Research productivity across different ophthalmic subspecialties in the United States

Neuro-ophthalmology output in high-impact clinical ophthalmology and neurology journals

OBJECTIVE

To characterize the neuro-ophthalmology publishing trends of the top general clinical ophthalmology and neurology journals and to report (i) the proportion of articles that are neuro-ophthalmology focused and (ii) the correlation between annual proportion of neuro-ophthalmology-focused articles and annual proportion of neuro-ophthalmologist journal editors.

DESIGN

Retrospective database review.

MATERIALS

Articles in the top 5 general clinical ophthalmology and neurology journals.

METHODS

Publications from 2012 through 2021 were retrieved from Embase and classified as teaching or nonteaching articles based on journal indexing. Duplicate screening was conducted to further categorize articles as either focused or not focused on neuro-ophthalmology.

RESULTS

The titles, abstracts, and (or) full texts of 34,660 articles were reviewed. The total proportions of nonteaching articles and teaching articles focused on neuro-ophthalmology were 3.4% and 13.8%, respectively. Neuro-ophthalmology contributions to nonteaching and teaching publications were greater among the ophthalmology journals (4.0% and 15.2%) than among the neurology journals (2.6% and 13.3%). There were no clear trends in the annual proportion of neuro-ophthalmology-focused articles across the 10-year period. The annual proportion of neuro-ophthalmologist journal editors was positively correlated with annual neuro-ophthalmology output for teaching articles (Pearson's r = 0.541; p < 0.001) but not articles unrelated to teaching (Pearson's r = 0.067; p = 0.598).

CONCLUSIONS

Our study found that there was a lower prevalence of neuro-ophthalmology papers in high-impact-factor general clinical ophthalmology and neurology journals over the last 10 years. It is important to have good representation of neuro-ophthalmology studies in such journals to promote best neuro-ophthalmic practices among all clinicians.

Descriptive Analysis of Vitreoretinal Surgery Fellowship Program Directors

Purpose: To evaluate the demographic, educational, and scholarly characteristics of Association of University Professors of Ophthalmology-accredited vitreoretinal surgery fellowship program directors in the United States and Canada. Methods: Demographic, educational, and scholarly profiles of identified program directors were collated from online public resources. Characteristics were compared by sex, program size, ranking, and affiliation. Results: Eighty-one program directors (mean age [±SD] 54.7 ± 11.0 years) from 78 fellowship programs were identified. The minority were women (14.8%), who were on average 6 years younger than their male counterparts (P = .07). The majority of program directors had an academic affiliation (90.1%), most commonly professor (54.8%). The mean h-index, 5-year h-index, and m-quotient were 20.9 ± 14.9, 5.9 ± 4.4, and 0.82 ± 0.42, respectively. Compared with their counterparts, program directors of both "top 10" and large programs published more manuscripts (P < .05), accrued more citations (P < .05), and had a higher h-index (P < .05). Fellowship programs with female program directors had a significantly larger proportion of female retina faculty (P = .002). Conclusions: The backgrounds of vitreoretinal surgery program directors are diverse. However, women remain underrepresented in this position, highlighting an area with the potential for greater equity in ophthalmology.

Analysis of Research Activity Among Ophthalmology Fellows

PURPOSE

The academic success of ophthalmology fellows may be significantly impacted by their research engagement. Evaluating the research activity of fellows by subspecialty may provide insight into trends useful for prospective applicants. The objective of this study was to assess the research activity of ophthalmology fellows in the year 2023.

METHODS

Ophthalmology fellowship programs were compiled using the Association of University Professors of Ophthalmology and the American Society of Ophthalmic Plastic and Reconstructive Surgery websites. Program subspecialties were categorized as: Cornea and External Disease [CED]; Cornea, External Disease, and Refractive Surgery [CEDRS]; Glaucoma; Medical Retina [MR]; Neuro-Ophthalmology [NO]; Oculoplastics; Pediatric Ophthalmology [PO]; Surgical Retina [SR]; Uveitis; and Other. "Other" consisted of Oncology, Pathology, combined Oncology and Pathology fellowships. We identified current fellows using publicly available online information. Programs and fellows that did not have information available were excluded. Total publications, Hirsch index (h-index), and weighted-relative citation ration (w-RCR) were utilized as measures of research output, while total citations and mean-RCR (m-RCR) served as proxies for research impact. Duration of publishing was calculated using the years of the oldest and most recent publications. Statistical analysis was performed using Kruskal-Wallis H tests with an alpha value of .05.

