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Paul ME, Frempong T. Treatment rate of strabismus and amblyopia is associated with the location of pediatric ophthalmologists in the United States. J AAPOS 2024; 28:103868. [PMID: 38458596 DOI: 10.1016/j.jaapos.2024.103868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 11/14/2023] [Accepted: 12/04/2023] [Indexed: 03/10/2024]
Abstract
PURPOSE To determine whether the geographic density of pediatric ophthalmologists is associated with the rate of children treated for strabismus and amblyopia. METHODS This cross-sectional study included children treated for strabismus and amblyopia 0-17 years of age with commercial insurance who were included in the Vision and Eye Health Surveillance System. Additionally, pediatric ophthalmologists by state were determined using the American Association for Pediatric Ophthalmology and Strabismus website. Unadjusted linear regression was used to compare the geographic density of pediatric ophthalmologists and the rate of children treated for strabismus and amblyopia by state in 2016. This was repeated using multivariable linear regression, controlling for race, poverty, non-English-speaking children, and insurance coverage for children by state. RESULTS New York and Mississippi had the highest and lowest rates of treatment of strabismus and amblyopia, with 3.97 and 0.83 children treated per 100 children, respectively. The geographic density of pediatric ophthalmologists was associated with the rate of children treated for strabismus and amblyopia in unadjusted analyses (β = 0.62, P < 0.001). Further, the geographic density of pediatric ophthalmologists was associated with the rate of children treated for strabismus and amblyopia in adjusted analyses (β = 0.61, P < 0.001). CONCLUSIONS The geographic density of pediatric ophthalmologists by state was positively associated with the rate of children treated for strabismus and amblyopia.
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Affiliation(s)
- Megan E Paul
- Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Tamiesha Frempong
- Icahn School of Medicine at Mount Sinai, New York, New York; Department of Ophthalmology, Icahn School of Medicine at Mount Sinai/New York Eye & Ear, Eye and Vision Research Institute, New York, New York
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Vought V, Vought R, Sharma R, Razdan G, Zhu L, Sutariya R, Wagner RS. Evaluating Pediatric Ophthalmic Care Using Sentiment Analysis of Physician Review Sites. J Pediatr Ophthalmol Strabismus 2024:1-8. [PMID: 38275203 DOI: 10.3928/01913913-20240108-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
PURPOSE To assess patient satisfaction within pediatric ophthalmology and identify trends in patient sentiment. METHODS Pediatric ophthalmologists in the United States were identified using the American Association for Pediatric Ophthalmology and Strabismus member directory. Demographic data were recorded using publicly available websites. Online written reviews and Stars ratings were obtained from Healthgrades.com. A sentiment analysis package, Valence Aware Dictionary for Sentimental Reasoning (VADER), was used to generate a compound score of reviews, and word frequency analyses were applied. RESULTS A total of 377 pediatric ophthalmologists (2,640 online reviews) were evaluated. Physicians received an average of 4.22/5 Stars and a compound sentiment score of 0.56, indicating positive sentiment. No differences in scores were observed by gender or location, although physicians with fewer years in practice had higher Stars ratings compared to peers (P < .001). The three most common words in the word frequency analysis of all reviews were "surgery," "staff," and "time," with heavy emphasis on bedside manner and addressing patient concerns. CONCLUSIONS This study demonstrates overall high patient satisfaction in pediatric ophthalmology care, with differences in sentiment based on physician demographic features. The study highlights that patient perspective is influenced by non-clinical features of care. These data may be used by pediatric ophthalmologists seeking to improve health care delivery.[J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].
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Antonio-Aguirre B, Ambrosino CM, Dai X, Collins ME. Addressing Health Disparities in Pediatric Eye Care for School-Age Children: A Call to Action. Transl Vis Sci Technol 2023; 12:17. [PMID: 37962540 PMCID: PMC10653256 DOI: 10.1167/tvst.12.11.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/25/2023] [Indexed: 11/15/2023] Open
Abstract
Disparities in access to pediatric eye care among school-age children pose significant challenges to their health and well-being; addressing these disparities will necessitate coordination across multiple systems. Although vision screenings are mandated in most US states, differences persist in terms of who receives screenings and subsequent follow-up care. Racial, ethnic, and socioeconomic factors exacerbate the issue, with potential ramifications of unaddressed eye problems on learning performance and the risk of widening preexisting educational disparities. To address these challenges, various initiatives and strategic plans have emphasized the need to improve access, enhance diversity in the workforce, and promote health literacy. School-based vision programs (SBVPs) have shown promise in improving access to care and academic outcomes, but issues with integration into the health care system exist. This article explores opportunities to address structural barriers, establish resilient and equitable systems for delivering pediatric eye care to school-age children, and leverage the success of SBVPs to build stronger connections with community providers. Proposed strategies include developing standardized guidelines; establishing referral mechanisms; fostering communication with parents, teachers, and community providers; and promoting eye health literacy across the school community. Collectively, these measures aim to improve health outcomes, address social determinants of health, and reduce disparities in access to care.
