North American Neuro-Ophthalmology Society Research Articles

The 50th Annual Meeting of the North American Neuro-Ophthalmology Society in Honolulu, Hawaii.

The 50th Annual Meeting of the North American Neuro-Ophthalmology Society in Honolulu, Hawaii.

Demographics, Practice Analysis, and Geographic Distribution of Neuro-Ophthalmologists in the United States in 2023

To assess the demographic characteristics and geographic distribution of neuro-ophthalmologists practicing in the US. A cross-sectional study. Neuro-ophthalmologists across the US. In this cross-sectional study, public databases from the American Academy of Ophthalmology, North American Neuro-ophthalmology Society, American Neurological Association, and American Academy of Neurology were used to identify neuro-ophthalmologists in the US as of April 2023. Providers' office locations were geocoded using ArcGIS pro, version 2.9 (Esri). Data on age, sex, and residency and fellowship training were collected. Analysis was performed using SPSS 28.0 (IBM Corp, Armonk, NY). Neuro-ophthalmologists' demographics, and information about their medical education, post-graduate education, residency training, fellowship training, years in practice, practice environment, and geographic distribution of neuro-ophthalmologists across US. A total of 635 neuro-ophthalmologists (436 male, 68.7%) were identified. The strong majority (599, 94.3%) graduated from an allopathic medical school. Most of the 85 physicians who held a secondary graduate degree had a PhD (54, 63.5%). Although nearly three-quarters (429, 67.6%) completed their residency in ophthalmology, 159 (25%) did residency in neurology and 47 (7.4%) in both. Nearly one-third (191, 30.0%) were trained in more than one fellowship, including oculoplastic (78, 12.3%) or pediatric ophthalmology (53, 8.3%). The average post-fellowship years of experience was 23.8 ±13.7 years, with 134 (21.1%) in their early career (< 10 years), 120 (18.9%) in their mid-careers (10 - 19 years), and 381 (60.0%) in their late careers (> 20 years). Male neuro-ophthalmologists had 10.5 ± 1.1 more years of experience than females (p < 0.001). Three states (Maine, South Dakota, Wyoming) and 2897 counties (93.2%) had no neuro-ophthalmologists. Counties without a neuro-ophthalmologist had lower median income (p < 0.001), lower access to a vehicle (p = 0.024), and lower rates of health insurance (p = 0.012). Practicing neuro-ophthalmologists are mostly male and are often trained in more than one subspecialty. More than half of the practicing neuro-ophthalmologists are in their late careers, which may further exacerbate the existing geographic and socioeconomic disparities in access to neuro-ophthalmology.

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

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. A PubMed search for the terms "social media" AND "neuro-ophthalmology," "social media" AND "ophthalmology," and "social media" AND "neurology" was performed. 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. 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.

Pilot Implementation and Evaluation of an Outpatient Teleneurology Curriculum for Medical Students (S10.007)

