Specialty Of Ophthalmology Research Articles

The Benefits and Challenges of Implementing Teleophthalmology in Low-Resource Settings: A Systematic Review.

Technology has significantly changed medical practice, including diagnosis, treatment, and availability. Telemedicine use in the specialty of ophthalmology seems to be a promising field. In underserved populations, limited coverage of ophthalmic healthcare facilities results in a higher burden of eye-related diseases and visual impairment. The main obstacle preventing these individuals from receiving eye care consultations is difficulty in access and transportation. There is an urgent need for eye care facilities for these people, and teleophthalmology has the potential to provide eye care facilities to these underserved people. Teleophthalmology was reported as cost-effective, time-saving, reliable, and efficient for underserved populations. However, teleophthalmology has certain limitations in its implementation in the form of a high initial cost of equipment, problems with consistent electricity and internet supply, and the reluctance of people in certain regions toward acceptance of teleophthalmology. This systematic review assessed the benefits and challenges of implementing teleophthalmology in low-resource settings.

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.

The Scholarly Impact of Student Authorship in Ophthalmology.

Purpose The H-index (H i ), an author-level metric of scholarly impact, is predictive of future scientific achievement. We sought to analyze the scholarly impact of student authorship on the H i of corresponding authors (CAs) within a major academic journal in the specialty of ophthalmology. Materials and Methods We compared the H i of all unique CAs for manuscripts published in Ophthalmology (Journal of the American Academy of Ophthalmology) in 2008, 2012, and 2016. Data abstraction was completed twice: in October 2018 and March 2021. We further grouped published articles for CAs into those with student authors (StA) and those without (nStA). Primary analysis involved a linear regression analysis with change in H i from October 2018 to March 2021 as the outcome variable, CA groups as the predictor variable, adjusting for the covariates of baseline H i , the year when the CA published his or her article, number of research items published in October 2018, and the academic appointment of the CAs. Secondary analysis involved a linear regression analysis with change in H i from October 2018 to March 2021 as the outcome variable, total number of student authors per CA as the predictor variable, adjusting for the covariates of baseline H i , the year CA published his or her article, number of research items published in October 2018, and the academic appointment of the CAs. Results The number of student authors increased from 168 in 2008 to 192 in 2016. Of the 902 articles, 316 articles were co-authored by one or more student authors. The average change in H i of CAs publishing with student authors (StA, 11.0 ± 14.7) was significantly greater ( p < 0.0001) than the change in H i of CAs publishing without student authors (nStA, 6.2 ± 6.2). As the total number of student authors increased, the change in H i of CAs increased linearly for all years combined (regression coefficient = 1.70, p -value < 0.0001). Conclusion CAs publishing with students in the field of ophthalmology have a higher scholarly impact than those publishing without students. The development of programs to integrate students into ophthalmology research early on may encourage their pursuit of a career in ophthalmology, while advancing the careers of their mentors.

Transitioning from a standalone practice to a private equity-partnered practice and impact on clinical operations.

Private equity has made significant inroads into the specialty of ophthalmology. The purpose of this review is to evaluate the effect of private equity on clinical operations in an ophthalmic practice. Private equity had become an important source of capital and management expertise that has resulted in the consolidation of many ophthalmic practices as an alternative to working for a hospital system, insurance carrier, or independent private practice. The recent growth of private equity presence in ophthalmology has resulted in significant changes in clinical operations. These changes in clinical operations include the increased importance of data management and data analytics, economies of scale, synergies, and introduction of patient-shared billing opportunities. Although physician input into clinical operations is decreased, provisional care decision-making can be maintained.

#Ophthalmology: Popular ophthalmology hashtags as an educational source for ophthalmologists, an Instagram study.

