Ophthalmology Residents Research Articles

Attending Perceptions on the Use of Preference Signaling in the Ophthalmology Residency Application Process.

Objective This article characterizes perspectives of ophthalmologists involved in the residency selection process regarding the potential impact of preference signaling on the ophthalmology residency match. Methods An anonymous online questionnaire generated from SurveyMonkey was approved by the Association of University Professors of Ophthalmology (AUPO) Data Resource Committee for distribution to 391 individuals from the AUPO Departmental Chairs, Program Directors, and Directors of Medical Student Education email listservs in August 2022. Results A total of 96 (24.6%) ophthalmology faculty completed the questionnaire. The majority ( n = 76, 79.2%) agreed or strongly agreed that preference signaling should be implemented in the ophthalmology residency application system. Most respondents agreed or strongly agreed that preference signaling will allow for more holistic reviews of applications ( n = 55, 57.3%), agreed or strongly agreed that it will benefit applicants who do not have connections to home programs or faculty that can reach out to desired programs ( n = 81, 84.4%), and agreed or strongly agreed that it will improve the distribution of interviews to applicants ( n = 76, 79.2%). Participants agreed or strongly agreed that applicants who have signaled interest in their program will receive preference when offering interviews ( n = 59, 61.5%), and those signals will be used as a tiebreaker for similar applications ( n = 75, 78.1%). The majority of participants believed that the ideal number of preference signals' applicants should be given three to four signals ( n = 35, 36.0%) or five to six signals ( n = 29, 30.2%). Conclusion A majority of ophthalmology faculty surveyed support the integration of preference signaling into the ophthalmology residency match.

Perspectives of Resident and Attending Ophthalmologists on Common Ethical Dilemmas in Research.

Purpose To assess how resident and attending ophthalmologists perceive and evaluate ethically controversial scenarios regarding mentorship, authorship, and ethics compliance that may occur during research involving residents. Methods An online survey was developed and contained 14 controversial vignettes based on common research scenarios that can occur when conducting research with trainees. The scenarios were designed to capture issues regarding three themes: mentorship, authorship, and compliance with ethical guidelines. Resident and attending ophthalmologists at eight military and civilian academic residency programs in the United States were invited to participate. Respondents used a Likert scale to assess the ethicality of the situations in addition to self-reported demographic characteristics. Results The response rate was 35.6% (77/216), consisting of 37.7% ( n = 29) residents and 62.3% ( n = 48) attendings. More attending ophthalmologists responded than residents ( p = 0.004). Many respondents identified controversies around compliance (67.3%) and authorship (57.1%) as unethical, whereas situations regarding mentorship were largely viewed as neutral to ethical (68.0%). Responses to two scenarios, one regarding mentorship and one regarding authorship, significantly differed between residents and attendings ( p = 0.001 and p = 0.022, respectively). Conclusion Academic ophthalmologists' perceptions of the ethicality of common research scenarios varied. There is a need for more prescriptive guidelines for authorship and mentorship ethics at all training levels to ensure consistency, fairness, and integrity of research.