RESULTS

A total of 373 fellows from 229 programs met our inclusion criteria. More than half of fellows were men (54.4%), and the most common degree type was MD (93.0%). Across all subspecialties, the median h-index was 3.0 (IQR = 4), m-RCR was .9 (IQR = 1.2) and w-RCR was 3.2 (IQR = 9.8). The median number of publications was six (IQR = 10, with 34 citations (IQR = 110) and 4 years of publishing (IQR = 6). We observed significant differences in h-index (p = .038), total publications (p < .001), and w-RCR (p = .028) by subspecialty.

CONCLUSION

We observed significant differences in research output, but no differences in research impact by subspecialty. Overall, Uveitis and Oculoplastics fellows had higher research activity, while Medical Retina and Other fellows had the lowest. This data is pertinent to better understand the landscape of ophthalmology fellowship applications.

A scientometrics analysis and visualisation of diabetic foot research from 1955 to 2022

Diabetic foot (DF) has become a serious health problem in modern society, and it has been a hotspot of research for a long time. However, little scientometric analysis has been carried out on DF. In the present study, we analysed 8633 literature reports on DF in the Web of Science Core Collection from database inception until April 23, 2022. VOSviewer (Centre for Science and Technology Studies at Leiden University, Leiden, the Netherlands) and CiteSpace (College of Computing and Informatics, Drexel University, Philadelphia, United States) were employed to address high-impact countries and institutions, journals, references, research hotspots, and key research fields in DF research. Our analysis findings indicated that publications on DF have increased markedly since 2016 and were primarily published in the United States of America. The recent studies focus on the amniotic membrane, foot ulcers, osteomyelitis, and diabetic wound healing. The five keyword clusters, which included DF ulcer and wound healing therapies, management and guidelines, neuropathy and plantar pressure, amputation and ischemia, and DF infection and osteomyelitis, are helpful for enhancing prevention, standardising treatment, avoiding complications, and improving prognosis. These findings indicated a method for future therapies and research in DF.

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.

Race and Gender in Ophthalmology: A National Analysis of Medical Students with Intention to Pursue the Field

Purpose  The field of ophthalmology must become more reflective of the increasingly diverse U.S. population. This study characterizes students intending to pursue ophthalmology and practice in an underserved area versus other surgical and nonsurgical fields. Subjects  Deidentified responses from 92,080 U.S. MD students who matriculated in the academic years beginning from 2007 to 2011 were obtained from the Association of American Medical Colleges (AAMC) Graduation Questionnaires. Methods  Study participants were those who fully completed the AAMC Graduation Questionnaire. Chi-squared and multivariate logistical regressions were used for analyses. Results  Ophthalmology intending graduates (OIG; n  = 1,177) compared with other surgical intending graduates ( n  = 7,955) were more likely to be female (adjusted odds ratio [aOR]: 1.46; 95% confidence interval [CI]: 1.28-1.66), Asian (1.71 [1.46-2.01]), and have conducted a research project with a faculty member (1.58 [1.26-1.98]). OIG compared with nonsurgery intending graduates ( n  = 35,865) were more likely to have completed a research project with a faculty member (4.78 [3.86-5.92]), to be Asian (1.4 [1.21-1.62]), and have received scholarships (1.18 [1.04-1.34]). OIG were less likely to be female (0.64 [0.57-0.73]) and Black/African American (0.5 [0.33-0.74]). Among OIG, Black/African American students and multiracial students were more likely than non-Hispanic (NH) White students to report intention to practice in underserved areas (IPUA; 14.29 [1.82-111.88] and 2.5 [1.06-5.92]), respectively. OIG with global health experience were more likely to report IPUA (1.64 [1.2-2.25]). Conclusion  Females and underrepresented in medicine (URM), respectively, were more likely to be nonsurgery intending graduates than OIG, which, if not addressed, may lead to a persistent underrepresentation of these groups in the field. In addition, URM students, including African American students, were more likely to report IPUA, which further emphasizes the importance of more URM students entering the field to address these growing gaps in medical care. Finally, we recommend increased mentorship to help address these disparities.

Descriptive analysis of cornea and anterior segment fellowship program directors in 2020

PURPOSE

To investigate demographic characteristics, educational backgrounds, and academic achievements among program directors (PDs) of cornea and external disease and anterior segment fellowships in the United States in 2020.

SETTING

Database study of U.S. fellowship programs.

DESIGN

Cross-sectional study.

METHODS

PDs of cornea and external disease and anterior segment fellowships were identified using the San Francisco Match website. Fellowship program features reviewed included academic or private practice type, number of cornea faculty, and sex of chairperson. PD demographic characteristics, educational and training background, and academic productivity were analyzed using publicly available profiles and databases.

