American Society Of Ophthalmic Plastic And Reconstructive Surgery Research Articles

Accuracy and Bias in Artificial Intelligence Chatbot Recommendations for Oculoplastic Surgeons.

Purpose The purpose of this study is to assess the accuracy of and bias in recommendations for oculoplastic surgeons from three artificial intelligence (AI) chatbot systems. Methods ChatGPT, Microsoft Bing Balanced, and Google Bard were asked for recommendations for oculoplastic surgeons practicing in 20 cities with the highest population in the United States. Three prompts were used: "can you help me find (an oculoplastic surgeon)/(a doctor who does eyelid lifts)/(an oculofacial plastic surgeon) in (city)." Results A total of 672 suggestions were made between (oculoplastic surgeon; doctor who does eyelid lifts; oculofacial plastic surgeon); 19.8% suggestions were excluded, leaving 539 suggested physicians. Of these, 64.1% were oculoplastics specialists (of which 70.1% were American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) members); 16.1% were general plastic surgery trained, 9.0% were ENT trained, 8.8% were ophthalmology but not oculoplastics trained, and 1.9% were trained in another specialty. 27.7% of recommendations across all AI systems were female. Conclusions Among the chatbot systems tested, there were high rates of inaccuracy: up to 38% of recommended surgeons were nonexistent or not practicing in the city requested, and 35.9% of those recommended as oculoplastic/oculofacial plastic surgeons were not oculoplastics specialists. Choice of prompt affected the result, with requests for "a doctor who does eyelid lifts"resulting in more plastic surgeons and ENTs and fewer oculoplastic surgeons. It is important to identify inaccuracies and biases in recommendations provided by AI systems as more patients may start using them to choose a surgeon.

Telemedicine in Oculoplastic Surgery During the COVID-19 Pandemic: A Single Center Experience.

Purpose: To investigate patterns in oculoplastic surgery telemedicine visits at our institution during the pandemic period. Methods: Retrospective chart review of all patients who had a virtual consultation with the oculoplastic surgery service at Mayo Clinic Rochester between March 1, 2020, and March 1, 2021. Results: There were a total of 148 patients. Mean age was 65 years (95% confidence interval [CI]: 62-68). The mean driving distance to the medical center was 468 kilometers (95% CI: 352-586) and 15 (10%) patients came from states with no practicing American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) members. Out of the 205 virtual visits, 35 (17%) were new, 45 (22%) were return, and 125 (61%) were postoperative. Conversion rate to surgery was 60%. A comparison between type of virtual visits (new vs. return vs. postoperative) revealed that a diagnosis of eyelid malposition was most frequent in postoperative visits (p = < 0.001), skin malignancy was most frequent in new visits (p = 0.009), and orbital tumors (p = 0.018) and thyroid eye disease (p = < 0.001) were most frequent in return visits. Most virtual encounters had supportive media attached including external photographs in 127 (62%) visits and other imaging or testing in 18 (9%) visits. The average virtual visit lasted 18 min (95% CI: 14-22) with technical difficulties noted in 9 (4%) visits. Unanticipated conversion to in-person visits was noted in three (1%) cases. Conclusions: A wide range of oculoplastic surgery conditions was managed virtually during the COVID-19 pandemic. Utilization of initial virtual visit versus follow-up care varied by diagnosis. Virtual visits may improve access to oculoplastic subspecialty care for patients from underserved areas.

Timing of Jones Tube Placement After Excision of Nasal or Lacrimal Drainage System Malignancy: A Survey of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS).