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 Jimmy K. LeeJimmy K. LeeDr Jimmy Lee specializes in laser vision correction surgery. His surgical expertise also includes complex cataract surgery, anterior segment reconstruction, all forms of corneal transplantation, and limbal stem cell transplantation. Dr Lee's research interests are new technologies in refractive surgery and improving surgical techniques for endothelial keratoplasty (DSAEK and DMEK). A member of the American Academy of Ophthalmology and American Society of Cataract and Refractive Surgery, he has extensively lectured nationally and internationally on these topics. A Phi Beta Kappa graduate from Johns Hopkins University, USA, Dr Lee obtained his medical degree from Cornell University Medical College, USA. Following his residency at Albert Einstein Montefiore Hospital, he completed a fellowship in cornea, external diseases, and refractive surgery at the Wilmer Eye Institute of The Johns Hopkins Hospital and is a Diplomate of the American Board of Ophthalmology. Shahzad I. MianShahzad I. MianShahzad I. Mian, M.D., is a professor of ophthalmology and visual sciences in the University of Michigan Medical School. He also serves the Department as Vice Chair for Clinical Sciences and Learning. Dr. Mian earned his medical degree in 1996 from the Emory University School of Medicine. He then completed a residency at the Wills Eye Hospital of Thomas Jefferson University in Philadelphia. From 2000-02, he was a fellow in cornea and refractive surgery at Harvard Medical School, Massachusetts Eye and Ear Infirmary. He joined the U-M faculty in 2002 and was promoted to associate professor with tenure in 2010. He became professor of ophthalmology and visual sciences in 2016. His research focuses on eye banking, keratoplasty techniques, and ocular graft versus host disease. He served as director of the residency training program between 2004 and 2019 and previously served as fellowship director in the department. In 2003 and 2012, he received the Bergstrom Teaching Award presented by ophthalmology residents. Dr. Mian received the 2007 Anthony Adamis Award for Outstanding Research from the U-M Kellogg Eye Center, and the Senior Achievement Award from the American Academy of Ophthalmology. He received the Straatsma Award for resident education from the Association of University Professors in Ophthalmology in 2017 and the Payton Award for Eye banking from the Eye Bank Association of America in 2019. He serves as the Senior Medical Director for Eversight Eye banks as well as on the Board of Directors. He also serves on the Board of Directors for the Cornea Society and the Eye Bank Association of America. He also serves on the Residency Review Committee for Ophthalmology.

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

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

The Matthew Effect: Prevalence of Doctor and Physician Parents among Ophthalmology Applicants.

Objective This article determines the prevalence of physician parents among ophthalmology residency applications. Design Retrospective, single-center cohort study. Subjects All applicants to the University of Kentucky Ophthalmology Residency between 2018 and 2023. Methods Residency applications were reviewed, with data collection including applicant gender, self-identified Under-Represented in Medicine (URiM) status, United States Medical Licensing Examination (USMLE) Step 1 score, USMLE Step 2 score, and whether the application identified a doctor or physician as a parent. Doctor was defined as a profession requiring a doctorate degree, and similarly, physician as a profession requiring a medical degree. Results A total of 2,057 applications were reviewed, representing 54% of all match participants during the study period. Fourteen percent (296) of applications indicated a parent was a doctor and 12% (253) a parent was a physician. There were no differences between gender, URiM, USMLE Step 1, and Step 2 scores between applicants indicating a doctor or physician as a parent and those that did not ( p all > 0.4 and Cohen's d all < 0.02). Of the type of doctors, 85% (253) were physicians, 6% (17) optometrists, 6% (17) Doctors of Philosophy, 3% (8) dentists, 1% (1) pharmacist, and 1% (1) veterinarian. Eighty-six percent (217) of applications with a physician parent provided the type of physician, with ophthalmologist the most common (93, 43%). Ninety-eight percent (249) of applications with a physician parent provided the gender of the parent, with father (168, 68%) more common than mother (42, 17%) or both parents (39, 16%). Conclusion Physician parents are substantially overrepresented in ophthalmology residency applicants. This raises concerns regarding diversity and inclusion efforts for recruitment in medicine.

The Big Data Gap: Asymmetric Information in the Ophthalmology Residency Match Process and the Argument for Transparent Residency Data.

Background The ophthalmology match is an important step for graduating medical students that defines their future career. Residency programs demonstrate significant variability due to differences in size, location, research output, subspecialty exposure, surgical case load, and alumni fellowship/practice placement. Despite the importance of informed decision-making, applicants often find limited, inconsistent information about potential programs. Purpose The purpose of this study was to characterize and identify gaps in the information available to residents in the 2022 to 2023 Match. Methods The SFMatch Web site was reviewed to identify programs included as well as characteristics cited on each program's webpage. Program webpages were used to evaluate availability and consistency of data on site surgical caseload, fellowship slots, and teaching staff. Results Of the 121 programs included on SFMatch, 23 (19%) provided no data on August 15, 2022 (15 days prior to application submission deadline) and 9 (7%) lacked program data on October 15, 2022. Though most programs provided mean cataract volume, data on volume of other procedures for graduating residents was highly variable and occasionally misleading. Programs did not provide information on several academic and social considerations that may influence match ranking choice. Conclusion Applicants often must read "between the lines" to identify residency program strengths and weaknesses. Data crucial to informing the application process remain sparse, unavailable, or spread across resources. Limited data increases applicant dependence on word-of-mouth knowledge to inform decision-making. This might reduce diversity by limiting successful applicants to those with existing connections within the field.