This study aims to determine the content and intent of posts published under popular ophthalmology hashtags and to determine whether these posts were educational for ophthalmologists. A web-based, cross-sectional study design was used to evaluate the top public posts of five popular hashtags on three consecutive days by two ophthalmology specialists. The first 100 relevant English posts of each hashtag were studied. Selected hashtags were #Ophthalmology, #ophthalmosurgery, #ophthalmologyresident, #ophthalmologist, and #ophthalmicphotography. Posts were classified according to the type of post, post author, post intent, and whether the post was educational. Posts deemed educational were then categorized separately using the same classification system as above to determine whether there were defining characteristics of educational posts. One thousand posts were recorded and analyzed and a total of 500 posts were included in the study. The majority of posts 79.8% (n = 399), were by medical doctors with 95% (n = 379) being ophthalmology specialists. Sixty-three percent of posts (n = 315) were deemed educational, 25% promotional (n = 127), and 12% (n = 58) were entertainment posts. Medical retina (n = 119) and anterior segment (n = 90) were the most common subspecialties explored. #ophthalmicphotography (P = 0.001) was the hashtag with the highest number of educational posts (n = 91). The least educational hashtag was #ophthalmologist with only 44% of posts (n = 44) that were deemed to be educational. One hundred percent of glaucoma posts (n = 19), 98% of cornea posts (n = 41), and 99% of medical retina posts (n = 118) were found to be educational which was significantly more educational than the other topics posted (P ≤ 0.001). Ophthalmologists are the main authors of posts in popular ophthalmology hashtags. The majority of posts were educational posts with promotional posts being the second most common intent. The authors conclude that while Instagram is a possible source of ancillary education for the visual specialty of ophthalmology, careful selection of hashtags and post authors are needed for maximum benefit.

Farmacoepidemiología en el programa de formación de la especialidad de oftalmología en Cuba

Introducción: En la formación del especialista de oftalmología es necesarios abordar los temas de farmacoepidemiologia para garantizar seguridad del paciente. Objetivo: Identificar en el programa de formación del oftalmólogo cubano los contenidos temáticos de farmacoepidemiología y proponer los necesarios en su formación. Metodología: estudio cualitativo del programa de formación de la especialidad de oftalmología. Se realizó un análisis de contenido cualitativo directo del programa de la especialidad utilizando las tres etapas según la metodología de por García Milian permitir el análisis y crítica a un programa de estudio. Los expertos definieron los contenidos temáticos a través de la técnica Delphi. Resultados: En el programa de formación del oftalmólogo cubano, no se explicitan contenidos temáticos relacionados con la farmacoepidemiología, los expertos propusieron siete contenidos temáticos a incorporar en el programa. Conclusiones: Se evidenció la poca inclusión y sistematización de contenidos temáticos de farmacoepidemiologia en la formación del oftalmólogo cubano, estos fueron definidos por expertos y su inclusión en curriculum de formación de este especialista puede contribuir a un mejor desempeño profesional y seguridad del paciente. Introduction: In the training of the ophthalmology specialist, it is necessary to address pharmacoepidemiology issues to guarantee patient safety. Objective: To identify the thematic contents of pharmacoepidemiology in the Cuban ophthalmologist's training program and propose those necessary in their training. Methodology: qualitative study of the training program for the specialty of ophthalmology. A direct qualitative content analysis of the specialty program was performed using the three stages according to the methodology of by García Milian to allow analysis and criticism of a study program. The experts defined the thematic contents through the Delphi technique. Results: In the Cuban ophthalmologist training program, thematic contents related to pharmacoepidemiology are not declared, the experts proposed seven thematic contents to be incorporated into the program. Conclusions: The little inclusion and systematization of thematic contents of pharmacoepidemiology in the training of the Cuban ophthalmologist was evidenced, these were defined by experts and their inclusion in the training curriculum of this specialist can contribute to a better professional performance and patient safety. Introdução: Na formação do oftalmologista é necessário abordar as questões da farmacoepidemiologia para garantir a segurança do paciente. Objetivo: Identificar os conteúdos temáticos da farmacoepidemiologia no programa de formação do oftalmologista cubano e propor os necessários à sua formação. Metodologia: estudo qualitativo do programa de formação da especialidade oftalmológica. Realizou-se uma análise de conteúdo qualitativa direta do programa de especialização em três etapas, segundo a metodologia de García Milian, permitindo a análise e crítica de um programa de estudos. Os especialistas definiram os conteúdos temáticos por meio da técnica Delphi. Resultados: No programa de formação do oftalmologista cubano, não são especificados conteúdos temáticos relacionados com a farmacoepidemiologia, os especialistas propuseram sete conteúdos temáticos a serem incorporados ao programa. Conclusões: Evidenciou-se a pouca inclusão e sistematização de conteúdos temáticos da farmacoepidemiologia na formação do oftalmologista cubano, estes foram definidos por especialistas e sua inclusão no currículo de formação deste especialista pode contribuir para um melhor desempenho profissional e segurança do paciente.