To elicit, from a survey of oculoplastic surgeons, the timing and reason for delaying Jones tube placement after the excision of nasal or lacrimal drainage system malignancy. The authors reviewed current literature and distributed an anonymous survey to 627 members of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) to determine the length of time members wait to perform a Jones tube placement after the removal of nasal or lacrimal drainage system malignancy. The survey also included questions about the rationale for this waiting period. Fifty-eight members of ASOPRS (9.3%) responded to our survey, 49 (84.4%) of whom had performed Jones tube placement on patients who had an excision of a nasal or lacrimal drainage system malignancy. Nearly 52% of respondents waited one year for Jones tube placement. However, a sizeable number of respondents opted to wait five years (15.1%). The most common rationale for waiting was a concern for tumor recurrence (42 responses). There is no consensus on when to perform Jones tube placement after the excision of nasal or lacrimal drainage system malignancy. This survey demonstrates a broad array of waiting periods between operations, although most surgeons wait 12 months.

Trends in Residency Academic Productivity of Ophthalmic Plastic and Reconstructive Surgery Fellows Between 2012 and 2019.

To characterize research productivity of ophthalmic plastic and reconstructive surgery (OPRS) fellows during residency. A database was compiled of OPRS fellows listed on the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) Annual Fall Scientific Symposium program books who began their fellowship between 2012 and 2019. PubMed was searched for all publications published between July 1st of the year they began residency and September 30th of the year they began fellowship training. Bibliometric variables captured for each fellow included: the number of publications, first-author publications, and ophthalmology-related publications. A total of 197 OPRS fellows who began their fellowship training between 2012 and 2019 published a mean (± SD) of 2.42 ± 2.80 publications, 1.43 ± 1.85 first-author publications, and 2.33 ± 2.74 ophthalmology-related publications during residency. Linear regression revealed that the number of publications ( P < 0.001), first-author publications ( P < 0.001), and ophthalmology-related publications ( P < 0.001) that OPRS fellows published during residency have all significantly increased over the time assessed. The academic productivity of OPRS fellows during residency was quantified through bibliometric analysis to establish a national benchmark for the benefit of both prospective applicants and program directors. Residency research output of OPRS fellows has significantly increased between 2012 and 2019. Since ASOPRS program requirements necessitate academic productivity and thesis completion, publication records and involvement in research become valuable considerations when evaluating fellowship applicants. The knowledge of what accepted fellows have published provides the opportunity to make historical comparisons and may prove useful in the evaluation of the competitiveness of a given year's applicant pool.

Perceived Barriers to Increasing Diversity within Oculofacial Plastic Surgery.

Purpose Physician diversity is limited in ophthalmology and oculofacial plastic surgery. Determination of barriers within the application process for oculofacial plastic surgery may help target efforts to improve the recruitment of underrepresented groups. This study aimed to illuminate perceived barriers to increasing diversity in oculofacial plastic surgery trainees, according to the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) fellows and fellowship program directors (FPDs). Methods During the month of February 2021, we sent surveys out to 54 current oculofacial plastic surgery fellows and 56 FPDs at 56 oculofacial plastic surgery programs recognized by the ASOPRS nationwide using a 15-question Qualtrics survey. Results Sixty-three individuals (57%) responded to the survey: 34 fellows (63%) and 29 FPDs (52%). Eighty-eight percent of fellows and 68% of FPDs identified as non-underrepresented in medicine (UiM). Forty-four percent of fellows and 25% of FPDs identified as men. FPDs most commonly noted, "Not enough minorities applying to our program" and "The objective data (Ophthalmic Knowledge Assessment Program score, United States Medical Licensing Examination Step scores, clinical honors, Alpha Omega Alpha status, letter of recommendation) for minority applicants often do not meet the threshold required to offer an interview or to be ranked to match" as barriers. Among fellows, the lowest-rated considerations when applying to oculofacial plastic surgery were "Racially/ethnically diverse faculty" and "Perceptions of minority candidates by fellowship programs," whereas "Likelihood of matching in program of choice" was ranked highest in considerations. Fellows identifying as men indicated greater concern for "Financial factors related to fellowship (e.g., loans, salary, cost of living, or cost of interviewing)" compared to fellows identifying as women who noted greater concern for "Program or preceptor acceptance of starting or having a family during fellowship." Conclusion Responses from FPDs suggest that efforts focused on recruiting and supporting diverse students to medicine and ophthalmology, mentoring applicants interested in oculofacial plastic surgery, and restructuring the application process to decrease bias, may improve diversity within the subspecialty. The lack of UiM representation in this study, 6% fellows and 7.4% FPDs identified as UiM, shows both the stark underrepresentation and the need for further research into this topic.