Resident Sleep During Traditional Home Call Compared to Night Float.

Purpose This article aims to compare resident sleep while on night float with a traditional home call. Methods We conducted a crossover observational study assessing sleep patterns of seven postgraduate year-2 ophthalmology residents at the University of Washington from 2019 to 2021 using the Fitbit Alta HR device. Overnight call was scheduled from 5 p.m. to 8 a.m. on weekdays, and 8 a.m. to 8 a.m. on weekends. The residency program implemented a partial night float rotation, during which two to three nights of consecutive call were assigned to a resident without other clinical duties. Sleep was recorded using the Fitbit Alta HR for residents while on a 5-week partial night float rotation, on 10-week home call rotations, with postcall relief, and for stretches of seven or more days without call responsibilities. Mixed model regression analysis was used to compare average sleep on home call, night float, and periods without call. Results Sleep data were recorded for a total of 1,015 nights, including 503 nights on home call rotation and 230 nights on night float rotation. Residents slept more during periods away from call compared to either night float or home call rotations ( p < 0.001). Residents experienced increased average overall sleep during 10-week rotations on night float compared to home call ( p = 0.008). While there was no difference in overnight sleep on call between night float and home call ( p = 0.701), residents experienced more sleep overall while on call on night float compared to home call due to more sleep being recorded during postcall naps ( p = 0.016). Conclusion Implementing a night float system can increase resident sleep by allowing for more sleep recovery during time away from clinical duties.

Ophthalmology Residency Program Director Survey on Pass/Fail U.S. Medical Licensing Exam Step 1 Scoring.

Background Beginning January 26, 2022, the U.S. Medical Licensing Exam (USMLE) Step 1 changed from a numerical score to pass/fail (P/F). The purpose of this study was to determine the perspective of ophthalmology program directors regarding this change in evaluating applicants. Methods After institutional review board approval, a survey was sent out to program directors of all 125 ophthalmology programs accredited by the Accreditation Council for Graduate Medical Education. Survey questions asked for program demographics, the utility of USMLE Step 1 and 2 Clinical Knowledge scores in assessing applicants, and the importance of 16 different applicant metrics before and after Step 1 becomes P/F. The metrics examined were: letters of recommendation; clerkship grades; class ranking; Alpha Omega Alpha Membership; Gold Humanism Honor Society Membership; Dean's Letter; involvement and leadership; personal statement; number of abstracts, presentations, and publications; mean number of research experiences in the specialty; Step 2 Clinical Knowledge score; volunteering; preclinical grades; away rotation in the specialty; the applicant having another graduate degree; and graduation from a top 40 National Institutes of Health-funded program. Data were analyzed using nonoverlapping 95% confidence intervals. Results The survey was completed by 50 (40%) program directors. Sixty-eight percent of respondents stated a student's ranking would be considered more after USMLE Step 1 scores become P/F, and 60% stated medical schools should share clerkship shelf exam scores with residency programs. There were no significant differences in program directors' rankings of applicant metrics following the transition to P/F Step 1. Conclusion Based on our data, program directors will likely not place a greater emphasis on Step 2 scores, despite it being the only remaining objective measure for all applicants following the switch to a P/F Step 1. Nevertheless, program directors expressed an interest in receiving other objective measures, such as shelf exam scores and class ranking, as part of the application process. Notably, we found no significant changes in the rankings of various applicant metrics before and after the transition to P/F Step 1, indicating that the metrics that were important to program directors prior to the change remain just as critical in the new era of admissions.

Do ophthalmology residents know how to check the calibration of a Goldmann applanation tonometer?