The History of Modern Ophthalmology in Nigeria: A Synopsis of Institutions, Events and Personalities

Ophthalmology in Nigeria has developed over the decades with contributions from several personalities. Many events and institutions have served to shape the emergence of good care, from the establishment of ECWA Eye hospital in 1943 as one of the premiere indigenous dedicated Eye Hospitals, to the establishment of the National Eye Centre as well as the University College Hospital Ophthalmology department, the specialty of Ophthalmology has grown to enviable heights. The formation of the Ophthalmological Society of Nigeria in 1969 and the establishment of the National Postgraduate College and The West African College of Surgeons equally stand out as landmark events in History.&#x0D; The Nigerian National Survey of Blindness and Visual Impairment (2005 to 2007) was the biggest ever survey in Africa, no national level estimates existed in Nigeria before the survey. This gigantic task took more than three years to complete including 30 months of rigorous fieldwork and was only possible because of the special efforts of key individuals. The MTN EYE FOUNDATION Eyeris Program (2013 - 2017) also stands out as a landmark surgical intervention scheme involving 12 states in all geopolitical zones in Nigeria. A total of 18,438 free cataract surgeries were performed, 23,528 eyeglasses and 23,226 ocular medications for ocular allergies, glaucoma and ocular infections were also given free to beneficiaries.

Referenciação oftalmológica em idade pediátrica: estudo retrospetivo de doze meses consecutivos de referenciação oftalmológica hospitalar

The aim of this study was to evaluate the current state of the referral of children to the specialty of Ophthalmology at our Hospital-Centro Hospitalar do Porto, analyzing the reasons for referral, diagnosed diseases, effectiveness of referral and the visual impact on children. Methods: Retrospective and descriptive study of medical records of children aged ≤10 years-old referred to the Pediatric Ophthalmology Clinic, between July 2011 and July 2012. Results: A total of 649 children were referred and the most frequent reasons included suspected strabismus in 41.9%, screening for ocular pathology in 22.6%, and suspected low visual acuity (VA) in 15.2% of the cases. Amongst children referred for suspected strabismus, the diagnosis was confirmed in 40.8% of the cases (mean age of 4.5±2.2 years); 16.8% of children referred for other reasons also had strabismus. 62.3% were classified as esotropias and 32.3% as exotropias. Amongst the children referred for suspected low VA, the diagnosis was confirmed in 39% of the cases, and the main cause were ametropias (52% of cases). Of the children referred for other reasons, 13.3% had a measurable decrease in AV and 20% had potentially amblyogenic ametropias. Only 40% of the children referred by suspected low VA had a VA evaluation in the referral request. Amblyopia was diagnosed in 20.1% of all children observed. Discussion: The problems that most frequently motivated referral for pediatric ophthalmology were the suspicion of strabismus and of decreased VA. However, the diagnosis was confirmed in less than half of the referred children, and a significant percentage of diagnosed cases was referred for another reason. The mean age of diagnosis of strabismus was late, and the percentage of amblyopia was high. This study reinforces the importance of conducting ophthalmologic screening in primary health care, and its impact on a timely referral, diagnosis and treatment of these pediatric diseases.

Evolution of refractive surgeries

The use of surgical procedures to correct refractive errors of the eye has come a long way. The two main types are corneal procedures and intraocular procedures. Corneal procedures have evolved from thermokeratoplasty, keratotomies, epikeratoplasty, laser ablation, conductive keratoplasty, and collagen cross-linking. Intraocular procedures involve phakic intraocular lens (IOL), toric IOL, refractive lens exchange, and accommodating IOLs. Various physicists and ophthalmologists have played a role in this saga. From the idea of using thermal energy to shrink corneal tissue to using femtosecond laser, this article highlights the important landmarks in the history of evolution of refractive surgeries. Refractive surgeries form an ever-growing specialty of ophthalmology with addition of novel techniques with every quantum of time.