An Analysis of Ophthalmic Plastic and Reconstructive Surgery Fellowship Program Directors in the United States.

PurposeThis study aims to examine the demographic features, academic backgrounds, and scholarly achievements of ophthalmic plastic and reconstructive surgery (OPRS) fellowship program directors (PDs) in the United States.MethodsIn this cross-sectional analysis, publicly accessible sources were accessed in March 2022 to collate the demographic and academic profiles of PDs of American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS)-accredited OPRS fellowships. Differences by gender and program rank were assessed using the Mann-Whitney Utest.ResultsFifty-four PDs were identified, the majority of whom were males (88.89% (n = 48)). The average age was 58.48 years. Of the PDs, 96.3% (n = 53) obtained a medical degree, and all completed residency training in the United States. In addition, 9.26% (n = 5) had another degree, either a Doctor of Philosophy (n = 3) or master’s degree (n = 2). A substantial proportion of individuals completed medical school (20.37% (n = 11)), residency (20.37% (n = 11)), or fellowship (31.48% (n = 17)) at an institution affiliated with the program where they were PDs. The most common additional fellowship obtained was neuro-ophthalmology (16.67% (n = 9)). The average h-index was 19.30 (range, 0-60), average five-year h-index was 4.85 (range, 0-36), and average m-quotient was 0.63 (range, 0-2.22). A significant difference in the median five-year h-index was observed between females and males (7 (range, 3-36) versus 4 (range, 0-10); p= 0.038).ConclusionsThis analysis indicated that OPRS PDs in the United States were principally males with extensive scholarly productivity. As women remain underrepresented in OPRS, increased gender parity at this leadership position should be encouraged in order to expand the recruitment of women into the field.

Board Certification in Cosmetic Surgery: An Evaluation of Training Backgrounds and Scope of Practice

In the article published in the November 2020 issue of Plastic and Reconstructive Surgery,1 Ms. Long and Drs. Gabrick, Janis, Perdikis, and Drolet seek to “examine the training backgrounds and advertised scope of practice of the American Board of Cosmetic Surgery (ABCS) diplomates using a nationwide sample.” However, in their discussion, the authors focus on patient safety and argue that, essentially, patient safety is at risk if the patient does not choose an American Board of Plastic Surgery (ABPS)–certified surgeon. Surely the editorial staff of a prestigious journal such as Plastic and Reconstructive Surgery understands the distinction between a scientific article and an editorial. It is concerning that this article made it through the review process: in the discussion, the authors state that patients are safer having surgery with ABPS-certified rather than ABCS-certified physicians, but their data provide no evidence of safety to support this. They cite “current literature, media reports, and legal proceedings” to make their argument, but sensational anecdotal media cases or medicolegal cases are patently unscientific. It is hoped that these comments were not designed to be inflammatory, but a layperson reading this article might fail to understand the difference between scientific data and anecdotes. With regard to the actual data, which are described in the authors’ Table 2, an important methodologic flaw regarding ophthalmology is that the authors assigned the scope of training for these American Board of Medical Specialties disciplines based on residency training. However, most ophthalmologists who sit for the ABCS board are fellowship trained in ophthalmic plastic and reconstructive surgery, which is a 2-year fellowship overseen by the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS), with a published curriculum approved by the Accreditation Council for Graduate Medical Education that includes aesthetic facial surgery. Because the authors cite case numbers for plastic surgery residencies, it is worth noting that the mean number of cases documented by ASOPRS fellowship graduates was 1783 for our 2020 cohort (in addition to many hundreds of cases already performed in ophthalmology residency.) Certainly, patient safety is a paramount goal for training and for certification. The mission of specialty boards is appropriately focused on patient safety. Any study that intends to compare the safety results of different specialty boards is fraught with political and economic overlays. Therefore, the bar for careful study design, impartial data analysis, and unbiased discussion based on data is, appropriately, extremely high. The authors of this study failed to demonstrate these benchmarks. As a consequence, we request that the Journal publish this letter, as well as an acknowledgment of the many deficiencies in the article by Ms. Long and Drs. Gabrick, Janis, Perdikis, and Drolet. DISCLOSURE The authors have no financial disclosures to report. Robert Goldberg, M.D.UCLA Stein Eye InstituteDavid Geffen School of MedicineUniversity of California, Los AngelesLos Angeles, California Jill Foster, M.D.Plastic Surgery OhioNationwide Children’s UniversityThe Ohio State UniversityColumbus, Ohio Robert Fante, M.D.Fante Eye and Face CentreUniversity of ColoradoDenver, Colo. Mark Lucarelli, M.D.University of Wisconsin-MadisonMadison, Wis.