The purpose of this observational study was to determine whether ophthalmology residents know how to check Goldmann applanation tonometer (GAT) calibration. The step-by-step technique for checking the calibration of a GAT was taken from the manufacturer's manual and developed into a mark sheet. Ophthalmology residents in years 2-8 of training from 11 hospitals were individually observed and assessed checking calibration of a GAT. Participation was voluntary. Contact between participants was minimised to prevent communication about the study. Sixty-eight per cent (n = 30) of eligible ophthalmology residents (years 2-8) from 11 hospitals (three teaching hospitals and eight local general hospitals) were observed checking GAT calibration. Only 33% (n = 10; 95% CI: 16-50%) of ophthalmology residents were able to correctly check GAT calibration. Those participants who were previously taught (p = 0.046) or assessed (p = 0.015) were more likely to be successful in GAT calibration. Most ophthalmology residents were unable to correctly check GAT calibration. Although better than previously published results, this observational study shows that further training and assessment is required for ophthalmology residents to learn the technique of checking GAT calibration.

Evaluation of commitment to equity, diversity, and inclusion on Canadian ophthalmology residency program websites

ObjectifLes sites Web des programmes de résidence jouent un rôle de premier plan pour ce qui est de présenter les attraits de ceux-ci aux résidents candidats. Notre article examine à quel point les sites Web des programmes de résidence en ophtalmologie du Canada démontrent leur engagement envers l’équité, la diversité et l'inclusion (EDI) et identifie les zones à améliorer. MéthodesNous avons procédé à une analyse transversale des sites Web affiliés aux 15 programmes accrédités de résidence en ophtalmologie au Canada. Chaque site s'est vu attribuer un score en fonction de 16 éléments relevant de l'EDI conformément à la littérature récente. On a ainsi examiné la façon dont chaque site tenait compte d’éléments relevant de l'EDI en lien avec la langue, la géographie et la diversité de la population régionale. RésultatsSur les 15 programmes de résidence en ophtalmologie du Canada, 12 (80 %) respectaient au moins 1 des 16 éléments relevant de l'EDI, le score moyen par programme se chiffrant à 2,4 (é.-t. : 1,92). Le programme qui a obtenu le score le plus élevé respectait 7 des 16 éléments en question. Les programmes anglophones ont obtenu un score moyen plus élevé (2,92; é.-t. : 1,78) que les sites francophones (0,33; é.-t. : 0,58; p = 0,023). Aucune différence significative n'a été observée entre les programmes de l'ouest du Canada, de la région centrale ou de l'est du Canada (p = 0,86). La proportion de minorités régionales associées à chaque programme n'a pas eu d'effet sur les scores (p = 0,088). ConclusionsLes sites Web des programmes de résidence en ophtalmologie du Canada abordaient rarement les éléments relevant de l'EDI. Nous proposons des recommandations dans 4 domaines: mise en valeur de la diversité de l’équipe, transparence au chapitre du recrutement, ressources en matière d'inclusion et organisation du programme. L'amélioration de la visibilité de l'EDI des programmes figurant sur les sites Web grâce à la révision de sites existants ou à la création de nouveaux sites promotionnels pourrait favoriser le recrutement d'une population diversifiée de résidents.

Research productivity of first-year Canadian ophthalmology residents: a 12-year trend

ObjectifL'expérience dans le domaine de la recherche constitue l'un des critères de sélection des candidats aux programmes de résidence. Nous souhaitons quantifier les tendances chronologiques en matière de productivité dans le domaine de la recherche de la part des étudiants en médecine qui ont été admis à un programme de résidence en ophtalmologie au Canada. NatureRevue rétrospective d'une base de données. ParticipantsUn total de 465 résidents ayant entrepris leur formation dans 15 programmes de résidence en ophtalmologie au Canada entre 2010 et 2022. MéthodesOnt été identifiés par leur nom tous les résidents qui ont entrepris leur formation dans l'un des programmes de résidence en ophtalmologie du Canada entre 2010 et 2022. Les données bibliométriques (nombre et type de publications, position dans la liste d'auteurs et indice h correspondant à l'année de jumelage) ont été tirées de la base de données Scopus. Des analyses statistiques descriptives et univariées ont servi à caractériser et à évaluer les tendances au chapitre de la productivité dans le domaine de la recherche. RésultatsOn a identifié 461 résidents en ophtalmologie (99 % de l'ensemble de la base de données) qui provenaient des 15 programmes de résidence en ophtalmologie et qui étaient responsables de 1179 publications, dont 679 en ophtalmologie. Dans la plupart des cas, il s'agissait de travaux de recherche inédits (676; 58 %), suivis de rapports de cas ou de lettres à l’éditeur (324; 27 %) et de revues de synthèse (162; 14 %). Dans l'ensemble, 62 % des résidents avaient signé au moins 1 publication au moment du jumelage, la moyenne se chiffrant à 2,56 ± 3,49 publications (indice h moyen de 1,03 ± 1,48 publication). On a noté une hausse significative (p < 0,001) de tous les paramètres de mesure de la productivité dans le domaine de la recherche, sauf pour ce qui est du « premier auteur », pendant les années 2019–2022, comparativement aux années 2010–2018. Fait à noter, 91 % des résidents avaient signé ≥ 1 publication en 2022, comparativement à 38 % en 2010. ConclusionLa productivité en matière de publication des résidents de première année en ophtalmologie a doublé entre 2010–2016 et 2017–2022, ce qui laisse supposer que l'on exige plus de travaux de recherche de la part des étudiants en médecine, tendance qui a également été observée dans d'autres spécialités.