The Physician Payments Sunshine Act: Data Evaluation Regarding Payments to Ophthalmologists

To review data for ophthalmologists published online from the Physician Payments Sunshine Act. Retrospective data review using data acquired from a publicly available electronic database. A database was downloaded from the Centers for Medicare and Medicaid Services website under Identified General Payments to Physicians and a primary specialty of ophthalmology. Basic statistical analysis was performed including mean, median, and range of payments for both single payments and per provider. Data summary by category of payment and geographic region and comparison with other surgical subspecialties. From August 1, 2013, through December 31, 2013, a total of 55 996 individual payments were reported to 9855 ophthalmologists for a total of $10 926 447. The mean amount received in a single payment was $195.13 (range, $0.04-$193 073). The mean amount received per physician identifier (ID) was $1108 (range, $1-$397 849), and the median amount was $112.01. Consulting fees made up the largest percentage of fees. There was not a large difference in payments received by region. The mean payments for the subspecialties of dermatology, neurosurgery, orthopedic surgery, and urology ranged from $954 to $6980, and median payments in each field by physician ID ranged from $88 to $173. A large amount of data were released by the Centers for Medicare and Medicaid Services for the Physician Payment Sunshine Act. In ophthalmology, mean and median payments per physician did not vary greatly from other surgical subspecialties. Most single payments were less than $100, and most physicians received less than $500 in total payments. Payments for consulting made up the largest category of spending. How this affects patient perception, patient care, and medical costs warrants further study.

Subspecialization of the Ophthalmic Literature: A Review of the Publishing Trends of the Top General, Clinical Ophthalmic Journals

To investigate the publishing trends of the top general clinical ophthalmic journals and to report: (1) the proportions of articles published in terms of ophthalmic subspecialty, (2) the study design used, (3) any changes in publishing trends, and (4) any differences in the quality of study design between the subspecialties.Retrospective, database review.All original articles published in the top general, clinical ophthalmology journals from 2005 through 2009.All general, clinical ophthalmic journals were selected from the top 20 journals based on 2008 impact factor. All abstracts from original articles were reviewed, and the subject matter was recorded as belonging to 1 of the 11 ophthalmic subspecialties. After the content of the article was assigned, then the study design was recorded as one of the following: nonanalytic study, case-control or cohort study, randomized control trial, meta-analysis, laboratory science article, or systemic review.Subspecialty of the article and the study design used.Seven journals were included, and 12 426 abstracts were reviewed. Articles relating to medical retina were the most prevalent (29.1%), and those relating to strabismus were the least prevalent (2.3%). Case-control or cohort studies comprised most study designs (40.1%), with meta-analyses comprising the least (0.3%). The mean number of articles per year was 2485 (standard deviation, 125.1), remaining stable over the study period. Medical retina articles were significantly more common in 2009 than in 2005 (chi-square, 11.2; P = 0.0008), whereas the proportion of oculoplastic articles was significantly reduced (chi-square, 16.9; P<0.0001). Cataract and refractive surgery had the highest proportions of articles using the higher forms of study design (7.8%), and oculoplastics had the highest proportion of nonanalytic studies (64.5%).There are great differences across the specialty of ophthalmology in the subject matter of published literature, probably driven by recent advances in treatments. Medical retina is the subspecialty that is most represented in the literature, with strabismus being the least represented. Cataract and refractive surgery articles have the greatest proportion of higher-quality research strategies.The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Randomisierte kontrollierte und kontrollierte klinische Studien in deutschsprachigen, ophthalmologischen Fachzeitschriften