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Affiliation(s)
| | | | - Xi Dai
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Megan E. Collins
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
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Mahmud F, Karmouta R, Strawbridge JC, Prasad P, Chu A, Khitri M, Tsui I. A MULTICENTER STUDY OF RETINOPATHY OF PREMATURITY FOLLOW-UP ADHERENCE. Retina 2023; 43:1780-1787. [PMID: 37399574 DOI: 10.1097/iae.0000000000003875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
PURPOSE Characterize clinical and socioeconomic factors that impact follow-up to complete retinal vascularization and subsequent pediatric ophthalmology follow-up in neonates with retinopathy of prematurity. METHODS Medical records of 402 neonates diagnosed with retinopathy of prematurity from neonatal intensive care units at the University of California, Los Angeles Mattel Children's Hospital and the University of California, Los Angeles Santa Monica Hospital, both academic medical centers, and the Harbor-University of California, Los Angeles Medical Center, a safety-net county hospital, were reviewed. Primary study outcomes were the rate of follow-up to complete retinal vascularization and adequate pediatric ophthalmology follow-up. Secondary outcome was the rate of nonretinal ocular comorbidity. RESULTS In whole-cohort analysis, 93.6% of neonates were followed to complete retinal vascularization, and 53.5% had adequate pediatric ophthalmology follow-up. Public insurance was associated with lower rates of pediatric ophthalmology follow-up (Odds ratio 0.66, 95% confidence interval 0.45-0.98, P = 0.04). Participants screened at the academic medical center had lower rates of pediatric ophthalmology follow-up compared with the safety-net county hospital (50.7% vs. 63.5%, P = 0.034). In subgroup analysis, academic medical center participants with public insurance were less likely to have pediatric ophthalmology follow-up than safety-net county hospital participants with public insurance (36.5% vs. 63.8%, P < 0.001) or those with private insurance at the academic medical center (36.5% vs. 59.2%, P< 0.001). CONCLUSION This study identified high follow-up rates to complete retinal vascularization, lower pediatric ophthalmology follow-up rates, and nonretinal ocular comorbidity at all hospitals. Insurance status relative to hospital type was identified as a risk factor for loss to follow-up. This demonstrates a need to further study health care disparities in retinopathy of prematurity infants.
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Affiliation(s)
- Fahim Mahmud
- Department of Ophthalmology, David Geffen School of Medicine, Stein Eye Institute and Doheny Eye Institute, University of California, Los Angeles, CA
| | - Reem Karmouta
- Department of Ophthalmology, David Geffen School of Medicine, Stein Eye Institute and Doheny Eye Institute, University of California, Los Angeles, CA
| | - Jason C Strawbridge
- Department of Ophthalmology, David Geffen School of Medicine, Stein Eye Institute and Doheny Eye Institute, University of California, Los Angeles, CA
| | - Pradeep Prasad
- Department of Ophthalmology, David Geffen School of Medicine, Stein Eye Institute and Doheny Eye Institute, University of California, Los Angeles, CA
- Department of Ophthalmology, LA County Department of Health Services, Harbor-UCLA Medical Center, Los Angeles, CA; and
| | - Alison Chu
- Division of Neonatology and Developmental Biology, Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Monica Khitri
- Department of Ophthalmology, David Geffen School of Medicine, Stein Eye Institute and Doheny Eye Institute, University of California, Los Angeles, CA
- Department of Ophthalmology, LA County Department of Health Services, Harbor-UCLA Medical Center, Los Angeles, CA; and
| | - Irena Tsui
- Department of Ophthalmology, David Geffen School of Medicine, Stein Eye Institute and Doheny Eye Institute, University of California, Los Angeles, CA
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Oke I, Hunter DG, Mantagos IS, Heidary G. The impact of the COVID-19 pandemic on the surgical volume of pediatric ophthalmology and strabismus fellows. J AAPOS 2023; 27:305-307. [PMID: 37611817 DOI: 10.1016/j.jaapos.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/14/2023] [Accepted: 06/23/2023] [Indexed: 08/25/2023]
Abstract
This study used data from the annual fellowship survey over 7 academic years (2014-15 to 2020-21) to describe the trends in surgical experience for pediatric ophthalmology and strabismus fellows and to quantify the impact of the COVID-19 pandemic on trainee surgical volume. The overall number of procedures performed by fellows in the primary surgeon role declined during the first academic year impacted by the pandemic but recovered in the second year. There was an increase in the number of intraocular cases performed per year during the 7-year study interval.