Residency Program Characteristics Associated with Higher Cataract Surgery Volume

ABSTRACT Purpose Prior research has shown that ophthalmology residents improve their cataract surgery competency as they perform additional surgeries beyond the 86 minimum cases mandated by the Accreditation Council for Graduate Medical Education (ACGME). Therefore, cataract surgery volume is an important benchmark for ophthalmology programs. Understanding the possible influence of residency program characteristics on resident cataract surgery volume may help educators in identifying areas for improvement and aid applicants in choosing between programs. The aim of this study was to assess residency program characteristics associated with higher mean cataract surgery volume for ophthalmology residents. Methods We conducted a retrospective, cross-sectional analysis of the San Francisco Match Program Profile Database to assess various program characteristics from the 113 listed ophthalmology residency programs. The associations between program characteristics and the mean cataract surgery volume per graduating resident (CSV/GR) over years 2018–2021 were analyzed using multiple linear regression. Results Out of 113 listed residency programs, 109 (96.5%) were included in our study. Across all programs, the mean (SD) CSV/GR was 195.9 (56.9) cases with a range of 86 to 365 cases. In multiple linear regression analysis, the presence of a Veteran Affairs (VA) training site (β = 38.8, P = .005) and the number of approved fellows per year (β = 2.9, P = .026) were positively correlated with higher mean CSV/GR. The 85 (78.0%) programs with VA training sites had a higher mean (SD) CSV/GR of 204.1 (55.7) cases compared to 166.7 (52.7) cases in the 24 (22.0%) programs without VA sites (P = .004). The mean CSV/GR increased by 2.9 cases for each additional fellow slot after adjusting for other factors. The number of approved residents per year, affiliation with a medical school, and the number of faculty were not significantly associated with CSV/GR. Conclusion All ophthalmology residency programs included in this study currently meet or exceed the ACGME requirements for cataract surgery case numbers. The presence of a VA training site and a higher number of fellowship positions were associated with higher mean resident cataract surgery volumes. Residency programs may consider further investing in these areas when seeking to improve resident surgical education. Additionally, residency applicants prioritizing cataract surgery volume may consider these factors when evaluating programs.

Variability in Grading Diabetic Retinopathy Using Retinal Photography and Its Comparison with an Automated Deep Learning Diabetic Retinopathy Screening Software.

Diabetic retinopathy (DR) screening using colour retinal photographs is cost-effective and time-efficient. In real-world clinical settings, DR severity is frequently graded by individuals of different expertise levels. We aim to determine the agreement in DR severity grading between human graders of varying expertise and an automated deep learning DR screening software (ADLS). Using the International Clinical DR Disease Severity Scale, two hundred macula-centred fundus photographs were graded by retinal specialists, ophthalmology residents, family medicine physicians, medical students, and the ADLS. Based on referral urgency, referral grading was divided into no referral, non-urgent referral, and urgent referral to an ophthalmologist. Inter-observer and intra-group variations were analysed using Gwet's agreement coefficient, and the performance of ADLS was evaluated using sensitivity and specificity. The agreement coefficient for inter-observer and intra-group variability ranged from fair to very good, and moderate to good, respectively. The ADLS showed a high area under curve of 0.879, 0.714, and 0.836 for non-referable DR, non-urgent referable DR, and urgent referable DR, respectively, with varying sensitivity and specificity values. Inter-observer and intra-group agreements among human graders vary widely, but ADLS is a reliable and reasonably sensitive tool for mass screening to detect referable DR and urgent referable DR.