The medical database MEDLINE contains only a part of all published randomized controlled (RCTs) and controlled clinical (CCTs) trials. The validity of a systematic review depends on the complete consideration of all studies pertaining to a clinical question. Therefore, a manual systematic search in medical journals is mandatory. The last 30 years of the three peer-reviewed German-language ophthalmological journals Der Ophthalmologe, Klinische Monatsblätter für Augenheilkunde, and Spektrum der Augenheilkunde were retrospectively searched for controlled trials. All identified RCTs and CCTs were classified according to their ophthalmological subspecialty. The quality of the studies was evaluated using the CONSORT Statement. Moreover, a comparison was made of how many of the studies identified by hand searching are registered in MEDLINE and correctly classified as RCTs/CCTs. In total 984 RCTs and CCTs were identified; 62% of the trials were from the subspecialty anterior eye segment, 14% belonged to the subspecialty posterior eye segment, and 18% belonged to glaucoma. A sample size calculation was reported in less than 2% of the full-text publications and 34% reported a blinded study design. A randomization process was described in 23% of the RCTs. Most controlled trials were published in the 1990s in all three journals. From 1998 onward, there was a decrease in the number of published controlled trials in the reviewed German literature. About 63% of the studies registered in MEDLINE are correctly classified. In the specialty of ophthalmology there are many important studies which provide basic information for compilation of systematic reviews and clinical guidelines. However, many of the identified clinical trials in German-language journals show deficiencies in the study quality. Only a part of the identified controlled trials are correctly classified in MEDLINE. Therefore, a retrospective registration is essential to complete the electronic database in ophthalmology.

Does sex affect the success rate of Canadian ophthalmology residency applicants?

Background: Despite equalization of the ratio of men and women among matriculating medical students, it is possible that different rates of success for applicants at the level of resident selection in the annual residency match may occur on the basis of sex. As part of a larger project, we examined this issue across the medical specialties. In the current article, the effect of sex on resident selection within the specialty of ophthalmology is explored. Methods: Data were obtained from the Canadian Medical Association, Canadian Institute for Health Information, Royal College of Physicians and Surgeons of Canada, Canadian Ophthalmological Society, and Canadian Residency Matching Service regarding sex- and age-specific demographics, as well as success rates for male and female applicants ranking an ophthalmology residency program as their top choice. The proportion of men who ranked ophthalmology as their top choice but did not match to any ophthalmology program was compared to the corresponding proportion of women. Results: The female:male ratio of practicing ophthalmologists has slowly increased over the past decade and is highest (0.41∶1) within the under-45 age group. By grouping data from 1993 to 2004, we found that men who ranked an ophthalmology program as their first choice had odds of not being accepted to an ophthalmology program that were 1.1 times (95% confidence interval 0.8–2.0; p = 0.34) the corresponding odds for women. Interpretation: Our data suggest that discrimination on the basis of sex does not occur at the level of residency selection. The lower level of female recruitment may be due to decreased interest in this specialty among women. Nonetheless, the proportion of female ophthalmologists within the Canadian workforce continues to increase.

Medical students perception of undergraduate ophthalmology training in Nnamdi Azikiwe University Nnewi Campus

To determine the perception and aspiration of medical students towards ophthalmology. Information for the study was obtained through forced-choice questionnaire set to 102 medical students in 2000/2001 graduating class in Nnamdi Azikiwe University. One hundred questionnaires were completed. As a specialty of choice ophthalmology ranked fourth {16.0%} as a first choice; second {21.0%} as a second choice and first {26.0%} as a third choice. Ninety-five of respondents found ophthalmology training useful. This cohort of medical students considered ophthalmic training in this institution essential and adequate. Undergraduate ophthalmic course should ensure an understanding of the basic principles of ophthalmology and should be designed to motivate the interest and confidence of the medical students in the specialty. Training period should be at least 4 weeks. With appropriate training ophthalmology can attract reasonable interest as a choice for specification.

Lasers in opthalmology: Past, present and future

In no area of medicine has the laser been more successful as a treatment modality than in the specialty of ophthalmology. This article presents an overview of the history of laser applications including photocoagulation, photodisruption and photoablation, with reference to systems in whose development the present author was involved. Lasers used in ophthalmology use wavelengths from the near infrared to the ultraviolet and pulse durations that are measured in femtoseconds to seconds. The primary ophthalmic laser treatments are for diabetic retinopathy, glaucoma, secondary cataracts and, most recently, laser vision correction.