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Affiliation(s)
- Isdin Oke
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - David G Hunter
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Iason S Mantagos
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gena Heidary
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Lee KE, Sussberg JA, Nelson LB, Thuma TBT. What We Learned About the Economic and Workforce Issues in Pediatric Ophthalmology: Access to Eye Care and Possible Solutions. J Pediatr Ophthalmol Strabismus 2023; 60:323-329. [PMID: 37747159 DOI: 10.3928/01913913-20230620-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
PURPOSE To provide a blueprint reviewing the major economic and workforce issues in pediatric ophthalmology and its effect on access to pediatric eye care, as well as potential solutions. METHODS This was a systematic review of the landmark studies examining the economic and workforce issues in pediatric ophthalmology was performed. RESULTS The number of residents pursuing pediatric ophthalmology fellowship has steadily declined since the early 2000s. Increasing overhead costs, low Medicaid reimbursements, practice pattern changes, and workforce shortages have all contributed to a significant crisis in access to pediatric eye care. CONCLUSIONS Solutions to improve access to pediatric eye care involve pursuing more economical strategies within the confines of the pediatric ophthalmology practice, early exposure to the field during medical education, and enhancing residents' interest through faculty mentorship. Low reimbursements are a major driver contributing to extended appointment wait times for pediatric ophthalmology visits at major academic eye centers. Legislative changes at both the federal and state levels are needed to make appropriate increases in reimbursements, starting with states in the lowest quartile of Medicaid reimbursements. [J Pediatr Ophthalmol Strabismus. 2023;60(5):323-329.].
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Young TL. Using Adjustable-Focus Spectacles in Young Children to Meet Increasing Eyecare Needs. JAMA Ophthalmol 2023; 141:860-861. [PMID: 37615948 DOI: 10.1001/jamaophthalmol.2023.3760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Affiliation(s)
- Terri L Young
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison
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Lee KE, Sussberg JA, Nelson LB, Thuma TBT. Unanswered Questions Pertaining to the Economic and Workforce Issues in Pediatric Ophthalmology. J Pediatr Ophthalmol Strabismus 2023; 60:163-169. [PMID: 37227986 DOI: 10.3928/01913913-20230213-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE To create a survey that examines remaining unanswered questions related to the economic and workforce issues in pediatric ophthalmology. METHODS A 12-question survey was distributed to U.S.-based pediatric ophthalmologists on the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) discussion board and various other social media forums. Statistical analysis was performed on the basis of practice setting groups. RESULTS Two hundred eighty-seven pediatric ophthalmologists completed the survey. Of all respondents, 150 (52.3%) believed pediatric ophthalmology is a prestigious subspecialty, 137 (47.7%) thought that a hybrid fellowship combining pediatric ophthalmology and adult cataract surgery would increase the number of practicing pediatric ophthalmologists, 189 (65.9%) felt that early exposure during medical school would increase the number of residents who ultimately apply to pediatric ophthalmology fellowship, and 81 (28.2%) believed that the lobbyists hired by the AAPOS will be successful in preventing further Centers for Medicare and Medicaid Services reimbursement cuts. Medicaid patients comprised more than 25% of the total practice for 156 (54.4%) respondents. New patient, follow-up, and surgery wait times were greater than 2 months in 50.9%, 46.7%, and 38.7% of respondents, respectively. CONCLUSIONS As the economic crisis in pediatric ophthalmology continues to worsen, questions related to increasing interest in the field through early exposure, hybrid fellowship, prestige, appointment wait times, and belief in the success of AAPOS lobbyists remain. Exceptional measures are required to revitalize the field and improve access to care. [J Pediatr Ophthalmol Strabismus. 2023;60(3):163-169.].