<h3>Objective:</h3> To assess the feasibility and outcomes for a novel teleneurology educational curriculum <h3>Background:</h3> Stemming from the COVID-19 pandemic, medical students rotating on neurology electives were asked to participate in telehealth encounters with limited formal teaching and evaluation on the principles and practice of teleneurology. <h3>Design/Methods:</h3> We developed a 2-week outpatient teleneurology curriculum consisting of virtual asynchronous video modules and virtual synchronous patient interactions designed to address AAMC telehealth competencies. It was delivered as a supplement to an established outpatient neurology elective for 4^th year medical students from July 2021-September 2022 at a US medical school. Participation was optional. Assessments included pre and post student self-rated confidence in 6 telehealth competencies on a 4-point scale. Students participated in a summative virtual visit with a neurological patient under direct observation of an attending neurologist well-versed in telehealth. Both the observing neurologist and patient evaluated the student in the telehealth competencies. <h3>Results:</h3> Twenty-six 4^th year medical students participated in the pilot. Each student spent 1 hour viewing asynchronous video modules, and had 454 ± 200.5 (mean+/−SD) minutes of virtual patient contact over 15 ± 8.2 virtual visits. After completing the curriculum, students were 92–100% moderately or very confident regarding their capabilities across telehealth competencies, representing an improvement from 12–96% compared to pre-curriculum (average increase 0.56–1.84 on the 4–point scale; p&lt;0.005 for all competencies). Examination and regulatory competencies demonstrated the greatest improvement. Competencies were rated as effective or very effective for 88–100% of students by patients and 92–100% of students by faculty during the summative visit. <h3>Conclusions:</h3> This pilot teleneurology curriculum demonstrated that students not only increased in self-rated confidence in performing telehealth competencies, but also demonstrated meeting these competencies in the opinion of both physician and patient observers. Further research into effective methods for integrating telehealth competencies into the neurology and broader medical school curriculum is warranted. <b>Disclosure:</b> Dr. Ko has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AAN. The institution of Dr. Ko has received research support from HRSA. Dr. Ko has received research support from IU Health. Dr. Moss has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Twenty Twenty Therapeutics. Dr. Moss has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Verana Health. Dr. Moss has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Medlink Inc. Dr. Moss has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Legal Firms. The institution of Dr. Moss has received research support from NIH. The institution of Dr. Moss has received research support from Department of Defense. The institution of Dr. Moss has received research support from Research to Prevent Blindness. Dr. Moss has received personal compensation in the range of $0-$499 for serving as a grant review panel with NASA. Dr. Moss has received personal compensation in the range of $0-$499 for serving as a grant review panel with National Institutes of Health. Dr. Moss has a non-compensated relationship as a Board of Directors with North American Neuro-ophthalmology Society that is relevant to AAN interests or activities. Dr. Mackay has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for various law firms. Dr. Ko has nothing to disclose. Dr. Chartier has received personal compensation in the range of $50,000-$99,999 for serving as a Instructional Design Consultant, IU School of Medicine PRIME Grant with Health Resources &amp; Services Administration. Dr. Reese has nothing to disclose. Dr. Wallach has nothing to disclose. The institution of Dr. Allen has received research support from AMA Accelerating Change in Medical Educaiton Program. The institution of Dr. Allen has received research support from HRSA Medical Education Program Grant.

Advancing knowledge and clinical development in frontotemporal dementia (FTD) using the American Academy of Neurology’s (AAN) Axon Registry® (S15.007)

<h3>Objective:</h3> Evaluate feasibility of a registry-based approach to real-world research and trial recruitment for FTD. <h3>Background:</h3> FTD is a rare, disabling disease with no cure. Registries play an important role in understanding rare diseases and also have application to identifying clinical trial candidates. The Axon Registry includes electronic health record data (EHR) of more than 3.1 million patients from over 150 U.S. neurology practices. We assessed the utility of the Axon Registry to support FTD trial recruitment by characterizing FTD patients identified. <h3>Design/Methods:</h3> We performed a retrospective cohort analysis of patients between 25 and 85 years old with FTD (≥1 FTD ICD code and no other neurodegenerative disease ICD codes) between 09/16/2017 to 09/16/2021. Patients with &lt;12 months of follow-up were excluded. Structured data was used to assess demographics, outpatient follow-up, and comorbidities. <h3>Results:</h3> Of 3,031 patients with ≥1 FTD ICD code, 698 met the eligibility criteria. Of excluded patients, 46.6% had other neurodegenerative disease ICD codes at some point. The eligible cohort had age of 60.9±9.2 (mean±standard deviation) years and was 50.0% female. Among patients with known race and ethnicity, 91.7% were White, 5.4% were Black, and 6.2% were Hispanic. A third (33.8%) of patients were seen at neurology practices that did not have experience with trials. Patients had on average 4.0 encounters within their first year in the Axon Registry with visit frequency decreasing to 2.5 encounters during the second year. Memory loss (47.7%), aphasia (17.9%), and psychiatric symptoms (anxiety, depression) (24.9%) were the most common concomitant diagnoses. <h3>Conclusions:</h3> EHR data in the Axon Registry can be used to surface patients with FTD. While minority patients are likely underrepresented, we identified 698 potential FTD clinical trial subjects, including 236 who were seen at non-trial experienced practices. Pairing the Axon Registry with provider outreach and education might expand access to clinical trials. <b>Disclosure:</b> Mrs. Oliver has received personal compensation for serving as an employee of Verana Health. Mrs. Oliver has stock in Verana Health. Mrs. Kane has received personal compensation for serving as an employee of The Association for Frontotemporal Degeneration. Dr. Dodge has received personal compensation for serving as an employee of The Association for Frontotemporal Degeneration. Mr. Doherty has received personal compensation for serving as an employee of Verana Health. An immediate family member of Mr. Doherty has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Delfi Diagnostics. Mr. Goldfeder has received personal compensation for serving as an employee of Verana Health. Mrs. Popescu has nothing to disclose. Ms. Li has received personal compensation for serving as an employee of Verana Health. Ms. Li has a non-compensated relationship as a Strategic Partnerships lead with Verana Health that is relevant to AAN interests or activities. Dr. Torres has received personal compensation for serving as an employee of Verana Health. Dr. Moss has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Twenty Twenty Therapeutics. Dr. Moss has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Verana Health. Dr. Moss has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Medlink Inc. Dr. Moss has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Legal Firms. The institution of Dr. Moss has received research support from NIH. The institution of Dr. Moss has received research support from Department of Defense. The institution of Dr. Moss has received research support from Research to Prevent Blindness. Dr. Moss has received personal compensation in the range of $0-$499 for serving as a grant review panel with NASA. Dr. Moss has received personal compensation in the range of $0-$499 for serving as a grant review panel with National Institutes of Health. Dr. Moss has a non-compensated relationship as a Board of Directors with North American Neuro-ophthalmology Society that is relevant to AAN interests or activities.

