new departmental role-a professionalism mentor-who receives sexual harassment reporting, liaisons with campus resources, and organizes educational sessions. Study Design Multicenter randomized controlled survey study. Methods Academic ophthalmology departments in the United States were randomized to a professionalism mentor group ( n = 9) and a control group ( n = 7). Among both pre- and postsurveys, 605 faculty and trainee responses were received and 546 were complete. The intervention group was assigned a professionalism mentor with educational session for a 6- to 10-month period. Sexual harassment and reporting rate change over time were compared between the two groups. Results Among 546 anonymous responses, 16% experienced workplace sexual harassment during the prior 10 months. Location in the South or Midwest was a risk factor ( p < 0.001). Victims were mostly women (76%), including residents/fellows (46%) and academic attendings (49%); perpetrators included patients (35%) and academic attendings (35%). Departments with and without a professionalism mentor had stable harassment from pre- to postsurvey ( p = 0.95 comparing change). The professionalism mentor group had an increase in reporting to an authority from pre- to postsurvey (7-23%), whereas the control group had a decrease (27-12%; p = 0.07 comparing change). Most faculty and trainees in the interventional arm of this study recommended instituting a professionalism mentor with educational session (66% presurvey and 68% postsurvey), compared with educational session alone (25% presurvey and 23% postsurvey), or neither (9% presurvey and 9% postsurvey). Residency program directors in the professionalism mentor group even more strongly supported instituting both a professionalism mentor and educational program (100% presurvey and 100% postsurvey) as opposed to educational program alone (0% presurvey and 0% postsurvey) or neither (0% presurvey and 0% postsurvey). Conclusion This study identified a high sexual harassment rate in academic ophthalmology departments over a brief period. The presence of a professionalism mentor was viewed favorably and may lead to increased reporting.

A novel think tank program to promote innovation and strategic planning in ophthalmic surgery

BackgroundContinuous quality improvement is a pillar of all surgical groups. Innovation is a critical aspect to continuously improve, but traditional staff retreats have several disadvantages which limit their utility in identifying needs and developing innovative solutions. To address these challenges, we designed the novel Think Tank Program to spur innovation and strategic planning for an academic ophthalmology department including the Kellogg Eye centre 6 operating rooms. MethodsThe Think Tank program is a structured seven-phase program for faculty in small teams to identify, innovate, and implement meaningful change. Participants brainstormed problems and possible solutions to those problems, formed teams, acquired data, and implemented meaningful change in clinical care, research, education, and administration. ResultsThe program generated 19 novel proposals and significant faculty engagement and discussion in improving the department. A case example of improving the operating room (OR) utilization resulted in improved OR utilization from 63.8% to 74.6% over a 3 month period before and after implementation. It also resulted in a reduction of cancelled or rescheduled surgeries within 2 weeks or surgery from 29.8% to 15.2%. This resulted in an estimated positive financial margin of over $141,000 to the institution in addition to improvement in patient, surgeon, and staff satisfaction with the quality of care. ConclusionsEngaged faculty, critical data analysis, and value proposition analysis with data-driven metrics and accountability can result in a significant increase in OR utilization and reduction in surgical cancellations. Think Tank serves as a model transformative program to assist practices and institutions to best fulfil their mission while actively engaging and retaining their members.

Authorship Gender Composition in the Ophthalmology Literature from 2015 to 2019

Despite progress toward gender equality, female academic ophthalmologists continue to face considerable challenges. Although ophthalmology ranks third among surgical specialties in female representation, 1 Association of American Medical CollegesActive Physicians by Sex and Specialty, 2017. AAMC, Washington, DC2017 Google Scholar 72% of US residency program directors and 90% of department chairs are male. 2 Kloosterboer A. Yannuzzi N.A. Gedde S.J. Sridhar J. Residency program directors of United States Ophthalmology Programs: a descriptive analysis. Am J Ophthalmol. 2020; 209: 71-76 Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar ,3 Dotan G. Qureshi H.M. Gaton D.D. Chairs of United States Academic Ophthalmology Departments: a descriptive analysis and trends. Am J Ophthalmol. 2018; 196: 26-33 Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar This study assessed the ophthalmology literature to track female authorship trends over 5 years, focusing specifically on first and last author positions given their relative importance for promotion and tenure. 4 Nichani A.S. Whose manuscript is it anyway? The 'Write' position and number of authors. J Indian Soc Periodontol. 2013; 17: 283-284 Crossref PubMed Scopus (3) Google Scholar