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Walsh HL, Parrish A, Hucko L, Sridhar J, Cavuoto KM. Access to Pediatric Ophthalmological Care by Geographic Distribution and US Population Demographic Characteristics in 2022. JAMA Ophthalmol 2023; 141:242-249. [PMID: 36701149 PMCID: PMC9880864 DOI: 10.1001/jamaophthalmol.2022.6010] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/29/2022] [Indexed: 01/27/2023]
Abstract
Importance The geographic distribution of pediatric ophthalmological care has not been reported on since 2007; understanding this distribution could shed light on potential avenues to increase access, which is a necessary first step in addressing the pediatric ophthalmological needs of underserved areas. Objective To analyze the number and location (ie, geographic distribution) of pediatric ophthalmologists in relation to US population demographic characteristics. Design, Setting, and Participants In this cross-sectional study, public databases from the American Academy of Ophthalmology and American Association for Pediatric Ophthalmology and Strabismus were used to identify pediatric ophthalmologists in the US as of March 2022. Main Outcomes and Measures Geographic distribution of pediatric ophthalmologists listed in public databases and any association between pediatric ophthalmologist distribution and US population demographic characteristics. Addresses were geocoded using ArcGIS Pro (Esri). Results A total of 1056 pediatric ophthalmologists (611 men [57.9%]) were identified. States with the most pediatric ophthalmologists were California (n = 116 [11.0%]), New York (n = 97 [9.2%]), Florida (n = 69 [6.5%]), and Texas (n = 62 [5.9%]), the 4 most populous states. A total of 2828 of 3142 counties (90.0%) and 4 of 50 states (8.0%) had 0 pediatric ophthalmologists. In 314 counties (10.0%) with 1 or more pediatric ophthalmologists, the mean (range) pediatric ophthalmologists per million persons was 7.7 (0.4-185.5). The range of practitioner to million persons has increased since 2007. Counties with 1 or more pediatric ophthalmologists had a higher median (SD) household income compared with counties with 0 pediatric ophthalmologists ($70 230.59 [$18 945.05] vs $53 263.62 [$12 786.07]; difference, -$16 966.97; 95% CI, -$18 544.57 to -$14 389.37; P < .001). Additionally, the proportion of families in each county without internet service (8.0% vs 4.7%; difference, 3.4%; 95% CI, 3.0%-3.7%; P < .001), the proportion of persons younger than 19 years without health insurance (5.7% vs 4.1%; difference, 1.6%; 95% CI, 1.1%-2.2%; P < .001), and the proportion of households without vehicle access (2.1% vs 1.8%; difference, 0.3%; 95% CI, 0.6%-5.2%; P = .001) were greater in counties with 0 compared with counties with 1 or more pediatric ophthalmologists. Conclusion and Relevance This cross-sectional study found that disparities in access to pediatric ophthalmological care have increased over the past 15 years and are associated with lower socioeconomic status. As patients may rely on online sources to identify the nearest pediatric ophthalmologist, accurate publicly available databases are important.
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Affiliation(s)
- Hannah L. Walsh
- University of Miami Miller School of Medicine, Miami, Florida
| | | | - Lauren Hucko
- University of Miami Miller School of Medicine, Miami, Florida
| | - Jayanth Sridhar
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Kara M. Cavuoto
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
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Law C, Yu CW, Hawley GD, Manickavachagam K, Hopman WM, Strube YNJ. Missed appointments in a tertiary academic pediatric ophthalmology and adult strabismus service: cross-sectional study and literature review. J AAPOS 2023; 27:77.e1-77.e6. [PMID: 36863683 DOI: 10.1016/j.jaapos.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/18/2022] [Accepted: 01/10/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE To investigate the rate of missed appointments in a Canadian academic hospital-based pediatric ophthalmology and adult strabismus practice and the demographic and clinical factors associated with missed appointments. METHODS This cross-sectional study included all consecutive patients seen from June 1, 2018, to May 31, 2019. Multivariable logistic regression model assessed associations between clinical and demographic variables with no-show status. A literature review on evidence-based interventions to reduce no-show appointments in ophthalmology was performed. RESULTS Of 3,922 visits, 718 (18.3%) were no-shows. Characteristics associated with no-shows included new patient (OR = 1.4; 95% CI, 1.1-1.7 [P = 0.001]), age 4-12 years (OR = 1.6; 95% CI, 1.1-2.3 [P = 0.011]) or age 13-18 years (OR = 1.8; 95% CI, 1.2-2.7 [P = 0.007]) compared with age 19+ years, history of previous no-shows (OR = 2.2; 95% CI, 1.8-2.7 [P = 0.001]), referrals from nurse practitioners (OR = 1.8; 95% CI, 1.0-3.2 [P = 0.037]), nonsurgical diagnoses such as retinopathy of prematurity (OR = 3.2; 95% CI, 1.8-5.6 [P < 0.001]), and winter season (OR = 1.4; 95% CI, 1.2-1.7 [P < 0.001]). CONCLUSIONS Missed appointments in our pediatric ophthalmology and strabismus academic center are more likely new patient referrals, prior no-shows, referrals from nurse practitioners, and nonsurgical diagnoses. These findings may facilitate targeted strategies to help improve utilization of healthcare resources.