Gender Disparities Among Academic Vitreoretinal Specialists in the United States With Regard to Scholarly Impact and Academic Rank.

Background and objective While men outnumber women in the specialty of ophthalmology in general, the subspecialty of vitreoretinal surgery in particularhas the highest percentage of men across all ophthalmic subspecialties. This study aimed to analyze the gender disparities regarding the publication productivity and academic rank of academic vitreoretinal specialists in the United States (US). Methods This cross-sectional study evaluated 116 ophthalmology residency programs in the US participating in the 2022 San Francisco Match. The academic vitreoretinal faculty from each ophthalmology residency program was included. The information on gender, academic rank, and publication activity in terms of the h-index were collected from institutional websites, the Scopus database, and the National Library of Medicine PubMed website. Results A total of 467 academic vitreoretinal specialists were identified. Among them, 345 (73.9%) were men, and 122 (26.1%) were women (p<0.001). When the academic ranks were analyzed, a higher number of men (43.8%) were found to hold the rank of full professor as compared to women. Furthermore, a higher number of women (47.5%) were found to hold the rank of assistant professor as compared to their male colleagues. Regarding the number of publications, in all academic rankcategories, women had a significantly lower number of publications compared to men (p<0.001). Men also had a higher publication productivity or scholarly impact [h-index=15.2 ± 0.82 standard error of the mean (SEM)] compared to women (h-index=12.8 ± 0.99 SEM) (p=0.0004). Higher h-index correlated with higher academic rank, from assistant professor through full professor (p<0.001). Conclusion The field of vitreoretinal surgery has significantly fewer women compared to men, with women producing fewer publications and having less scholarly impact. H-index and total number of publications are also associated with a higher academic rank. Furthermore, full professors are more likely to be men, while assistant professors are more likely to be women. Future efforts should be aimed at reducing the gender disparity in vitreoretinal surgery.

Curriculum satisfaction of graduates of medical residency in ophthalmology

BackgroundThe number of ophthalmologists trained in Brazil has increased, but their satisfaction with the medical residency curriculum is unclear.The purpose of this study is to evaluate the satisfaction and self-confidence of graduates of a reference ophthalmology residency program in Brazil and to analyze whether there is a difference in these parameters among those who graduated in different decades.MethodsThis is a cross-sectional web-based study conducted in 2022 with 379 ophthalmologists who graduated from the Faculty of Medical Sciences of the State University of Campinas (UNICAMP), Brazil. We aim to obtain data on satisfaction and self-confidence in clinical and surgical practices.ResultsIn total, 158 questionnaires were completed (41.68% response rate); 104 respondents completed their medical residency between 2010 and 2022, 34 between 2000 and 2009, and only 20 before 2000. Most respondents were satisfied or very satisfied with their programs (98.7%). Respondents reported insufficient exposure to low vision rehabilitation (62.7%), toric intraocular implants (60.8%), refractive surgery (55.7%), and orbital trauma surgery (84.8%), particularly among graduates before 2010. They also reported insufficient training in certain non-clinical areas, such as office management (61.4%), health insurance management (88.6%), and personnel and administration skills (74.1%). We found that respondents who graduated a long time ago had higher confidence in clinical and surgical practices.ConclusionsBrazilian ophthalmology residents and UNICAMP graduates expressed high levels of satisfaction with their residency training programs. Those who completed the program a long time ago appear to have more confidence in clinical and surgical practices. There were clinical and non-clinical areas with insufficient training identified for improvement.

Impact of a formal manual small-incision cataract surgery curriculum in an American ophthalmology residency program.