Implementation of COVID-19 Protocols and Tele-Triage in an Academic Ophthalmology Department

Abstract Background The coronavirus disease-2019 (COVID-19) pandemic has affected academic ophthalmology departments globally, causing changes in educational, research, and clinical operations in the short and long term. Healthcare workers are at higher risk of contracting the disease and given early reports suggestive of transmission through the tear film in COVID-19 cases with conjunctivitis, and close proximity during examination, eye care providers in particular may be at increased risk. Objective To provide the experience from a single academic ophthalmology program in responding to the COVID-19 pandemic. Methods This article describes the changes executed in the Department of Ophthalmology and Visual Sciences at the University of Illinois at Chicago, Illinois Eye and Ear Infirmary, with emphasis on the implementation of a tele-triage process for urgent visits. Results In response to the pandemic, our department made rapid changes to its departmental protocols for education, research, and patient management. Early measures focused on limiting face-to-face interactions among patients, staff, residents, and faculty, decreasing the risk of exposure to disease while also providing access for patients in urgent need of care. Conclusion We hope that the UIC experience will assist other academic tertiary referral centers in maximizing their opportunities to deliver excellent patient care while minimizing risks to patient and provider, all while continuing to provide a quality graduate medical educational experience during and beyond the pandemic.

Impact of Standardized Prescribing Guidelines on Postoperative Opioid Prescriptions after Ophthalmic Surgery

To determine the effect of implementing standardized opioid prescribing guidelines on prescription patterns for acute pain after ophthalmic surgery in opioid-naïve patients. Quality improvement study. Ophthalmic surgeons in an academic department of ophthalmology. Postoperative opioid prescribing patterns were compared before and after the implementation of standardized opioid prescribing guidelines for ophthalmic surgery at an academic institution. Only prescriptions provided to opioid-naïve patients 18 years of age or older were included. Surgeons reached a consensus for standardized prescribing guidelines appropriate for the type of surgery within their subspecialty. Guidelines were disseminated in conjunction with postsurgical pain management education to all ophthalmologists in the department, including trainees. The frequency of opioid prescriptions, the quantity of opioid prescribed (converted to oral morphine equivalent [OME]), and opioid prescription refill rates were compared before and after intervention. Prescriptions with more than 80 OME, frequency of opioid prescriptions, mean OME, and refill rates. Of 5349 ophthalmic surgeries performed during the 2 assessment periods, 196 (3.7%) were associated with opioid prescriptions for acute postoperative pain. The frequency of opioid prescriptions decreased to 3.0% (81/2736) after intervention compared with 4.4% (115/2613) before intervention (P= 0.005). When opioids were prescribed, the mean OME decreased from 93 (range, 27-500) before intervention to 42 (range, 14-100) after intervention (P= 0.003). The number of prescriptions for more than 80 OME decreased from 56 (2.1%) before intervention to 4 (0.1%) after intervention (P < 0.001). Based on the standardized guidelines, 103 of the 115 (89.6%) preintervention opioid prescriptions would not have adhered to the guidelines, whereas 39 of the 81 (48.1%) postintervention prescriptions did not adhere to the guidelines (P < 0.001). The proportion of refill prescriptions did not differ before and after intervention (P= 0.44). The process of discussing postsurgical pain management and developing standardized opioid prescribing guidelines reduces overprescribing of opioids after ophthalmic surgery without increasing refill rates. Continued education is required to improve adherence to the prescribing guidelines further.