Telemedicine Use by Oculoplastic Surgeons During the COVID-19 Pandemic.

Background: Telemedicine use expanded dramatically during the COVID-19 pandemic, including to surgical fields that had limited prior adoption of telehealth such as oculoplastic surgery. To assess telemedicine usage patterns, barriers to implementation, and satisfaction with telemedicine, we conducted a survey among members of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS). Methods: We performed a Web-based, anonymous survey of ASOPRS members from November to December 2020. Statistical analyses were performed by using Fisher's exact and Chi-squared tests. Results: We received 196 unique survey responses from 963 invited participants (20.5% response rate). Among the 192 ASOPRS members who participated, the majority (79%) reported currently using telemedicine. Very few of those currently using telemedicine (14%) had used telemedicine before March 15, 2020 and a significant proportion (36%) were unsure or did not plan to use telemedicine post-pandemic. Telemedicine use was more common among participants with fewer years in practice (p < 0.01) and those who were university- versus self-employed (p < 0.01). The most common barriers to telemedicine use were technological issues, reimbursement concerns, and a perceived lack of patient acceptance. Nearly half of the surgeons reported being satisfied with telemedicine (48%), and the majority reported perceived patient satisfaction with telemedicine (74%). Discussion: Telemedicine adoption increased significantly among oculoplastic surgeons during the COVID-19 pandemic. However, many current users reported that they were unsure or did not plan to use telemedicine post-pandemic. Conclusions: Further research is needed to design sustainable telemedicine programs to enhance patient access to oculoplastic specialty care in the long term.

Sex Disparities in Productivity among Oculoplastic Surgeons.

Purpose The aim of the study is to investigate sex differences in academic rank, publication productivity, and National Institute of Health (NIH) funding among oculoplastic surgeons and whether there is an association between American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) membership and scholarly output. Methods Sex, residency graduation year, and academic rank were obtained from institutional websites of 113 U.S. ophthalmology programs. H-indices and m-quotients were obtained from the Scopus database. NIH funding information was obtained from the NIH Research Portfolio Online Reporting Tool. Results Of the 272 surgeons, 74 (30.2%) were females. When adjusted for career duration, differences in female to male proportions were only significant at the rank of assistant professor (assistant: 74.3 vs. 48.5%, p = 0.047; associate: 18.9 vs. 24.6%, p = 0.243; full professor: 13.0 vs. 37.2%, p = 0.114). Women had a shorter career duration than men [10.0 (interquartile range or IQR 12.0) vs. 21.0 (IQR 20.0) years; p < 0.001] and a lower h-index [4.0 (IQR 5.0) vs. 7.0 (IQR 10.0); p < 0.001], but similar m-quotients [0.4 (IQR 0.4) vs. 0.4 (IQR 0.4); p = 0.9890]. Among ASOPRS members, females had a lower h-index than males [5.0 (IQR 6.0) vs. 9.0 (IQR 10.0); p < 0.001] due to career length differences. No difference in productivity between sexes was found among non-ASOPRS members. ASOPRS members from both sexes had higher scholarly output than their non-ASOPRS counterparts. Just 2.7% (2/74) of females compared with 5.3% (9/171) of males received NIH funding ( p = 0.681). Conclusion Sex differences in academic ranks and h-indices are likely due to the smaller proportion of females with long career durations. ASOPRS membership may confer opportunities for increased scholarly output.