Global ophthalmology educational activities often include the ability of ophthalmology residents to partake in low-resource clinical care at home and abroad. Low-resource surgical techniques have become a pillar of education during formalized global ophthalmology fellowships. A formal manual small-incision cataract surgery (MSICS) curriculum was started in the University of Colorado's residency training program to meet the growing demand for this surgical skill and to allow for more sustainable outreach work from our graduates. The survey was conducted to collect evaluations on the value of formal MSICS training within a United States-based residency program. This was a survey study in a US ophthalmology residency program. A formal MSICS curriculum was created that included didactic lectures on epidemiology of global blindness, MSICS technique, and how MISCS compared to phacoemulsification in terms of cost and sustainability in low-resource settings, followed by a formal wet lab experience. Residents were then exposed to MSICS procedures in the operating room (OR) under supervision of an experienced MSICS surgeon. An anonymous online survey was conducted on three consecutive cohorts of recently graduated senior ophthalmology residents from 2019 to 2021 with the aim of eliciting opinions about and outcomes from the new curriculum. Fifteen graduating senior residents comprised the three cohorts with a 100% survey response rate. All residents agreed or strongly agreed that "MSICS is a valuable skill to have". Eighty percent of respondents agreed or strongly agreed that "exposure to MSICS has increased my likelihood of doing any type of outreach work in the future" and 86.67% agreed or strongly agreed that "exposure to MSICS increased my understanding about sustainable outreach work". The average number of cases assisted or performed per resident was 8.2 (SD 2.7, range 4-12). A formal MSICS curriculum for US-based ophthalmology residents was well-received by the trainees. The majority felt it increased their likelihood of pursuing and improved their understanding of sustainable outreach work. The curriculum, which included lectures, wet lab training, and formal teaching in the OR, could add value to a residency program's curriculum. Furthermore, a formal domestic program can avoid ethical pitfalls that can be seen with resident teaching during international mission work.

A Platform for Tracking Surgeon and Observer Gaze as a Surrogate for Attention in Ophthalmic Surgery.

To develop and validate a platform that can extract eye gaze metrics from surgeons observing cataract and vitreoretinal procedures and to enable post hoc data analysis to assess potential discrepancies in eye movement behavior according to surgeon experience. Experimental, prospective, single-center study. Eleven ophthalmic surgeons observing deidentified vitreoretinal and cataract surgical procedures performed at a single university-based medical center. An open-source platform was developed to extract gaze coordinates and metrics from ophthalmic surgeons via a computer vision algorithm in conjunction with a neural network to track and segment instruments and tissues, identifying areas of attention in the visual field of study subjects. Eleven surgeons provided validation data by watching videos of 6 heterogeneous vitreoretinal and cataract surgical phases. Accuracy and distance traveled by the eye gaze of participants and overlap of the participants' eye gaze with instruments and tissues while observing surgical procedures. The platform demonstrated repeatability of > 94% when acquiring the eye gaze behavior of subjects. Attending ophthalmic surgeons and clinical fellows exhibited a lower overall cartesian distance traveled in comparison to resident physicians in ophthalmology (P<0.02). Ophthalmology residents and clinical fellows exhibited more fixations to the display area where surgical device parameters were superimposed than attending surgeons (P < 0.05). There was a trend toward gaze overlap with the instrument tooltip location among resident physicians in comparison to attending surgeons and fellows (41.42% vs. 34.8%, P>0.2). The number and duration of fixations did not vary substantially among groups (P>0.3). The platform proved effective in extracting gaze metrics of ophthalmic surgeons. These preliminary data suggest that surgeon gaze behavior differs according to experience.

Utilization of Instagram by Ophthalmology Residency Programs in the Era of COVID-19.