Identifying Multiple Sclerosis Relapses from Clinical Notes Using Combined Rule-based and Deep Learning Methodologies (P3-3.001)

<h3>Objective:</h3> To develop an algorithm to extract multiple sclerosis (MS) relapse events from clinical notes from the American Academy of Neurology Axon Registry, a neurology-specific patient registry that uses real-world electronic health record (EHR) data. <h3>Background:</h3> Relapse frequency is a key outcome measure for MS patients, indicating disease activity. MS relapses are often documented in unstructured clinical notes rather than structured fields in the EHR, and mechanisms to automatically extract this information will better enable real-world evidence (RWE) studies. <h3>Design/Methods:</h3> As of May 2022, 46,600 MS patients were identified using structured ICD codes and mention of MS in clinical notes from 3.2 million patients and their 24 million patient visits in the Axon Registry. A combined rule-based, deep learning (DL) approach was developed to classify, at a given encounter, the relapse status (current relapse, no relapse, discussion of past relapse only, or unknown) of these patients. A thousand notes were randomly sampled from MS patient notes containing relapse phrases, identified via string searches. These notes were labeled by a clinical expert for their relapse statuses to generate training, validation, and testing sets (70-15-15 split). Using the training and validation sets, a DL model was trained to classify notes into one of the relapse statuses. Performance was assessed on the test set. <h3>Results:</h3> The model had an overall accuracy of 0.88. For current relapse status, a sensitivity of 0.83 and specificity of 0.97 were achieved. Identified MS patients averaged 0.58+/−0.55 relapses/year and the proportion of patients with relapses decreased over time (2014: 14.74% vs. 2021: 9.86%), consistent with clinical expectations. <h3>Conclusions:</h3> We used a combined rule-based, DL methodology to extract relapses from clinical notes. Performance metrics and clinically consistent patterns found in the results provide confidence to support using this scalable algorithm for RWE studies. <b>Disclosure:</b> Dr. Chin has received personal compensation for serving as an employee of Verana Health. Dr. Moss has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Twenty Twenty Therapeutics. Dr. Moss has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Verana Health. Dr. Moss has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Medlink Inc. Dr. Moss has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Legal Firms. The institution of Dr. Moss has received research support from NIH. The institution of Dr. Moss has received research support from Department of Defense. The institution of Dr. Moss has received research support from Research to Prevent Blindness. Dr. Moss has received personal compensation in the range of $0-$499 for serving as a grant review panel with NASA. Dr. Moss has received personal compensation in the range of $0-$499 for serving as a grant review panel with National Institutes of Health. Dr. Moss has a non-compensated relationship as a Board of Directors with North American Neuro-ophthalmology Society that is relevant to AAN interests or activities. Ms. Sands has received personal compensation for serving as an employee of Verana Health. Ms. Sands has received personal compensation for serving as an employee of Tempus Labs. Dr. Kocher has received personal compensation for serving as an employee of Verana Health. Mr. AKKAS has nothing to disclose. Dr. Torres has received personal compensation for serving as an employee of Verana Health.