Oculoplastic fellow education during the COVID-19 crisis

ABSTRACT Purpose In March 2020, the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) advised the suspension of all non-emergent oculofacial patient care, imparting unprecedented interruptions in fellowship training. Methods ASOPRS fellows and program directors were asked to complete an anonymous survey regarding their perceived impact of the COVID-19 crisis. Results Forty ASOPRS fellows (70.2%) participated, including 20 first-year and 20 second-year trainees, from all country regions. During the social distancing restrictions, 100% of fellows continued to participate in surgical procedures, including orbital biopsy (77.5%), abscess drainage (55.0%), fracture repair (45.6%), eyelid lesion excision (70.0%) and temporal artery biopsy (57.5%). ASOPRS fellows evaluated patients, including in emergency room (84.6%) and inpatient hospital (76.9%) settings, wearing surgical (85.0%) or N-95 (40.0%) masks, gloves (80.0%) and eye protection (62.5%). Most ASOPRS fellows (87.5%) participated in virtual interinstitutional education sessions and indicated a desire to continue this curriculum. Fellows also used available time for research (85.0%), independent study (77.5%), personal health (70.0%) and social interaction (60.0%). ASOPRS fellows reported COVID-19 restrictions to have a mild (72.5%) to moderate (27.5%) impact on their overall training, and most (75.0%) felt their surgical confidence to decline. Fellowship program directors also asserted a mild (72.2%), moderate (19.4%) or significant (5.6%) impact on subspecialty training, and 94.4% predict adverse effects on graduation case logs. Conclusions During the COVID-19 restrictions most ASOPRS fellows participated in emergent clinical activities and novel telemedicine curriculum. Most fellows and program directors expressed concern regarding a negative impact on overall subspecialty education and surgical confidence.

