Surgeon demographic and surgical volume trends in adult strabismus surgery in the United States

To explore the influence of career stage, gender, and age on procedural trends of surgeons performing strabismus surgery. Data on ophthalmologists who performed strabismus surgery and on the Medicare beneficiaries who underwent surgery between 2012 and 2017 was retrieved from Medicare Provider Utilization and Payment Data. A total of 133 strabismus surgeons (78.9% male and 21.1% female) were reimbursed by Centers for Medicare and Medicaid Services for 10,598 strabismus procedures during the study period. The overall number of strabismus surgeries increased (P = 0.039) over time. Most surgeons were 50-59 years of age (n = 45 [33.8%]), with an average age of 54.5 ± 9.5 years. The number of services per physician did not differ by gender (85 ± 97 procedures/male surgeon and 60 ± 149 procedures/female surgeon [P = 0.13]). There was no difference in the gender proportion of physicians, with 0-9 post-fellowship years of experience (P = 0.32), but there were significantly more men with 10-19 (P = 0.003), 20-29 (P < 0.001), and 30-39 (P < 0.001) years of post-fellowship experience. There was no difference in the number of procedures performed between women and men 30-39 (P = 0.83) or 60-69 (P = 0.48) years of age; however, women 40-49 (P = 0.009) and 50-59 (P < 0.001) years of age performed significantly fewer procedures per surgeon than men. Women performed significantly fewer surgeries midcareer compared to their male counterparts

Optical coherence tomography angiography and multimodal imaging in the management of coats’ disease

To illustrate the spectrum of clinical and imaging features in patients with unilateral Coats’ disease at baseline and in response to treatment with laser, intravitreal bevacizumab, and regional steroids. Telangiectasias, macular exudates, and vascular leakage were present in all 3 patients included in this series. After treatment with laser and bevacizumab, OCT angiography findings included an anomalous foveal vascular loop and chorioretinal anastomoses. Choroidal flow voids appeared to improve after intravitreal bevaziumab and laser treatment in 2 patients with OCT angiography obtained at follow up. A-scan axial lengths in affected eyes were 1.5–1.8 mm smaller than fellow eyes. OCT angiography is a non-invasive tool that can be a useful adjunct to multimodal imaging studies in the management of Coats’ disease. Improved vascular density following anti-VEGF injection suggests a possible role of the choroidal vasculature in this retinal vascular pathology

Paradoxical Exudative Retinopathy and Macular Star Formation After Treatment Initiation in Coats Disease

Purpose: This work describes a unique clinical feature in Coats disease. Methods: A retrospective series of 2 cases is reported. Results: Two pediatric patients receiving treatment for Coats disease were included. In both cases, vision worsened secondary to paradoxically increased exudation and macular star formation following standard treatment with intravitreal bevacizumab, sub-Tenon triamcinolone acetonide, and laser photocoagulation. After serial treatments under general anesthesia, the exudates in both cases consolidated. Conclusions: A paradoxical exudative retinopathy can occur in some patients when initiating standard treatment of Coats disease. Longitudinal follow-up with continued intravitreal antivascular endothelial growth factor agents, laser photocoagulation, and corticosteroids might help control persistent exudation in these cases

Single-Blind and Double-Blind Peer Review: Effects on National Representation

To assess whether the type of peer-review (single-blinded vs double-blinded) has an impact on nationality representation in journals. A cross-sectional study analyzing the top 10 nationalities contributing to the number of articles across 16 ophthalmology journals. There was no difference in the percentage of articles published from the journal's country of origin between the top single-blind journals and double-blind journals (SB = 42.0%, DB = 26.6%, p = .49), but there was a significant difference between the percentage of articles from the US (SB = 48.0%, DB = 22.8%, p = .02). However, there was no difference for both country of origin (SB = 38.0%, DB = 26.6%, p = .43) and articles from the US (SB = 35.0%, DB = 22.8%, p = .21) when assessing the top eight double-blind journals matched with single-blind journals of a similar impact factor. The US (n = 16, 100%) and England (n = 16, 100%) most commonly made the top 10 lists for article contribution. This held true even for journals established outside the United States (US=11/12, England = 11/12). There was no significant difference in country-of-origin representation between single-blind journals and double-blind journals. However, higher income countries contributed most often to the journals studied even among journals based outside the US

Evaluation of Available Online Information Regarding Treatment for Vitreous Floaters

To assess the quality, content, and readability of information available online on vitreous floater information. Cross-sectional study. Not applicable. Websites were generated using a Google search of "vitreous floaters treatment" and "[State]" and were analyzed using a standardized checklist of 22 questions. Readability was assessed using the Flesch Reading Ease score. Websites met qualification criteria if they represented U.S.-based institutions, if they provided clinical care and addressed vitreous floater treatment on their website. Of the 1,065 websites screened, 456 were included. Of these, 406 (89%) were private institutions, 24 (5.3%) were academic, and 26 (5.7%) were a combination of private and academic. The average readability score correlated to a 10th-12th grade reading level. Vitreous floater treatment was discussed on 283 (62.1%) websites and 63 (21.8%) websites discussed potential side effects. Google rank was inversely correlated with the depth of explanation (r = -0.114, = .016). Observation was the main treatment recommended (55.8%, n = 158), followed by laser treatment (27.6%, n = 78), no specific treatment recommendation (11.3%, n = 32), and vitrectomy (5.3%, n = 15). Centers with vitreoretinal surgeons were 16.43 times more likely to recommend vitrectomy than those without vitreoretinal surgeons ( < .001). Online information about vitreous floater treatment is variable, and the material is at a higher than recommended reading level for health information. While treatment was discussed by nearly two thirds of websites, less than a quarter mentioned possible complications, and treatment recommendations varied significantly depending on physician training