Association Between Sex Composition and Publication Productivity of Journal Editorial and Professional Society Board Members in Ophthalmology

Because women remain underrepresented in leadership positions in medicine, including ophthalmology, knowledge of sex composition of ophthalmic journal editorial and professional society boards seems warranted. To investigate the sex composition of ophthalmic journal editorial and professional society boards and compare the publication productivity and number of citations of male vs female board members. In this cross-sectional study, the SCImago Journal Rank indicator was used to identify the 20 highest-ranked ophthalmology journals. Faculty members from each ophthalmic subspecialty were surveyed within a US academic ophthalmology department to identify 15 influential ophthalmology societies. The 2018 board members of each journal and society were identified from the journals' and societies' official websites, and the sex of each individual was recorded. Information regarding journals and societies was collected from October 1 to December 31, 2018. The Scopus database was accessed in January 2019 and then used to find each member's h-index and m-quotient. The h-index, defined as the highest number of an author's publications that received at least h number of citations, was calculated for each board member. The m-quotient, which accounts for varying lengths of academic careers, was calculated by dividing the h-index by the number of years since first publication. Of the 1077 members of ophthalmic journal editorial and society leadership boards, 797 (74.0%) were men and 280 (26.0%) were women. Among the 24 editors in chief of the 20 journals investigated, 23 (95.8%) were male. Thirteen of the 15 professional society presidents (86.7%) were men. Male board members had significantly higher median h-indexes (male vs female journals: 34 [interquartile range {IQR}, 23-47] vs 28 [IQR, 19-40], P < .001; male vs female societies: 27 [IQR, 15-41] vs 17 [IQR, 8-32], P = .006), median publication numbers (male vs female journal board members: 157 [IQR, 88-254] vs 109 [IQR, 66-188], P < .001; male vs female society board members: 109 [IQR, 57-190] vs 58 [IQR, 28-139, P = .001), and median citations (male vs female journal board members: 4027 [IQR, 1897-8005] vs 2871 [IQR, 1344-5852], P < .001; male vs female society board members: 2228 [IQR, 1005-5069] vs 1090 [IQR, 410-2527], P = .003). However, the median m-quotients for male and female board members were comparable (male vs female journal board members: 1.2 [IQR, 0.8-1.6] vs 1.1 [IQR, 0.8-1.5], P = .54; male vs female society board members: 1.0 [IQR, 0.7-1.4] vs 0.9 [IQR, 0.6-1.3], P = .32). The findings suggest that the sex composition on journal editorial and professional society boards in ophthalmology is consistent with the sex composition of ophthalmologists in the US, as reported by the Association of American Colleges, but that editor in chief and society president positions are male dominated despite the apparent equality in academic productivity.

Promoting Quality Face-to-Face Communication during Ophthalmology Encounters in the Electronic Health Record Era.

To evaluate informatics-enabled quality improvement (QI) strategies for promoting time spent on face-to-face communication between ophthalmologists and patients. This prospective study involved deploying QI strategies during implementation of an enterprise-wide vendor electronic health record (EHR) in an outpatient academic ophthalmology department. Strategies included developing single sign-on capabilities, activating mobile- and tablet-based applications, EHR personalization training, creating novel workflows for team-based orders, and promoting problem-based charting to reduce documentation burden. Timing data were collected during 648 outpatient encounters. Outcomes included total time spent by the attending ophthalmologist on the patient, time spent on documentation, time spent on examination, and time spent talking with the patient. Metrics related to documentation efficiency, use of personalization features, use of team-based orders, and note length were also measured from the EHR efficiency portal and compared with averages for ophthalmologists nationwide using the same EHR. Time spent on exclusive face-to-face communication with patients initially decreased with EHR implementation (2.9 to 2.3 minutes, p = 0.005) but returned to the paper baseline by 6 months (2.8 minutes, p = 0.99). Observed participants outperformed national averages of ophthalmologists using the same vendor system on documentation time per appointment, number of customized note templates, number of customized order lists, utilization of team-based orders, note length, and time spent after-hours on EHR use. Informatics-enabled QI interventions can promote patient-centeredness and face-to-face communication in high-volume outpatient ophthalmology encounters. By employing an array of interventions, time spent exclusively talking with the patient returned to levels equivalent to paper charts by 6 months after EHR implementation. This was achieved without requiring EHR redesign, use of scribes, or excessive after-hours work. Documentation efficiency can be achieved using interventions promoting personalization and team-based workflows. Given their efficacy in preserving face-to-face physician-patient interactions, these strategies may help alleviate risk of physician burnout.