RESULTS

76 cornea and external disease and 10 anterior segment fellowships were reviewed. Of 86 reviewed programs, 55 (64.0%) were considered academic, 30 (34.9%) were private practice, and 1 (1.2%) was hybrid. 76 cornea and external disease PDs and 12 anterior segment PDs were identified. Overall, 21 (23.9%) of PDs were women, and the mean age for all PDs was 52.6 ± 11.5 years. Of the 88 PDs, the average number of publications was 45.1 ± 55.9. The mean h-index was 16.7 ± 15.4 and was higher among cornea and external disease than anterior segment PDs (18.2 ± 15.5 vs 7.1 ± 11.4, P = .008) and also higher among academic than private practice PDs (19.9 ± 15.1 vs 11.2 ± 14.7, P = .011). More female PDs were in departments with a female chairperson compared with male PDs (6 [28.6%] vs 4 [6.0%], P = .011).

CONCLUSIONS

Cornea and external disease and anterior segment fellowship PDs represent a wide array of backgrounds and scholarly achievements. Female PDs remain in the minority and are more common in departments with female chairpersons.

The Relative Citation Ratio: Examining a Novel Measure of Research Productivity among Southern Academic Ophthalmologists

PurposeTo analyze research productivity, as assessed by the National Institutes of Health-supported relative citation ratio (RCR), for a cohort of Southern academic ophthalmologists.DesignA descriptive and cross-sectional design was used. Data on gender, academic rank (assigned as an assistant professor, associate professor, professor, or "other"), degrees, and career duration were collected using online resources. Research yield was quantified using mean and weighted RCR data queried from the iCite database. Significant between-group differences were calculated using the Mann-Whitney U-test and the Kruskal-Wallis test.SettingsPracticing academic ophthalmologists at Accreditation Council for Graduate Medical Education-accredited ophthalmology programs in the Southern United States (n = 1018).ResultsFor all Southern academic ophthalmologists, median mean RCR was 0.90 (IQR 0.18-1.71) and median weighted RCR was 5.12 (IQR 0.34-33.18). Advanced academic rank and PhD acquisition were significantly associated with increased mean and weighted RCR. After exclusion of faculty within the "other" category, median mean RCR was 1.12 (IQR 0.54-1.80) and median weighted RCR was 11.65 (IQR 2.03-45.58). Furthermore, effects of career duration and gender emerged. Ophthalmologists with longer careers had significantly higher mean and weighted RCR than their younger counterparts. Males had significantly higher mean and weighted RCR than females.ConclusionsAcademic rank and attainment of a PhD degree were correlated with increased research productivity. When analyses focused exclusively on faculty not in the "other" subgroup, male gender, and lengthier career were associated with increased mean and weighted RCR, the former of which potentially highlights differences in professional advancement between genders.

Research productivity and impact of Canadian academic ophthalmologists: trends in H-index, sex, subspecialty, and faculty appointment

OBJECTIVE

H-index has historically functioned as a metric of academic success for acquisition of research grants, awards, and faculty appointments. Our objective was to characterize the landscape of Canadian academic ophthalmology on the basis of research productivity and impact-as measured by H-index-with sex, subspecialty, and faculty appointment.

DESIGN

Cross-sectional study based on data abstracted from publicly available databases.

PARTICIPANTS

Academic ophthalmologists from all schools in Canada with an ophthalmology residency program.

METHODS

Academic ophthalmologists and their faculty appointments were identified from university websites. Sex was determined from available provincial College of Physicians and Surgeons or Ophthalmology Society databases. H-indices were collected from Scopus and Web of Science. Descriptive, univariate, and multivariate statistics were used to analyze the relationship of H-index with sex, faculty appointment, and subspecialty.

RESULTS

We included data from 696 academic ophthalmologists. The mean H-indices for lecturers and assistant, associate, and full professors were 4.0 (±5.6), 5.6 (±5.0), 8.8 (±6.3), and 15 (±12), respectively. H-index had a significant positive correlation with faculty appointment (0.521, 95% confidence interval 0.469-0.579, p = 1.77e-41). The mean H-index was 6.7 (±8.2) for women and 8.1(±8.4) for men (p = 0.0635). Women comprised 27% of faculty positions, and men were more likely to have a higher faculty appointment than women (p = 0.0073). The top subspecialties for underrepresentation of women were surgical retina, medical retina, and oculoplastics.

CONCLUSIONS

Faculty appointments are associated with research productivity, as measured by H-index. There are significant sex disparities in faculty appointments and subspecialty representation. Future directions include exploring other contributory factors to success in academic ophthalmology.