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

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

Editorial introductions

Current Opinion in Ophthalmology was launched in 1990. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of Ophthalmology is divided into nine sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Cynthia AlleyCynthia AlleyDr Cynthia Alley specializes in pediatric ophthalmology and strabismus. She has a special interest in treating adult strabismus. Dr Alley earned her medical degree from the Temple University School of Medicine, and then completed her training in ophthalmology at Temple University Hospital. She went on to complete a fellowship in Pediatric Ophthalmology and Strabismus at Children's National Medical Center in Washington, DC. Dr Alley is a fellow of the American Academy of Ophthalmology, a member of the American Association for Pediatric Ophthalmology and the Costenbader Society, where she serves on the board. Dr Alley is the former Director of Pediatric Ophthalmology at Temple University Hospital, where she also served as Residency Program Director. Currently, she is on staff at Wills Eye Hospital, where she trains ophthalmology residents and medical students. She is also an Assistant Professor of Ophthalmology at The Philadelphia College of Osteopathic Medicine. Dr Alley is actively involved with World Blindness Outreach, a non-profit humanitarian organization dedicated to treating preventable causes of blindness around the world. She has participated in multiple missions in India, Brazil, Nicaragua, Dominican Republic, and Ecuador, and serves on the board of directors. Richard C. AllenRichard C. AllenRichard C. Allen, MD, PhD, FACS is a Professor in the Dept. of Ophthalmology at Baylor College of Medicine in Houston, TX. Dr Allen attended Duke University and graduated magna cum laude and Phi Beta Kappa with a BS in chemistry where he received the Departmental Award in Chemistry. He was accepted into the Medical Scientist Training Program at Baylor College of Medicine where he received his MD and PhD Degrees. His dissertation “Molecular Genetics of X-linked Immunodeficiencies Affecting B Lymphocyte Function” was awarded the Sigma Xi Thesis Excellence Award. Dr Allen completed a residency in ophthalmology at the University of Iowa Hospitals and Clinics. Under the mentorship of Edwin M. Stone, MD, PhD, and Thomas A. Oetting, MD, MS, he completed a fellowship in molecular ophthalmology and comprehensive ophthalmology at the University of Iowa. In 2000, Dr Allen joined the faculty in the Dept. of Ophthalmology at Baylor College of Medicine where he was Chief of the Ophthalmology Service at Ben Taub General Hospital. In 2002, he joined the faculty in the Division of Ophthalmology, Dept. of Surgery at the University of New Mexico School of Medicine. From 2004 to 2006, he completed additional fellowship training in oculoplastic surgery at the University of Iowa under the direction of Jeffrey A. Nerad MD and Keith D. Carter MD, sponsored by the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS). In 2006, Dr Allen returned to New Mexico where he rejoined the faculty at the University of New Mexico. In 2009, Dr Allen returned to the University of Iowa as an Associate Professor with tenure in the Dept. of Ophthalmology. From 2013–2014, he was a visiting physician at St. Erik's Eye Hospital, Stockholm, Sweden. In 2015, Dr Allen joined the faculty at MD Anderson Cancer Center in Houston, Texas, USA; in 2018, he moved his primary appointment to Baylor College of Medicine where his is a Professor with tenure. Dr Allen is a member of ASOPRS, the Orbital Society, the European Society of Ophthalmic Plastic and Reconstructive Surgery, the North American Skull Base Society, and the American Eye Study Club. His research interests include oncologic and genetic diseases of the eyelids, orbit, and lacrimal system. He sees patients at Alkek Eye Center, Texas Children's Hospital, MD Anderson Cancer Center, and Ben Taub General Hospital. He resides in Houston, TX with his wife Missy, son Augustus, and daughter Astrid.

Isolated Orbital Floor Fracture Management: A Survey and Comparison of American Oculofacial and Facial Plastic Surgeon Preferences.

This article aimed to characterize, compare, and contrast the management of isolated orbital floor fractures among oculofacial and facial plastic surgeons in the United States. An anonymous 17-question multiple-choice web-based survey was distributed to all 590 members of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) and all 1,300 members of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) using each society's email database from November 2016 to January 2017. Two-hundred twenty-five oculofacial and 135 facial plastic surgeons completed the survey. The most important indications for surgery among both oculofacial and facial plastic surgeons were motility restriction, enophthalmos, and diplopia at 2 weeks. The most common preferred time to surgical intervention was 8 to 14 days; however, facial plastic surgeons were more likely to operate after 4 to 7 days ( p < 0.001). The most common choices of orbital implant material were porous polyethylene and porous polyethylene plus titanium for both oculofacial and facial plastic surgeons, nylon for oculofacial surgeons, and titanium for facial plastic surgeons. The majority rarely/never used intraoperative computed tomography imaging or navigation. Facial plastic surgeons were more likely to perform postoperative imaging ( p < 0.001). We report results of the first survey of isolated orbital floor fracture management among oculofacial and facial plastic surgeons in the United States. This survey characterizes practice patterns and areas of similarities/differences among oculofacial and facial plastic surgeons in the management of isolated orbital floor fractures, which may help define the current standard of care.

Diversity in the American Society of Ophthalmic Plastic and Reconstructive Surgery.