Multi-registry Analysis of Patients with Multiple Sclerosis (MS) and Neuromyelitis Optica (NMO) to Improve Capture of Demographic Data and Compare Visual Outcomes (P2-9.006)

<h3>Objective:</h3> To combine American Academy of Neurology Axon Registry® data and American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) data to reduce missingness of demographic information and characterize visual outcomes in patients with MS and NMO. <h3>Background:</h3> The Axon Registry provides real-world data for patients with MS and NMO. However, some data are incomplete (e.g. demographics) and some relevant outcomes are not systematically captured in neurology documentation (e.g. visual acuity [VA]). The IRIS Registry contains demographic and visual function data that may complement Axon Registry-derived data to enhance understanding of real-world outcomes. <h3>Design/Methods:</h3> In this cross-sectional study, participants were included if they had repeated ICD-9/10 codes for MS or NMO in the Axon Registry and overlapped temporally in both registries. Age, sex, race, ethnicity and US census region were extracted and classified as conflicting, missing, and not missing in the combined data set. The IRIS Registry contributed VA data. <h3>Results:</h3> Among 60,316 patients with MS and 1,068 patients with NMO in the Axon Registry, 14,085 and 252 had temporal overlap in the IRIS Registry. When we combined data for the MS cohort, there was a 9–18% absolute reduction in missing or conflicting data for race, ethnicity, and location (all p=&lt;0.0005, McNemar), but not age (p=1.0, McNemar) or sex (p=0.08, McNemar). For patients in both registries, 10,907 with MS and 142 with NMO had VA data. VA was worse in patients with NMO (0.17 logMAR, 95%CI 0.12,0.21, p&lt;0.0005, linear model with age, gender). <h3>Conclusions:</h3> Using data from two registries reduced missing data for race, ethnicity and location and enabled examination of outcomes captured in the IRIS Registry for conditions that are diagnosed more frequently in the Axon Registry, demonstrating the utility of a multi-registry analysis. <b>Disclosure:</b> Dr. Moss has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Twenty Twenty Therapeutics. Dr. Moss has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Verana Health. Dr. Moss has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Medlink Inc. Dr. Moss has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Legal Firms. The institution of Dr. Moss has received research support from NIH. The institution of Dr. Moss has received research support from Department of Defense. The institution of Dr. Moss has received research support from Research to Prevent Blindness. Dr. Moss has received personal compensation in the range of $0-$499 for serving as a grant review panel with NASA. Dr. Moss has received personal compensation in the range of $0-$499 for serving as a grant review panel with National Institutes of Health. Dr. Moss has a non-compensated relationship as a Board of Directors with North American Neuro-ophthalmology Society that is relevant to AAN interests or activities. Lauren Wiener has received personal compensation for serving as an employee of Verana Health. Ms. Rizy has received personal compensation for serving as an employee of Verana Health. Ms. Rizy has stock in Verana Health. Dr. Baxi has received personal compensation for serving as an employee of Verana health . Dr. Kocher has received personal compensation for serving as an employee of Verana Health. Dr. Torres has received personal compensation for serving as an employee of Verana Health. Dr. Mbagwu has received personal compensation for serving as an employee of Verana Health. Dr. Mbagwu has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Verana Health. Dr. Mbagwu has received research support from Stanford University. Dr. Mbagwu has received intellectual property interests from a discovery or technology relating to health care.

Inter- and Intra-Rater Reliability of a Virtual Concussion Assessment During the Era of the COVID-19 Pandemic (P8-1.004)

<h3>Objective:</h3> To assess inter-examiner agreement of virtual concussion telemedicine examinations and to determine agreement of virtual and in-person concussion examinations performed by the same physician. <h3>Background:</h3> We developed a virtual concussion telemedicine examination by adapting several in-office examination methods. The virtual exam was compared to the in-person concussion exam to examine reliability and to validate the use of telemedicine via audio-video conferencing technology. <h3>Design/Methods:</h3> A virtual concussion examination form with instructions on how to perform this was developed. The standardized examination included 29 elements, such as orthostatic tolerance, ocularmotor exam, and balance tests. We enrolled 21 participants referred for an initial concussion evaluation at the NYU Concussion Center. Two virtual concussion telemedicine examinations were conducted in the office setting following study enrollment; one examination was perfomed by the treating physician and another was compled by another physician. The in-person concussion examination was then performed by the treating physician. We used Cohen’s Kappa to determine inter-modality and inter-examiner agreement. <h3>Results:</h3> We determined Cohen’s kappa to assess agreement on dichotomous examination ratings for each of 29 exam elements across 21 participants. Kappa values for inter-examiner agreement ranged from 0.31–1.0, with median kappa=0.76; 45% of exam elements had excellent inter-examiner agreement between the two telemedicine examiners (kappa&gt;0.75), while 75% of exam elements had at least intermediate inter-examiner agreement for telemedicine examiners (kappa&gt;0.40). Within the same examiner for telemedicine vs. in-person examinations, Cohen’s kappa values were even higher, with values ranging from 0.48–1.0 overall. <h3>Conclusions:</h3> We found that the treating physician’s virtual and in-person concussion examination findings largely agreed. However, there was less agreement between virtual concussion examinations performed by two different physicians. This suggests that expertise and experience of examining physicians contribute more to variability than do modality or area of the examination. This study sets the stage for investigations of reliability between in-person and teleneurology examinations. <b>Disclosure:</b> Ms. Jack has nothing to disclose. Miss Digney has nothing to disclose. Mr. Bell has nothing to disclose. Binu Joseph has nothing to disclose. Ms. Hyman has nothing to disclose. Dr. Galetta has nothing to disclose. An immediate family member of Dr. Balcer has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Children’s Hospital of Philadelphia. Dr. Balcer has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for North American Neuro-Ophthalmology Society. Prof. Willer has nothing to disclose. Mr. Haider has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for BlinkCNS. The institution of Mr. Haider has received research support from NIH. Dr. Saleem has nothing to disclose. Dr. Grossman has nothing to disclose. Dr. Leddy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Neurolign. Dr. Leddy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Stage 2 Contract Engineering. Dr. Leddy has received stock or an ownership interest from Highmark Innovations. The institution of Dr. Leddy has received research support from NIH. The institution of Dr. Leddy has received research support from DoD. The institution of Dr. Leddy has received research support from AMSSM. Dr. Busis has received personal compensation in the range of $500-$4,999 for serving as a Consultant for American Academy of Neurology. Dr. Busis has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology Today. Dr. Torres has received publishing royalties from a publication relating to health care.