Lasers in ophthalmology: past, present and future

In no area of medicine has the laser been more successful as a treatment modality than in the specialty of ophthalmology. This article presents an overview of the history of laser applications including photocoagulation, photodisruption and photoablation, with reference to systems in whose development the present author was involved. Lasers used in ophthalmology use wavelengths from the near infrared to the ultraviolet and pulse durations that are measured in femtoseconds to seconds. The primary ophthalmic laser treatments are for diabetic retinopathy, glaucoma, secondary cataracts and, most recently, laser vision correction.

Ignacio Barraquer (1884-1965) and the Barraquer family of ophthalmologists

T he Barraquer name is well known among ophthalmologists. The Barraquer family has produced generations of ophthalmologists who continue to be productive today. The role of the Barraquer family in ophthalmology may be clarified by understanding its most prominent member, Ignacio Barraquer. Ignacio was one of the great Spanish ophthalmologists of the 20th century. His ideas, instruments and surgical techniques are still in use today. Both of his sons, whom he trained, as well as several grandchildren are currently internationally recognized ophthalmologists. Ignacio was born on Mar. 25, 1884, in Barcelona. He was the second generation of what has become four generations of outstanding ophthalmologists. His father, Jose Antonio Barraquer Roviralta, was one of the founders of the specialty of ophthalmology in Spain. I Jose founded the chair of ophthalmology at the University of Barcelona and was a leader in the study of the hi~tology of the eye.I In addition, in 1888 he initiated the teaching of ophthalmology in Spanish medical schools. Interestingly, Jose's brother, Llufs Barraquer Roviralta (1855-1928), founded the specialty of neurology in Spain and was the first to describe progressive, or partial, lipodystrophy, otherwise known as Barraquer's syndrome.2,3 Jose Barraquer began teaching Ignacio ophthalmology while Ignacio was still a young boy (Fig. 1). Ignacio entered medical school at the University of Barcelona and received his medical degree in 1908. After his graduation he spent 1 year taking special classes in physics and chemistry in Paris. In 1909 he was granted

The Ophthalmoscope, Part I: A Contribution to the History of Its Development Up to the Beginning of the Twentieth Century

The study of the living retina and the diseases that affect it was made possible by the invention of the ophthalmoscope. This instrument remains a cornerstone of the specialty of ophthalmology. In 1971, Dr C. Wilber Rucker of the Mayo Clinic, Rochester, Minn, privately published a slender volume titled<i>A History of the Ophthalmoscope</i>, summarizing with charm and accuracy the history of this instrument and its in

Economic appraisal of laser applications in health care. Report of a project

This article reports on the results of a project evaluating effectiveness and cost-effectiveness of laser applications in health care. The literature was collected, emphasizing well-designed clinical trials and cost-effectiveness analyses. Few randomized clinical trials (RCTs) have been done outside the specialty of ophthalmology. Even fewer cost-effectiveness studies have been done, despite the frequent claims of cost-effectiveness in the medical literature. Review papers were commissioned, and a group of laser experts, economists, and policy-analysts met for 2 days to discuss the policy implications of lasers. The main conclusion from the conference is that inappropriate and unskilled use of lasers is presently the greatest problem with their application in health care.

An Ophthalmologist's Definition of OphthaImology

Ophthalmology has long been on the vanguard of medicine and innovation. Ophthalmologists have enjoyed high levels of satisfaction from restoring sight to patients. But the world as we know it has shifted, and now we are burdened by the pressures of modern medicine and a competitive marketplace. Ophthalmology should take the lead in medicine in learning how to weather these crises and how to emerge a revitalized specialty. It seems that the right choice for the specialty of ophthalmology is to reclaim our role as comprehensive providers of total eye care. Ophthalmologists can lead teams formed to provide comprehensive eye care. A dialogue on a consensus definition of the scope of ophthalmology should take place, involving all segments of the profession. Another dialogue that is critical to the future of the specialty is a deliberate examination of the issue of formal accreditation and/or certification of ophthalmologic subspecialties. Ophthalmology needs to define itself for the future.