The aim of this research is to describe the use of the social media platform, Instagram, by academic ophthalmology residency programs in the United States over time and consider the impact of the COVID-19 pandemic on ophthalmology's social media presence. This cross-sectional study was conducted online by reviewing the publicly accessible Instagram accounts of all accredited US academic ophthalmology residency programs. Number of US ophthalmology residency programs with an affiliated Instagram account were analyzed by year of creation. The content of the top six accounts with the most followers was analyzed by evaluating amount of engagement within defined post categories. Of the 124 ophthalmology residency programs, 78 (62.9%) were identified as having an affiliated Instagram account, 60 accounts (48.4%) were created during the years 2020 or 2021, and 62 (50.0%) accounts focused specifically on promoting the residency training program. Of the top six accounts with the most followers, post categories that received the most engagement were "Medical" and "Group Photo", while those that received the least engagement were "Department Bulletin" and "Miscellaneous." User engagement on posts as measured by likes and comments increased across multiple post categories after January 2020. Social media presence of ophthalmology residency programs on Instagram increased substantially in 2020 and 2021. As a result of the COVID-19 pandemic restricting in-person interactions, residency programs have used alternative platforms to reach applicants. Given the increasing use of such applications, social media will likely continue to become an important aspect of professional engagement in ophthalmology.

Comparing morphologic features and complications of main clear corneal incision between junior and senior residents observed using anterior segment optical coherence tomography.

Wound construction is a critical step in phacoemulsification. Using anterior segment optical coherence tomography (AS-OCT), we compared the morphological features and complications of main incisions made by junior or senior residents during phacoemulsification. This cross-sectional comparative study included eyes with senile cataracts that underwent uneventful phacoemulsification with a clear corneal incision made by seven senior and eight junior ophthalmology residents. All eyes underwent postoperative image acquisition using AS-OCT on day one and at three months, examining for morphological features and potential complications of the main incision. We included 50 eyes of 50 patients with a male-to-female ratio of 22 (44%) to 28 (56%); 26 (52%) were operated on by junior residents and 24 (48%) by seniors. The mean geometric features of the main incisions and the frequency of early and late wound complications were comparable between the two groups (all P > 0.05). A significant correlation was found between the incision length and angle with the superior (r = + 0.80; P < 0.001 and r = - 0.63; P < 0.001, respectively) and inferior (r = + 0.84; P < 0.001 and r = - 0.68; P < 0.001, respectively) areas of the incision, as well as between the length and angle of incision (r = - 0.74; P < 0.001). The number of planes in the wound architecture was not significantly different according to senior or junior resident status (P > 0.05). Although the number of eyes with stromal hydration was significantly greater for junior residents than for seniors (P < 0.001), the corneal thickness at the entrance to the cornea or the anterior chamber, presence of endothelial wound gaping, and Descemet's membrane detachment were comparable between eyes with and without stromal hydration (all P > 0.05). At three months, 29 (58%) patients returned for examination, in whom seven (24%) had late wound complications. This study found no significant differences in the performances of junior and senior residents in terms of wound construction or its associated complications. However, considering the overall rate of some observed wound-related complications, we recommended revision of the resident educational curriculum concerning the structure and complications of the main incision.

Level of Eye Care Among Eye Care Providers Themselves.

To assess the prevalence of eye disease and frequency of eye examinations among eye care providers themselves. In this cross-sectional study, an anonymous questionnaire was used to evaluate occurrence of eye disease and frequency of eye examinations among eye care providers including the clinicians (ophthalmologists, ophthalmology residents, and optometrists) as well as the support staff (ophthalmic technicians and eye clinic administrative staff). The survey response rate was 98 of 173 (56.6%) including 50 ophthalmic technicians, 27 ophthalmologists, 7 ophthalmology residents, 6 optometrists, and 8 eye clinic administrative staff members. The most common reported ocular condition was dry eye disease (36.7%). Myopia and hyperopia were present in 60 (61.2%) and 13 (13.3%), respectively. Myopia was significantly more prevalent among the clinicians (75.0%) than in the support staff (51.7%, P =0.02). The most recent eye examination was within the past year in 42 (42.9%), 1 to 2 years in 28 (28.6%), 3 to 5 years in 14 (14.3%), and over 5 years in 10 (10.2%). Four (4.1%) had never had an eye examination before. The number of eye examinations received was significantly higher in the support staff compared with the clinicians for the past one year (0.86±0.74 vs 0.43±0.59, respectively, P =0.003) and the past five years (2.81±2.08 vs 1.75±1.78, respectively, P =0.01). Dry eye disease and myopia are common among eye care providers. A significant portion of eye care providers do not have regular eye examinations for themselves.