MICK (Mobile Integrated Cognitive Kit) App: Feasibility of an Accessible Tablet-Based Rapid Picture and Number Naming Task for Concussion Assessment in a Youth Ice Hockey League (P2-9.005)

<h3>Objective:</h3> We evaluated the capacity of the Mobile Universal Lexicon Evaluation System (MULES, rapid picture naming) and Staggered Uneven Number (SUN) testing to be effective during pre-season baseline testing in a cohort of youth athletes using a novel and freely-available app (Mobile Integrated Cognitive Kit, MICK) and paper-pencil testing. <h3>Background:</h3> Visual symptoms are common following concussion. Rapid automatized naming (RAN) tasks are effective for identifying individuals with concussion and with other neurological disorders, such as multiple sclerosis, Parkinson’s disease and mild cognitive impairment (MCI) due to Alzheimer’s disease. The MULES test of picture naming and the SUN test of number naming demonstrate increased time scores (worse performance) after concussion. <h3>Design/Methods:</h3> Participants from a youth hockey league (n=59, median age 13 years, range 6–17) underwent pre-season testing. Each participant completed two trials of MULES and SUN. Children &lt;10 years of age completed paper versions, while children aged 10 or greater used the MICK app. The app records completion times for each trial and is semi-automated for use while supervised by research staff. <h3>Results:</h3> As noted in prior studies, learning effects were noted between the two baseline trials for both the MULES (median improvement=11.3 sec, range=−32.3–92.0 sec, <i>p</i>&lt;0.001, Wilcoxon sign-rank test) and SUN (median improvement=0.78 sec, range=−8.0–15.1 sec, <i>p</i>=0.002). Median best baseline for the MULES was 50.4 sec (range=34.2–141.0 sec) and for SUN 71.1 sec (range=36.6–200.0 sec). Age was a predictor of best baseline times for both tests, with longer times for younger participants for MULES (<i>p</i>&lt;0.001, <i>r</i>_<i>s</i>=−0.67, Spearman rank correlation) and SUN (<i>p</i>&lt;0.001, <i>r</i>_<i>s</i>=−0.54). Degrees of learning effect did not vary across age groups in this cohort (<i>p</i>=0.14, <i>r</i>_<i>s</i>=−0.20). <h3>Conclusions:</h3> Vision-based RAN tasks, such as the MULES and SUN, can be feasibly administered using the MICK app during pre-season baseline testing in youth sports teams. These data provide a foundation for post-injury sideline testing among youth athletes. <b>Disclosure:</b> Ms. Hyman has nothing to disclose. Mr. Blacker has nothing to disclose. Mr. Bell has nothing to disclose. Marc Balcer has nothing to disclose. Binu Joseph has nothing to disclose. Dr. Galetta has nothing to disclose. An immediate family member of Dr. Balcer has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Children’s Hospital of Philadelphia. Dr. Balcer has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for North American Neuro-Ophthalmology Society. Dr. Grossman has nothing to disclose.

Impact of COVID-19 on Neuro-Ophthalmology in the United States: A National Survey.