To assess the epidemiology of women and underrepresented minorities (URMs; Hispanic, African American, and Native American) in the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS). An observational retrospective study of living ASOPRS members was identified through the ASOPRS member directory, search engine-driven informatics, and direct communication. Members were profiled for gender, race, geographic location, and academic rank (or not). The percentage of women and URMs in the society over time was also assessed. The authors identified 617 living ASOPRS members as of June 2017. Of these, 109 (17.7%) were female and 58 (9.4%) were URMs. Surgeons completed fellowships from 1961 (male) or 1973 (female) until 2015. Women members significantly increased from 7 (4.9% of the total) before 1986 to 24 (30.4%) between 2011 and 2015 (last 5 years). URMs significantly increased over time, with 0 female and 5 (3.4%) male minorities before 1985 to 5 (6.3%) females and 13 (16.5%) males within the last 5 years (p < 0.05). With only 1 female and 3 male members, African American representation was sparse. ASOPRS members were not found in 5 states and were most represented in California, New York, Florida, and Texas. Among ASOPRS members in full-time academic positions, women tended to have lower rank compared to men; however, after controlling for number of years post-fellowship, this finding was narrowly not statistically significant (p = 0.0624). There were no academic differences with URMs and nonminority groups. Women and URMs have increased steadily in ASOPRS, especially in recent years. Similar to the rest of ophthalmology and general medicine, there remain opportunities for ASOPRS to increase diversity.

Editorial introductions

Editorial introductions

Surgical preferences in the management of recalcitrant endophthalmitis

ABSTRACTTo assess the practice patterns of current members of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) in the treatment of medically refractive endophthalmitis (MRE). A 17-question survey included the procedure of choice for MRE, the preferred type of orbital implant, the timing of implant placement, and the incidence of postoperative complications. 107 ASOPRS members participated in the study. In the setting of MRE, 72% preferred evisceration versus 28% who preferred enucleation. Fifty-nine percent of responders preferred enucleation if the MRE extended to orbital tissues versus 27% who would eviscerate. Among those that would place an orbital implant at the initial surgery, 65% would do so during an enucleation and 58% would do so during an evisceration. If an orbital implant was placed at the initial surgery, 52% of responders preferred a silicone implant, while 17% preferred hydroxyapatite implant. A minority of responders (6%) reported “yes” to ever having infectious complications after primary enucleation, compared to 10% after primary evisceration. Overall, 12% of responders noted more frequent complications (other than infectious) when an enucleation was performed compared to 5% for eviscerations. Current opinions on the surgical management of MRE show a trend toward evisceration, with 65% of ASOPRS respondents placing an orbital implant at the time of an enucleation and 58% at the time of an evisceration. Enucleation was preferred when involvement of orbital tissues was apparent. Both evisceration and enucleation remain a viable treatment option for MRE. The most appropriate initial approach is best determined by careful patient selection and informed decision-making by the patient.

Online Ratings of ASOPRS Surgeons: What Do Your Patients Really Think of You?

To characterize patient evaluations of American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) surgeons on a popular online physician rating website in an effort to determine which factors play a role in determining the likelihood of a patient recommending an ASOPRS surgeon to family and friends. After obtaining approval and access from Healthgrades.com, the website database was searched for 612 U.S.-based ASOPRS members using their name as published on http://www.asoprs.org/ as of May 2015. For each surgeon, the total number of ratings and average ratings were recorded under each category. The evaluator recommendation, defined as the response to the questions of "likelihood of recommending Dr. X to family and friends," constituted the main outcome measure. Variables from each surgeon were compared using unpaired t tests, with statistical significance set at p < 0.05. Correlations were analyzed using Spearman correlation (rs), with coefficients of greater than or equal to 0.40 or less than or equal to -0.40 considered significant. Five-hundred nineteen members (85%) had at least 1 rating while 222 members (36%) had 10 or more ratings. The mean number of ratings for all rated members was 11.4 (range, 1-77; standard deviation [SD] = 11.1) and mean evaluator recommendation score was 4.16 (range, 1-5; SD = 0.79). There was a strong negative correlation between total wait time and evaluator recommendation score (rs = -0.409, p < 0.001). The average number of ratings and rating scores for all categories were not significantly different when comparing male with female members. University-employed members had significantly fewer ratings (8.46; range, 1-52; SD = 9.3) compared with other members (11.9; range, 1-77; SD = 11.3) (p < 0.016). There were no differences in any other rating score when comparing those university-employed members with other members. Online patient-reported evaluations of ASOPRS surgeons appear high in many categories. Long wait times correlate strongly with lower recommendation scores. Further study is required to determine how online patient reviews correlate to objective outcome measures, and how these reviews affect surgeon selection by patients.