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Affiliation(s)
- Christine Law
- Department of Ophthalmology, Kingston Health Sciences Centre, Queen's University, Kingston, Canada
| | - Caberry W Yu
- Department of Surgery, McMaster University, Hamilton, Canada
| | - Gregory D Hawley
- Department of Family Medicine, University of Toronto, Toronto, Canada
| | | | - Wilma M Hopman
- Department of Public Health Sciences, Kingston Health Sciences Centre, Kingston, Canada
| | - Yi Ning J Strube
- Department of Ophthalmology, Kingston Health Sciences Centre, Queen's University, Kingston, Canada.
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Moon J, Geloneck M, Bowden E, Crowell E, Edmond J. Directors of accredited pediatric ophthalmology fellowship programs: a descriptive analysis. J AAPOS 2023; 27:95.e1-95.e6. [PMID: 36813128 DOI: 10.1016/j.jaapos.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/14/2023] [Accepted: 01/22/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE To examine the characteristics of pediatric ophthalmology fellowship program directors (FPDs) through cross-sectional analysis. METHODS All pediatric ophthalmology FPDs whose programs participated in the San Francisco Match in January 2020 were included. Information was collected through publicly available sources. Scholarly activity was measured by peer-reviewed articles and the Hirsch index. RESULTS Of the 43 FPDs, 22 (51%) were male, and 21 (49%) were female. The mean age of current FPDs was 53.5 ± 8.8 years old. There was a significant difference between the current age of male and female FPDs (57.8 ± 8 vs 49 ± 7.3, resp. [P <0.0001]). The mean term length of female and male FPDs also differed (11.5 ± 4.5 vs 16.1 ± 8.9 [P = 0.042]). Thirty-eight FPDs (88%) attended medical school in the United States. Forty-two FPDs had an MD (98%). Thirty-nine (91%) FPDs completed ophthalmology residency in the United States. Ten (23%) of the FPDs were dual fellowship trained. There was a significantly higher Hirsch-index among male than female FPDs (23.9 ± 15.7 vs 10.3 ± 10.1 [P = 0.0017]). There was a higher number of publications for male (91 ± 89) than female FPDs (31.5 ± 48.6 [P = 0.0099]). CONCLUSIONS Pediatric ophthalmology fellowship programs have a uniquely equal representation of male and female FPDs as women continue to be underrepresented in ophthalmology. Female FPDs were younger and had spent less time in the position, suggesting a shift toward more female FPD over time.
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Affiliation(s)
- Jared Moon
- Mitchel and Shannon Wong Eye Institute, Dell Medical School at the University of Texas at Austin.