To evaluate the impacts of the COVID-19 on neuro-ophthalmology practice in the United States. Cross-sectional study. The North American Neuro-ophthalmology Society distributed a survey on the impact of COVID-19 on neuro-ophthalmic practice to its members. The survey consisted of 15 questions regarding the impact of the pandemic on neuro-ophthalmic practice and perspectives. Twenty-eight neuro-ophthalmologists practicing in the United States responded to our survey. In this survey, 64% of survey respondents were male (n = 18), while 36% were female (n = 10). The average age of a respondent was 55 years old. According to 77% of survey respondents, various neuro-ophthalmic diseases were reported to have worsened during the pandemic including idiopathic intracranial hypertension, compressive optic neuropathy, optic neuritis, and giant cell arteritis. This survey represents one of the largest studies to describe the impact of the COVID-19 pandemic of neuro-ophthalmology. Given the underrepresentation of neuro-ophthalmology in the United States as described in the literature, this study strengthens the need for more neuro-ophthalmologists to provide timely care, particularly during the pandemic. Further interventions to incentivize the pursuit of neuro-ophthalmology training may help combat the effects of COVID-19 on neuro-ophthalmic conditions.

Sociodemographic and Geographic Variation in Access to Neuro-Ophthalmologists in the United States.

Neuro-ophthalmologists have expertise in rare and complex disorders, but the ability of patients to access neuro-ophthalmic care has not been examined at a nationwide level. Using the 2020 directory of all 502 members of the North American Neuro-Ophthalmology Society as a reference, we found the practice locations of 461 confirmed practicing members and converted each street address to latitude and longitude coordinates. We calculated the travel distance and time from each census tract to the nearest practice location and calculated population-weighted averages by state, region, and other prespecified factors. Choropleth maps were used to visualize the distribution of travel distances and times across the United States. California had the most practicing neuro-ophthalmologists out of any state (50), whereas 4 states (DE, MT, SD, and WY) had none. Washington, DC and MA had the most neuro-ophthalmologists per capita. The average travel distance and time to the nearest neuro-ophthalmologists were found to be 40.90 miles and 46.50 minutes, respectively, although a large portion of western plains and mountain regions had travel times of over 120 minutes. Patients in rural areas had longer travel times than those in urban areas, and Native American patients had the longest travel times of any racial or ethnic group. The travel time to see a neuro-ophthalmologist varies widely by state, region, and rurality, with Native American patients and rural patients being disproportionately affected. By identifying the areas with the greatest travel burdens, future policies can work to alleviate these potential barriers to care.

A Validated Method to Identify Neuro-Ophthalmologists in a Large Administrative Claims Database.

Validated methods to identify neuro-ophthalmologists in administrative data do not exist. The development of such method will facilitate research on the quality of neuro-ophthalmic care and health care utilization for patients with neuro-ophthalmic conditions in the United States. Using nationally representative, 20% sample from Medicare carrier files from 2018, we identified all neurologists and ophthalmologists billing at least 1 office-based evaluation and management (E/M) outpatient visit claim in 2018. To isolate neuro-ophthalmologists, the National Provider Identifier numbers of neuro-ophthalmologists in the North American Neuro-Ophthalmology Society (NANOS) directory were collected and linked to Medicare files. The proportion of E/M visits with International Classification of Diseases-10 diagnosis codes that best distinguished neuro-ophthalmic care ("neuro-ophthalmology-specific codes" or NSC) was calculated for each physician. Multiple logistic regression models assessed predictors of neuro-ophthalmology specialty designation after accounting for proportion of ophthalmology, neurology, and NSC claims and primary specialty designation. Sensitivity, specificity, and positive predictive value (PPV) for varying proportions of E/M visits with NSC were calculated. We identified 32,293 neurologists and ophthalmologists who billed at least 1 outpatient E/M visit claim in 2018 in Medicare. Of the 472 NANOS members with a valid individual National Provider Identifier, 399 (84.5%) had a Medicare outpatient E/M visit in 2018. The model containing only the proportion of E/M visits with NSC best predicted neuro-ophthalmology specialty designation (odds ratio 1.05 [95% confidence interval 1.04, 1.05]; P < 0.001; area under the receiver operating characteristic [AUROC] = 0.91). Model predictiveness for neuro-ophthalmology designation was maximized when 6% of all billed claims were for NSC (AUROC = 0.89; sensitivity: 84.0%; specificity: 93.9%), but PPV was low (14.9%). The threshold was unchanged when limited only to neurologists billing ≥1% ophthalmology claims or ophthalmologists billing ≥1% neurology claims, but PPV increased (33.3%). Our study provides a validated method to identify neuro-ophthalmologists who can be further adapted for use in other administrative databases to facilitate future research of neuro-ophthalmic care delivery in the United States.