The Effect of Market Competition on the Price of Topical Eye Drops

To describe the relationship between the number of Federal Drug Administration (FDA)-approved manufacturers and the price change of generic and branded topical eye drops. Retrospective analysis of topical eye drop medications with formulations listed in the FDA Orange Book and the National Average Drug Acquisition Cost database from 2013 to 2017. The most frequently prescribed generic topical drugs were glaucoma medications (34%), antimicrobials (32%), anti-inflammatories (24%), mydriatics (5%), and anesthetics (5%). The most frequently prescribed branded topical drugs were anti-inflammatories (45%), glaucoma medications (32%), antimicrobials (21%) and dry eye medications (3%). From 2013 to 2017, generic eye drops had a median price decrease of 20% (IQR 32%) while branded eye drops had a median price increase of 44% (IQR 28%) (P < .001). A significant inverse association was identified between the price change of generic eye drops and the total number of all manufacturers (r = −.41, P = .010), generic drug manufacturers (r = −.32, P = .0496), and alternative branded drug manufacturers (r = −.57, P = .002). There was no significant association between the price change of branded eye drops and number of manufacturers. Glaucoma (r = −.58, P = .039) and anti-inflammatory (r = −.69, P = .047) eye drops also had significant inverse associations with the number of generic manufacturers. From 2013 to 2017, the price of generic eye drops decreased whereas the price of branded eye drops increased. Market competition was significantly inversely associated with price changes of generic eye drops but not branded eye drops

Trends in Intravitreal Corticosteroid Agent Use by US Ophthalmologists in Medicare Beneficiaries and Association with Physician-Industry Interactions

PURPOSE: To report trends of intravitreal corticosteroid use and explore the relationship between career experience, reported industry payments, and prescribing habits. DESIGN: Retrospective review of ophthalmologists who administered intravitreal dexamethasone implants (DEX) and triamcinolone acetonide (TA) injections between August 2013 to December 2017. RESULTS: A total of 1070 US ophthalmologists were reimbursed by Medicare for 522,804 DEX injections and 2.6 million TA injections. There was a significant positive trend in the number of DEX (P=.01), but not TA, injections per year. Mid- and late-career physicians performed significantly greater total injections on average compared to early-career physicians (both P<.001). Early-career physicians performed a greater proportion of DEX injections than late-career physicians (P=.006). Industry payments were positively associated with the proportion of DEX used and inversely correlated with the proportion of TA administered (P<.001). On multivariate analysis, years in practice, number of payments, and total value of payments were significantly associated with the number of DEX injections administered (all P<.001). CONCLUSION: From 2013 to 2017, the use of DEX increased while TA use remained stable. There was a positive association between DEX use and physician-industry interactions, which may be explained by seniority and experience. This study does not define a causal relationship

Gender representation in pediatric ophthalmology: an analysis of trends over a decade

To assess trends in gender representation in pediatric ophthalmology. In this retrospective study, the names of oral and poster presenters at the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) annual meetings and the first and last authors of articles published in Journal of AAPOS (J AAPOS) from 2011 to 2019 were recorded. The gender of presenters and authors was determined with the aid of an online gender tool in conjunction with a comprehensive internet search. A total of 2,633 presentations, and 2,777 authors were included. Over the study period, female representation in both conferences and journal authorship increased (P > 0.01 and P = 0.01 resp.). Overall, women comprised 44% of oral presentations and 57% of poster presentations at the annual meetings. Of publications in J AAPOS, women comprised 47% of first authors and 38% of last authors. The gender of the first author did not correlate with the gender of the last author (P = 0.9). Conference roles that had the greatest gender disparities were named lecture speakers (27% female vs 73% male [P = 0.01]) and program committee members (34% female vs 66% male [P > 0.01]). Over the last decade, there has been an increase in representation of women at both AAPOS conferences and authorship in J AAPOS. Gender disparities persist in higher-visibility positions

Choroidal calcifications in two cases of aplasia cutis congenita and oculoectodermal syndrome

To describe choroidal calcifications as an ophthalmic feature in aplasia cutis congenita (ACC) with oculoectodermal syndrome (OES). Two cases of ACC/OES with characteristic echographic evidence of choroidal calcifications are described. The ophthalmic manifestations of ACC/OES may be expanded to include choroidal calcifications. The presence of a choroidal calcification with B-scan ultrasound in a case suspicious for ACC/OES may facilitate a more timely diagnosis and inform future follow-up regimens to monitor ophthalmic and systemic manifestations of this disease