Editorial introductions

Editorial introductions

The Role of Surgeon Technique in Current Practice Patterns for Combined Ptosis and Dermatochalasis.

The goal of this study is to identify and describe the role of surgical incision preference, insurance reimbursement, and geographical location on the current ptosis repair practice patterns of American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) members. A 9-question survey was designed with surveymonkey.com and a participation link was emailed to all active ASOPRS members' email addresses in February 2015. After a reminder email, the survey was closed and the results were analyzed. There are 3 major questions the survey data is to be used answer: 1) Surgical approach preference: The first question established preferred surgical technique (internal vs. external approach) for ptosis repair. This result was/is used to stratify the remaining responses into 2 groups. 2) Functional versus cosmetic surgical indication: Three clinical scenarios were presented for a functional versus cosmetic patient for ptosis repair and blepharoplasty. 3) Location: The responses were analyzed based on location to determine any geographic bias for surgical preference. For this analysis, the US was separated into 4 regions (West, Midwest, North, and South), as defined by the United States Census Bureau; all international respondents were grouped together. Three hundred and ten responses were included and analyzed; 61% preferred the internal surgical approach, there was no statistical significance to geographic location (p = 0.17). Surgeons who prefer the external surgical approach (76.1%) were more likely than internal (62.5%) to include a bundled (nonreimbursed) blepharoplasty at no additional charge in the setting of functional ptosis repair (p = 0.015). Treatment plans differed significantly in both groups between functional and cosmetic patients with visually significant ptosis (Margin Reflex Distance < 1.5) and moderate dermatochalasis; with both the internal and external group electing combined surgery at a higher rate in cosmetic patients (p < 0.01 for functional vs. cosmetic within each group, and internal vs. external repair). There was no statistical difference in the timeframe for adjusting external ptosis for functional or cosmetic patients (p = 0.79). More surgeons use nonabsorbable closure for cosmetic blepharoplasty patients (68.7%) than for functional (54.1%) surgery patients (p < 0.01). Previous studies have documented the immediate effect of Medicare reimbursement changes on the management of concurrent ptosis and dermatochalasis. This study illustrates current practice patterns for ptosis repair and blepharoplasty. The necessity of creating a separate surgical site for surgeons who prefer the internal approach to ptosis surgery to perform a functional blepharoplasty has a significant influence on surgeon's willingness to perform concurrent blepharoplasty as a nonreimbursed bundled procedure.

Trends in Orbital Decompression Techniques of Surveyed American Society of Ophthalmic Plastic and Reconstructive Surgery Members.

To assess current members of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) regarding preference in surgical techniques for orbital decompression in Graves' disease. A 10-question web-based, anonymous survey was distributed to oculoplastic surgeons utilizing the ASOPRS listserv. The questions addressed the number of years of experience performing orbital decompression surgery, preferred surgical techniques, and whether orbital decompression was performed in collaboration with an ENT surgeon. Ninety ASOPRS members participated in the study. Most that completed the survey have performed orbital decompression surgery for >15 years. The majority of responders preferred a combined approach of floor and medial wall decompression or balanced lateral and medial wall decompression; only a minority selected a technique limited to 1 wall. Those surgeons who perform fat decompression were more likely to operate in collaboration with ENT. Most surgeons rarely remove the orbital strut, citing risk of worsening diplopia or orbital dystopia except in cases of optic nerve compression or severe proptosis. The most common reason given for performing orbital decompression was exposure keratopathy. The majority of surgeons perform the surgery without ENT involvement, and number of years of experience did not correlate significantly with collaboration with ENT. The majority of surveyed ASOPRS surgeons prefer a combined wall approach over single wall approach to initial orbital decompression. Despite the technological advances made in the field of modern endoscopic surgery, no single approach has been adopted by the ASOPRS community as the gold standard.