Valérie Biousse: a leader in neuro-ophthalmology

Valérie Biousse: a leader in neuro-ophthalmology

Gender Representation Among Presenters in Ophthalmology Subspecialties in 2019: A Retrospective Review

To describe gender representation at 8 national ophthalmology conferences, stratified by role, session category, and subspecialty. Retrospective cross-sectional study. Data were examined on 3817 presenters at the 2019 American Academy of Ophthalmology subspecialty days, American Society of Cataract and Refractive Surgery, American Glaucoma Society, American Society of Retina Specialists, American Society of Ophthalmic Plastic and Reconstructive Surgery, American Association for Pediatric Ophthalmology and Strabismus, North American Neuro-OphthalmologySociety, and American Uveitis Society meetings. The main outcome measure was the gender of presenters in 7 subspecialties, stratified by category and role. The proportion of female presenters was less than the American Board of Ophthalmology (ABO)-estimated proportion of women in their respective fields in glaucoma (28.0% vs 39.8%), neuro-ophthalmology (35.3% vs 45.3%), and pediatrics (42.1% vs 53.3%) and greater than expected in retina (24.6% vs 19.8%). Overall, the proportion of female presenters exceeded the ABO-estimated proportion of women in ophthalmology (24.5%) for clinical (mean=38.5%, 95% CI [35.8%, 41.4%]) and scientific (39.4% [30.3%, 49.2%]) sessions. For clinical subspecialty sessions, the proportion of female leaders exceeded the overall proportion of female leaders in the respective subspecialty in cornea (35.1% [30.4%, 40.1%] vs 24.6% all sessions). Females represented fewer than the expected number of surgical session leaders in cornea (22.0% [19.9%, 24.3%]), glaucoma (18.0% [13.2%, 24.1%]), pediatrics (22.0% [14.4%, 32.1%]), and retina (18.6% [14.2%, 24.1%]). Gender representation varied, with fewer than expected female presenters in glaucoma, neuro-ophthalmology, and pediatrics. Women led relatively more clinical sessions but were underrepresented in surgical sessions in most subspecialties.

The 48th Annual Meeting of the North American Neuro-Ophthalmology Society in Austin, Texas.

The 48th Annual Meeting of the North American Neuro-Ophthalmology Society in Austin, Texas.

Open Educational Repository Produces Licensed Resources to Sustain Project

The Neuro-Ophthalmology Virtual Education library (NOVEL) is a partnership between the Spencer S. Eccles Health Sciences Library (EHSL) at the University of Utah and the North American Neuro-Ophthalmology Society (NANOS) that resulted in a peer reviewed digital collection of educational publications, journal articles, conference proceedings, a patient portal, and an illustrated curriculum of neuro-ophthalmology resources. This unique and innovative collaboration has evolved and expanded for more than 18 years. The partnership takes advantage of the strengths of each organization and combines them to create valuable scholarly products that support education and research in neuro-ophthalmology.

Gender of Award Recipients in Major Ophthalmology Societies

To assess the gender distribution of major ophthalmology society award recipients DESIGN: Retrospective, observational study METHODS: The study population included award recipients from 9 ophthalmologic societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Glaucoma Society, American Society of Cataract and Refractive Surgery (ASCRS), American Society of Ophthalmic Plastic and Reconstructive Surgery, American Society of Retina Specialists, American Uveitis Society, Cornea Society, and North American Neuro-Ophthalmology Society. A gender-specific pronoun and a photograph of each award recipient were extracted from professional websites to assign their gender. Main outcome measures were gender distribution by award society, year (1970-2020), type (lectureship or not), category (achievement, education, research contribution, research item, international member achievement, public service-global health, service to society), and training level. Out of 2,150 recipients for 78 awards, 1,606 (74.7%) were men and 544 (25.3%) were women. The proportion of women recipients increased from 0% in 1970 to 33.2% in 2020 (P < .001). Women representation varied within each society (P < .01), with ASCRS having the highest percentage (40.8%). Women received 11.0% of awards accompanied by a lecture. Women received a significantly greater proportion of research-related awards than achievement or service awards. Awards for trainees and early-career ophthalmologists had a greater proportion of women (39.8%) than the rest of the awards (21.5%) (P < .001). Overall, women received awards (25.3%) at a higher rate than the average 1970-2020 American gender distributions of ophthalmologists. However, women are still under-represented in many award categories and subspecialties.