Electronic Health Records in Ophthalmology: Source and Method of Documentation

This study analyzed and quantified the sources of electronic health record (EHR) text documentation in ophthalmology progress notes. EHR documentation review and analysis. Setting: a single academic ophthalmology department. a cohort study conducted between November 1, 2016, and December 31, 2018, using secondary EHR data and a follow-up manual review of a random samples. The cohort study included 123,274 progress notes documented by 42 attending providers. These notes were for patients with the 5 most common primary International Statistical Classification of Diseases and Related Health Problems, version 10, parent codes for each provider. For the manual review, 120 notes from 8 providers were randomly sampled. Main outcome measurements were characters or number of words in each note categorized by attribution source, author type, and time of creation. Imported text entries made up the majority of text in new and return patients, 2,978 characters (77%) and 3,612 characters (91%). Support staff members authored substantial portions of notes; 3,024 characters (68%) of new patient notes, 3,953 characters (83%) of return patient notes. Finally, providers completed large amounts of documentation after clinical visits: 135 words (35%) of new patient notes, 102 words (27%) of return patient notes. EHR documentation consists largely of imported text, is often authored by support staff, and is often written after the end of a visit. These findings raise questions about documentation accuracy and utility and may have implications for quality of care and patient-provider relationships.

Changes in Leadership: A 20-Year Study of Trends in Tenure of Chairs of Departments of Ophthalmology

Abstract Objective This article assesses recent trends in tenure length for chairs of academic departments of ophthalmology. Materials and Methods This is a cross-sectional study of current chairs from 136 institutions. Questionnaires emailed to ophthalmology chairs assessed duration of tenure and demographics of current and previous chairs. Based off of this data, trends in tenure length, turnover rates, and retention rates were determined. Results From 1998 to 2018, 255 individuals held the position of chair at 95 academic departments of ophthalmology. Mean tenure length was 17.8 years for chairs whose tenure included 2005, and decreased to 15.2 and 10.4 years for chairs whose tenures included 2010 and 2015, respectively. Mean annual turnover began at 5.3% in the first 5 years of the study, increasing to 6.5% in the following 5 years before returning to a baseline of 5.3% in the past 5 years. An average turnover of 5.2% was demonstrated during the entire study period. Five-year retention rates for new chairs averaged at 86.2%. Representation of female chairs rose from values of 2.1 and 3.1% in the beginning of the period to 7.3 and 8.4% in 2015 and 2016, respectively. Conclusions The average turnover rate for chairs of ophthalmology has remained stable over the past 20 years, with an observed slight decrease in mean tenure length. This stability is welcomed in the wake of predicted turnover within the field of ophthalmology, but continued assessment and preventative policies should be maintained to continue current trends.

Impact of Electronic Health Record Implementation on Ophthalmology Trainee Time Expenditures

Abstract Objective Electronic health records (EHRs) are widely adopted, but the time demands of EHR use on ophthalmology trainees are not well understood. This study evaluated ophthalmology trainee time spent on clinical activities in an outpatient clinic undergoing EHR implementation. Design Prospective, manual time-motion observations of ophthalmology trainees in 2018. Participants Eleven ophthalmology residents and fellows observed during 156 patient encounters. Methods Prospective time-motion study of ophthalmology trainees 2 weeks before and 6 weeks after EHR implementation in an academic ophthalmology department. Manual time-motion observations were conducted for 11 ophthalmology trainees in 6 subspecialty clinics during 156 patient encounters. Time spent documenting, examining, and talking with patients were recorded. Factors influencing time requirements were evaluated using linear mixed effects models. Main Outcome Measures Total time spent by ophthalmology residents and fellows per patient, time spent on documentation, examination, and talking with patients. Results Seven ophthalmology residents and four ophthalmology fellows with mean (standard deviation) postgraduate year of 3.7 (1.2) were observed during 156 patient encounters. Using paper charts, mean total time spent on each patient was 11.6 (6.5) minutes, with 5.4 (3.5) minutes spent documenting (48%). After EHR implementation, mean total time spent on each patient was 11.8 (6.9) minutes, with 6.8 (4.7) minutes spent documenting (57%). Total time expenditure per patient did not significantly change after EHR implementation (+0.17 minutes, 95% confidence interval [CI] for difference in means: –2.78, 2.45; p = 0.90). Documentation time did not change significantly after EHR implementation in absolute terms (+1.42 minutes, 95% CI: –3.13, 0.29; p = 0.10), but was significantly greater as a proportion of total time (48% on paper to 57% on EHR; +9%, 95% CI: 2.17, 15.83; p = 0.011). Conclusion Total time spent per patient and absolute time spent on documentation was not significantly different whether ophthalmology trainees used paper charts or the recently implemented EHR. Percentage of total time spent on documentation increased significantly with early EHR use. Evaluating EHR impact on ophthalmology trainees may improve understanding of how trainees learn to use the EHR and may shed light on strategies to address trainee burnout.