| | - Megan Geloneck
- Mitchel and Shannon Wong Eye Institute, Dell Medical School at the University of Texas at Austin
| | - Eileen Bowden
- Mitchel and Shannon Wong Eye Institute, Dell Medical School at the University of Texas at Austin
| | - Eric Crowell
- Mitchel and Shannon Wong Eye Institute, Dell Medical School at the University of Texas at Austin
| | - Jane Edmond
- Mitchel and Shannon Wong Eye Institute, Dell Medical School at the University of Texas at Austin
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Abstract
PURPOSE To create a survey that assesses potential solutions for an economic turnaround in pediatric ophthalmology and the frequency of their use. METHODS A 12-question survey was distributed to United States-based pediatric ophthalmologists on the American Association for Pediatric Ophthalmology and Strabismus discussion board and various social media fora. Demographic, economic, and workforce pattern data were collected and analyzed. RESULTS Three hundred one pediatric ophthalmologists completed the survey. Thirty-one (10.3%) respondents used optical coherence tomography in children with amblyopia, 81 (26.9%) were a partner in an ambulatory surgery center, 133 (44.2%) had a retinopathy of prematurity financial contract arrangement with a neonatal intensive care unit to examine premature children, and 95 (31.6%) had a financial contract arrangement with an optical shop in their office. Twenty-four (8.0%) respondents were currently in the process of being or had been bought out by a private equity investor, 52 (17.3%) owned a Spot Vision Screener (Welch Allyn) for refraction, 158 (52.5%) had hired a pediatric ophthalmology extender (pediatric optometrist, technician, or orthoptist), 87 (29.5%) had recently increased their marketing profile, and 90 (29.9%) owned the property that their practice occupied. CONCLUSIONS Potential for a revitalization and economic turnaround in pediatric ophthalmology depends on several income-generating suggestions that simultaneously improve workforce and manpower issues, thus increasing access to pediatric eye care. [J Pediatr Ophthalmol Strabismus. 2023;60(1):25-32.].
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Abstract
PURPOSE To discuss the economic downturn of pediatric ophthalmology in the setting of an alarming decline in the number of residents pursuing pediatric ophthalmology and its impact on limiting access to eye care. METHODS Survey studies and articles examining the recent economic impact of reimbursement cuts and practice pattern changes in pediatric ophthalmology were reviewed. Population data from the 2020 U.S. Census Bureau and the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) were analyzed to illustrate provider-to-population relationships by state. RESULTS Survey studies demonstrated a deteriorating economic situation marked by progression in reimbursement cuts, reductions in pediatric ophthalmologists accepting Medicaid patients, and dwindling numbers of residents pursuing pediatric ophthalmology fellowships. Provider-to-population relationships revealed that pediatric ophthalmologists are not evenly distributed to meet population demand, and that many states are suffering from a shortage of pediatric ophthalmologists. Furthermore, many states with high percentages of Medicaid coverage simultaneously have lower AAPOS members/million person ratios. CONCLUSIONS The simple economic principles of supply and demand reveal a crisis in access to pediatric eye and adult strabismus care. The economic downtown and change in practice patterns may produce rippling effects outside pediatric ophthalmology in fields such as pediatrics and comprehensive ophthalmology. An interdisciplinary effort among health care providers and governmental officials is needed to revive the field of pediatric ophthalmology and improve access to eye care. [J Pediatr Ophthalmol Strabismus. 2023;60(1):18-24.].
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Schott B, Seery C, Wagner RS, Guo S. Cycloplegic Autorefraction as a Substitute for Cycloplegic Retinoscopy in the Pediatric Population. J Pediatr Ophthalmol Strabismus 2022; 59:422-427. [PMID: 35446196 DOI: 10.3928/01913913-20220321-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate whether cycloplegic autorefraction can provide similar results as cycloplegic retinoscopy, allowing more comprehensive ophthalmologists to be comfortable in managing pediatric refractive error and refractive amblyopia. METHODS This retrospective chart review was performed to determine the mean difference in sphere, cylinder, and axis between cycloplegic autorefraction and retinoscopy, both of which were obtained on the same eye at least 30 minutes after cycloplegia and dilation with a mixed solution of tropicamide, cyclopentolate, and phenylephrine. RESULTS A total of 34 eyes (18 right, 16 left) from 18 patients were included in the analysis. Mean sphere difference between cycloplegic autorefraction and retinoscopy was 0.044 ± 0.278 diopters (D) (95% CI: -1.275 to 1.363 D), mean cylinder difference was -0.081 ± 0.236 D (95% CI: -0.706 to 0.544 D), and mean axis difference was 7.059 ± 19.676 degrees (95% CI: -32.527 to 38.878 degrees). Mean differences in sphere, cylinder, and axis were not statistically significant (P = .362, .0541, and .377, respectively). CONCLUSIONS In this small sample population, cycloplegic autorefraction was comparable to cycloplegic retinoscopy. Recognition of amblyopia should still prompt evaluation by a pediatric ophthalmologist. Further research is necessary to confirm whether uncomplicated refractive error in children may be sufficiently detected and managed by a comprehensive ophthalmologist. [J Pediatr Ophthalmol Strabismus. 2022:59(6):422-427.].