The 47th Annual Meeting of the North American Neuro-Ophthalmology Society Occurring Virtually.

The 47th Annual Meeting of the North American Neuro-Ophthalmology Society Occurring Virtually.

Factors Affecting Ophthalmology Resident Choice to Pursue Neuro-Ophthalmology Fellowship Training.

The number of ophthalmology-trained residents applying to neuro-ophthalmology fellowships has not increased despite a trend toward seeking fellowship training after residency. This study sought to identify factors affecting the choice to pursue or not pursue neuro-ophthalmology fellowship training by graduating ophthalmology residents and recently graduated neuro-ophthalmology fellows. An anonymous survey was sent to Association of University Professors of Ophthalmology residency directors to distribute to post-graduate Year 4 (PGY4) ophthalmology residents graduating in either 2018 or 2019. A second anonymous survey was distributed via the North American Neuro-Ophthalmology Society (NANOS) Young Neuro-Ophthalmologists listserv to ophthalmology-trained neuro-ophthalmology fellows. A total of 147 respondents, including 96 PGY4 ophthalmology residents not going into neuro-ophthalmology and 51 practicing neuro-ophthalmologists are included. The most common reasons for residents to choose to not pursue further training in neuro-ophthalmology included a stronger interest in other fields, types of patients seen, no intraocular surgery, and the assumption that it is a nonsurgical discipline. The leading factors influencing graduated, ophthalmology-trained fellows to choose neuro-ophthalmology included interest in the clinical diseases treated, interaction with other specialty fields, and a supportive NANOS culture. Interestingly, despite perceptions of graduating residents, two-thirds of the neuro-ophthalmologists surveyed perform surgery. There were no differences between the 2 groups with respect to the degree of exposure to neuro-ophthalmology in medical school, presence of a dedicated neuro-ophthalmology rotation in residency, or timing of the rotation. There are a variety of factors influencing decisions regarding pursuing neuro-ophthalmology fellowship among ophthalmology residents. The perceived lack of surgical opportunities in neuro-ophthalmology is a deterrent for many. However, a significant number of neuro-ophthalmologists continue to perform surgery, including intraocular surgery. Repeated exposure later in residency may provide an opportunity to reconsider the field and to re-emphasize opportunities to remain surgically involved as a neuro-ophthalmologist. Exposure to the practice patterns of recently graduated neuro-ophthalmologists offers residents in training excellent exposure to the contemporary practice of neuro-ophthalmology. Hence, ensuring trainees receive a balanced exposure to practicing neuro-ophthalmologists across the spectrum of seniority and scope of practice may promote greater interest among ophthalmology residents to pursue a career in neuro-ophthalmology.

Mismatch in Supply and Demand for Neuro-Ophthalmic Care.

Previous research suggests the number of neuro-ophthalmologists in the United States may be below a level that provides sufficient access to neuro-ophthalmic care in much of the United States. However, national estimates of the amount of clinical time spent on neuro-ophthalmology are lacking. The North American Neuro-Ophthalmology Society administered a survey on professional time allocation to its active members. Survey response was 95%. The survey characterized the hours each week each respondent allocated to overall work, clinical work, clinical work in ophthalmology/neurology, and clinical work in neuro-ophthalmology specifically. The survey additionally collected information regarding demographics, current wait times to be seen for new patients, and the difference in clinical time spent in neuro-ophthalmology spent between the current day compared with that shortly after completing clinical training. Linear regression was used to identify potential relationships between the above and average wait time. On average, responding physicians spent 70% of their clinical time on neuro-ophthalmology. In 6 states, there were no reported practicing neuro-ophthalmologists, and in only 8 states was the clinical full-time equivalent to population ratio below the suggested threshold of 1 for every 1.2 million. The median wait time for a new patient was 6 weeks. This wait time was associated with the fraction of clinical time spent in neuro-ophthalmology (0.2 weeks longer wait for a 10 percentage point increase in the fraction of time spent in neuro-ophthalmology; P = 0.02), and suggestively associated with training (training in ophthalmology was associated with 1.0 week shorter wait time; P = 0.06). The survey suggests that neuro-ophthalmologists are unable to see patients in a timely manner and a decreasing number of clinicians are entering the field. Future interventions should be considered to incentivize neuro-ophthalmology training in ophthalmology and neurology residents such that the United States population is able to appropriately access neuro-ophthalmic care.