Known and novel ocular toxicities of biologics, targeted agents, and traditional chemotherapeutics.

Increases in cancer with an aging population and the rapid development of new chemotherapeutics underscore the need for ophthalmologists to identify and manage potential ocular toxicities. This retrospective case series reports the ocular side effects of traditional and novel chemotherapeutic agents from a large center. The medical records of 3537 adult patients 18years and older who presented to an academic ophthalmology department on high-risk medications identified by ICD-9 search between January 2010 and February 2015 were reviewed. A cancer diagnosis, as well as a temporal association with chemotherapeutic use and ocular side effect, was deemed necessary for inclusion in the study. The main measures were ocular side effects in cancer patients taking chemotherapy, ocular imaging abnormalities, and the outcome of each side effect. Of the 161 oncology patients referred to the ophthalmology clinic for chemotherapeutic screening or ocular side effect, 31 (19.3%) were identified as having an ocular adverse reaction due to a novel or traditional chemotherapeutic medication. A novel flattening of the corneal curvature with hyperopic shift and corneal microcysts was identified in a patient taking the antibody-drug conjugate mirvetuximab soravtansine and was reversible with topical steroids. A bilateral medium-vessel choroidal vasculopathy with serous retinal detachment was seen with ipilimumab. The most frequent medication with ocular toxicity was interferon-α(2b) (IFN-α(2b)) (6/31, 19.4%); headache was typical in these patients (83.3%). Ibrutinib ocular toxicity was second most common (5/31, 16.1%), usually causing red or dry eye, while one patient developed branch retinal artery occlusion. Retinal abnormalities documented on OCT imaging occurred with IFN-α(2b), ipilimumab, binimetinib, and docetaxel, while rod-cone ERG abnormality was seen with cisplatin. Inflammatory conditions included anterior scleritis with zoledronic acid, focal eyelid inflammation with veliparib, bilateral chemosis with R-CHOP, iritis, and blepharospasm with IFN-α(2b). AION occurred with pemetrexed, and transient vision loss with hyperemic disc OS was seen with FOLFOX. Two patients (2/31, 6.5%) developed permanent vision loss. Six patients were lost to follow-up, and the clinical course was unknown (6/31, 19.4%). Cases of permanent visual loss were observed; yet, in the majority of side effects, they improved with topical therapy and/or holding the medication. Further research is needed to elucidate the incidence and the pathophysiology of these side effects and maximize patient quality of life.

Cost and Visit Duration of Same-Day Access at an Academic Ophthalmology Department vs Emergency Department