The Effect of a Points System on Incentivizing Academic Behaviors of Attending Ophthalmologists

(1) Background: Little is known regarding the best ways to promote academic throughput within the ranks of attending ophthalmology physicians. The purpose of this project is to evaluate the effect of a monetized points system on incentivizing research output and other academic activity in academic ophthalmology attendings. (2) Methods: This is a retrospective study of 15 academic ophthalmology attendings at a single academic teaching hospital from 1 July 2015 to 30 June 2020. A points system was implemented in the 2017 academic year (1 July 2016–30 June 2017), in which ophthalmology attendings accrued points for eight categories of academic achievement. We compared the overall number of publications, number of first/senior author publications, and corresponding impact factors of journals via the PubMed database in the two years of data before and after the points system was implemented. We analyzed points awarded for eight categories of academic achievement in the first, second, and third year of the program. (3) Results: There was no significant change in research productivity for attending ophthalmologists after institution of the points system. From 2017 to 2019, Mann–Whitney analysis revealed a significant increase in points awarded for mentorship per physician (p = 0.013). (4) Conclusions: Our data suggest that within the framework of the points system, attendings—rather than prioritizing publications—gravitated towards mentorship activities to accrue points.

Academic background, professional experience, and research achievements of United States academic ophthalmology leadership

PURPOSE

To characterize the academic background, professional experience, and scholarly achievements of United States (US) academic ophthalmologists serving in leadership positions.

METHODS

This is a cross-sectional study. An online search of publicly available resources was conducted for demographics, background, research productivity, and academic appointments of academic ophthalmologists in leadership positions: chairperson (CP), vice chair (VC), service director (SD), and program director (PD).

RESULTS

Five hundred and fifty-one academic ophthalmologists in leadership positions were analyzed. A male predominance was found in all positions, ranging from 86% male CPs to 68% of SDs. Eighty-nine percent were graduates of US medical schools, and 97% completed their residency in a US ophthalmology program. Harvard Medical School and The Johns Hopkins University School of Medicine and their affiliated programs were the most frequently attended by leaders. The most common subspecialties among leaders were surgical retina (21%), cornea (18%), and glaucoma (16%). Overall, 18% of leaders are endowed professors, 34% are full professors, 25% are associate professors, and 20% are assistant professors. Overall, 28% of department leaders were residents and 16% were fellows in their current program. Chairpersons, followed by their vice, are the most academically proficient leaders within their departments, having the largest number of publications and h, hc, hm, and AWCR bibliometric indices.

CONCLUSIONS

Ophthalmology leaders in all positions are highly accomplished with an established interest in research. Typically, CPs and their VCs have a longer duration of professional experience with a greater research output and a superior median academic appointment. Gender discrepancies within leadership positions are evident.

The 100 Most Cited Articles in Ophthalmology in Asia

PURPOSE

The aim of this study was to review the top 100 most-cited articles in ophthalmology in Asia since 1970.

METHODS

The Scopus database was used to identify the top 100 most-cited ophthalmology articles published in ophthalmology (T100-Eye) and nonophthalmology (T100-General) journals.

RESULTS

The T100-Eye articles were published between 1982 and 2015, and T100-General from 1982 to 2017. T100-Eye had higher citations [median (range) = 317 (249-1326)] than T100-General [158 (105-2628)], but T100-General were published in journals with higher impact factor (IF) than T100-Eye (median IF= 5.5 vs 4.4) and produced more landmark papers (3 vs 1 articles that were cited >1000 times). Fifty-five % of T100-Eye were published in 3 journals: Ophthalmology (n = 22), Investigative Ophthalmology and Visual Science (n = 17), and American Journal of Ophthalmology (n = 16). T100-Eye had 88 original research articles and 12 reviews, whereas T100-General had 84 original research and 16 reviews. The most-frequent studied disease categories were myopia (n = 16) and age-related macular degeneration (n = 15) in T100-Eye and diabetic retinopathy (n = 24) and glaucoma (n = 16) in T100-General. Japan and Singapore contributed most to T100-Eye (n = 42, n = 17) and T100-General (n = 36, n = 26) articles. More than 80% and 95% of first and last authors were male in both lists. Emerging research topics were optical coherence tomography in T100-Eye and artificial intelligence in T100-General.

CONCLUSIONS

Our citation analysis reveals differences in the focus of research topics of top-cited ophthalmology articles published in ophthalmology and nonophthalmology journals in Asia. It highlights that certain eye diseases are studied more in Asia and shows the contribution of specific countries to highly cited publications in ophthalmology research in Asia.