Convenient outpatient access for ophthalmology patients seeking urgent care could offer savings compared with an emergency department (ED) visit. To evaluate the costs and visit durations of same-day access (SDA) in an ophthalmology department at an academic medical center vs ED care. This single-center study was a retrospective quality improvement analysis of an institutional electronic medical record system at the Wilmer Eye Institute clinics and the Johns Hopkins Hospital ED. On June 1, 2015, the Wilmer Eye Institute and Johns Hopkins Hospital initiated an official policy of providing SDA to patients calling for appointments (ie, the same-day project). All ophthalmology clinic locations created same-day appointment slots for at least 1 practitioner. In recognition of seasonal variations in patient visit volumes, the 10 months before implementation (August 1, 2014, to May 31, 2015) were compared with complementary periods in 2015 to 2016 and 2016 to 2017. The study tabulated encounters, charges, and visit length for outpatients seen on the same day or by previously scheduled appointments. For the ED patients, volume, diagnoses, charges, and length of stay data were collected. The numbers of SDA patients who indicated urgency were tabulated. The number of SDA patients increased from 22 781 to 26 579 for the first year after SDA implementation. The mean charge was $258 (95% CI, $250-$266; median, $184; interquartile range [IQR], $175-$320), and the mean clinic transit time was 1.55 hours (95% CI, 1.54-1.57 hours; median, 1.28 hours). For patients seeking eye care in the ED, the mean professional fee was $401 (95% CI, $390-$411; median, $360; IQR, $255-$500), the mean (SD) total hospital charge was $1040 ($999) (95% CI, $729-$1079; median, $1002; IQR, $334-$1429), and the mean length of stay was 7.30 hours (95% CI, 7.01-7.57 hours; median, 7.20 hours). The top 4 ophthalmic diagnoses for ED patients were conjunctivitis, cornea abrasion, iritis, and visual loss, which were unchanged after SDA implementation. In calendar year 2017, a total of 4062 SDA patients reported urgency; their estimated savings in charges compared with an ED visit were $580 866 in professional fees and $3 176 484 in hospital charges. Same-day access appears to be less expensive and to require less time in the health care system than a visit to the ED for an ophthalmic diagnosis. Substantial savings in time and money might be achieved if urgent eye care is delivered in the clinic rather than the ED.

Time Requirements of Paper-Based Clinical Workflows and After-Hours Documentation in a Multispecialty Academic Ophthalmology Practice

To assess time requirements for patient encounters and estimate after-hours demands of paper-based clinical workflows in ophthalmology. Time-and-motion study with a structured survey. This study was conducted in a single academic ophthalmology department. A convenience sample consisted of 7 attending ophthalmologists from 6 subspecialties observed during 414 patient encounters for the time-motion analysis and 12 attending ophthalmologists for the survey. Outcome measurements consisted of total time spent by attending ophthalmologists per patient and time spent on documentation, examination, and talking with patients. The survey assessed time requirements of documentation-related activities performed outside of scheduled clinic hours. Among the 7 attending ophthalmologists observed (6 men and 1 woman), mean ± SD age 43.9 ±7.1 years, during encounters with 414 patients (57.8 ± 24.6 years of age), total time spent per patient was 8.1 ± 4.8minutes, with 2.8 ± 1.4minutes (38%) for documentation, 1.2 ± 0.9minutes (17%) for examination, and 3.3 ± 3.1minutes (37%) for talking with patients. New patient evaluations required significantly more time than routine follow-up visits and postoperative visits. Higher clinical volumes were associated with less time per patient. Survey results indicated that paper-based documentation was associated with minimal after-hours work on weeknights and weekends. Paper-based documentation takes up a substantial portion of the total time spent for patient care in outpatient ophthalmology clinics but is associated with minimal after-hours work. Understanding paper-based clinical workflows may help inform targeted strategies for improving electronic health record use in ophthalmology.

Chairs of United States Academic Ophthalmology Departments: A Descriptive Analysis and Trends

To characterize and analyze the profile of United States (US) academic ophthalmology department chairs. Cross-sectional study. Setting: Web search of publicly accessible sources. One hundred and eleven USophthalmology chairs. Demographic and academic data. Of the 111 chairs reviewed, 90% are male. Mean age of chairs is 59 years, and mean age at time of appointment is 47 years. Ninety-two percent of chairs graduated from an American medical school. Twenty-eight percent of chairs also have additional graduate degrees: 8% a Doctor of Philosophy (PhD) degree, 15% a master's degree, and 5% both. Ninety-five percent of chairs completed a clinical fellowship, most frequently in cornea (25%), vitreoretinal surgery (23%), and glaucoma (21%). The 3 programs that trained the largest number of chairs are Massachusetts Eye and Ear Infirmary, Wilmer Eye Institute, and Bascom Palmer Eye Institute. Thirty-two percent of chairs were previously trained in the program they currently head, more commonly as a resident (28%) than as a fellow (5%). The estimated mean number of publications per chair is 108 (range, 0-850) and the mean h-index is 24. Twenty-seven programs exchanged chairs from 2014 to 2017. The characteristics of appointed chairs are no different than those of recently retired chairs. Ophthalmology chairs remain predominately male, most often specializing in cornea, vitreoretinal surgery, or glaucoma. Most chairs tend to be prolific authors whose careers have placed an emphasis on research; however, a lack of demonstrated research experience does not preclude chairmanship in certain US programs.

Diagnostic Accuracy of Ophthalmoscopy vs Telemedicine in Examinations for Retinopathy of Prematurity

ImportanceExaminations for retinopathy of prematurity (ROP) are typically performed using binocular indirect ophthalmoscopy. Telemedicine studies have traditionally assessed the accuracy of telemedicine compared with ophthalmoscopy as a criterion standard. However, it is not known whether ophthalmoscopy is truly more accurate than telemedicine.ObjectiveTo directly compare the accuracy and sensitivity of ophthalmoscopy vs telemedicine in diagnosing ROP using a consensus reference standard.Design, Setting, and ParticipantsThis multicenter prospective study conducted between July 1, 2011, and November 30, 2014, at 7 neonatal intensive care units and academic ophthalmology departments in the United States and Mexico included 281 premature infants who met the screening criteria for ROP.ExposuresEach examination consisted of 1 eye undergoing binocular indirect ophthalmoscopy by an experienced clinician followed by remote image review of wide-angle fundus photographs by 3 independent telemedicine graders.Main Outcomes and MeasuresResults of both examination methods were combined into a consensus reference standard diagnosis. The agreement of both ophthalmoscopy and telemedicine was compared with this standard, using percentage agreement and weighted κ statistics.ResultsAmong the 281 infants in the study (127 girls and 154 boys; mean [SD] gestational age, 27.1 [2.4] weeks), a total of 1553 eye examinations were classified using both ophthalmoscopy and telemedicine. Ophthalmoscopy and telemedicine each had similar sensitivity for zone I disease (78% [95% CI, 71%-84%] vs 78% [95% CI, 73%-83%]; P > .99 [n = 165]), plus disease (74% [95% CI, 61%-87%] vs 79% [95% CI, 72%-86%]; P = .41 [n = 50]), and type 2 ROP (stage 3, zone I, or plus disease: 86% [95% CI, 80%-92%] vs 79% [95% CI, 75%-83%]; P = .10 [n = 251]), but ophthalmoscopy was slightly more sensitive in identifying stage 3 disease (85% [95% CI, 79%-91%] vs 73% [95% CI, 67%-78%]; P = .004 [n = 136]).Conclusions and RelevanceNo difference was found in overall accuracy between ophthalmoscopy and telemedicine for the detection of clinically significant ROP, although, on average, ophthalmoscopy had slightly higher accuracy for the diagnosis of zone III and stage 3 ROP. With the caveat that there was variable accuracy between examiners using both modalities, these results support the use of telemedicine for the diagnosis of clinically significant ROP.

The Current Online Face of U.S. Academic Ophthalmology

Purpose To evaluate the comprehensiveness and navigation ease of online content from Web sites of U.S. academic ophthalmology departments. Design Cross-sectional analysis of 117 U.S. academic ophthalmology department Web sites from October 1 to October 31, 2017. Methods Data were obtained on various categories, including: clinical access and subspecialty services, social media, patient support and accessibility, residency and fellowship details, and research and faculty characteristics. Percent of Web sites possessing each feature was calculated. In addition, a comparison of content completeness and navigation metrics of Web sites between the US News and World Report top 13 ranked departments and the remaining 96 that possess an ophthalmology residency was performed. Results Greater than 80% of Web sites list a basic core of information online: address, contact information, resident and faculty characteristics, and clinical expertise. However, only 69.2% have capabilities to donate online and 59.8% supply educational material for common eye conditions. Less than half of institutions list emergency and trauma, oncology, and low-vision rehabilitation services; only 49.6% provide a social network platform. Strikingly, accessibility features are limited; scalable text, changeable color, and multilingual capabilities are available in 20.5, 4.3, and 8.5% of Web sites, respectively. In the comparison of top 13 departments with the remaining 96, the high-ranking departments possess more Web site features, but are just as efficient to navigate. Conclusion U.S. academic ophthalmology departments in 2017 provide a basic foundation of online content, but few contain abundant features from the viewpoints of different users.