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Oke I, Heidary G, Mantagos IS, Shah AS, Hunter DG. A decline in the strabismus surgical experience of ophthalmology residents in the United States from 2010 to 2019. J AAPOS 2022; 26:263-265. [PMID: 36113703 DOI: 10.1016/j.jaapos.2022.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 11/19/2022]
Abstract
Subspecialty exposure during residency can influence the future pursuit of fellowship training. In this study, we compared the trends in strabismus surgical experience reported by graduating ophthalmology residents in the United States with other categories of ophthalmic surgery. Over the 10-year period (2010-2019), there was a decline in the total number of strabismus procedures performed during residency by ophthalmology residents graduating in a given year (1.4 fewer cases per year; 95% CI, 1.1-1.6 [P < 0.001]). Although several surgical categories experienced a decrease in cases performed in the assistant role, strabismus surgery was the only category with a decrease in cases performed in the surgeon role (0.4 fewer cases per year; 95% CI, 0.3-0.5 [P < 0.001]).
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Affiliation(s)
- Isdin Oke
- Department of Ophthalmology, Boston Children's Hospital, Massachusetts Eye and Ear, and Harvard Medical School, Boston, Massachusetts
| | - Gena Heidary
- Department of Ophthalmology, Boston Children's Hospital, Massachusetts Eye and Ear, and Harvard Medical School, Boston, Massachusetts
| | - Iason S Mantagos
- Department of Ophthalmology, Boston Children's Hospital, Massachusetts Eye and Ear, and Harvard Medical School, Boston, Massachusetts
| | - Ankoor S Shah
- Department of Ophthalmology, Boston Children's Hospital, Massachusetts Eye and Ear, and Harvard Medical School, Boston, Massachusetts
| | - David G Hunter
- Department of Ophthalmology, Boston Children's Hospital, Massachusetts Eye and Ear, and Harvard Medical School, Boston, Massachusetts.
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Thuma TBT, Sussberg JA, Nelson LB, Schnall BM. Economic Impact of the COVID-19 Pandemic Post-Mitigation on Pediatric Ophthalmologists. J Pediatr Ophthalmol Strabismus 2022; 59:291-295. [PMID: 36149924 DOI: 10.3928/01913913-20220623-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To create a survey to assess the economic impact that the coronavirus disease 2019 (COVID-19) pandemic post-mitigation (post-shutdown) has had on pediatric ophthalmologists. METHODS A 14-question survey was disseminated to United States-based pediatric ophthalmologists on the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) discussion board and on social media. Demographic data and data on the economic effect of the COVID-19 pandemic post-mitigation were collected. RESULTS A total of 129 pediatric ophthalmologists completed the survey. Eighty-four (65.1%) respondents reported a clinical revenue decrease of greater than 10%, 83 (64.3%) a surgical decrease of greater than 10%, and 66 (51.2%) an income decrease of greater than 10%. Fifteen (11.6%) respondents reported limiting the number of Medicaid patients. This was more prevalent among those in private practice (P = .027). Twenty-seven (20.9%) pediatric ophthalmologists responded that they planned to retire earlier than anticipated because of the pandemic and 2 (1.6%) responded that they have retired since the start of the pandemic. Six (4.7%) respondents reported that they have sold their practice since the start of the COVID-19 pandemic. CONCLUSIONS Pediatric ophthalmologists continue to face economic challenges introduced by the COVID-19 pandemic. Reduced revenue may represent a new normal for the near future in pediatric ophthalmology. These unprecedented economic upheavals come at a time when the field of pediatric ophthalmology already faces difficulties with low reimbursement and attracting new trainees. This multitude of issues may escalate into a crisis in providing appropriate pediatric ophthalmic care. [J Pediatr Ophthalmol Strabismus. 2022;59(5):291-295.].
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Oke I, Heidary G, Mantagos IS, Shah AS, Hunter DG. Comparison of fellowship match opportunities and results across pediatric surgical subspecialities. J AAPOS 2022; 26:145-148. [PMID: 35472597 DOI: 10.1016/j.jaapos.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 11/22/2022]
Abstract
There is a nationwide shortage of pediatric ophthalmologists, with trends in fellowship applicants foreshadowing a continued reduction in the number of active pediatric ophthalmologists in the years ahead. In this study, we investigated whether similar fellowship applicant shortages exist in other pediatric surgical subspecialties. We compared the match statistics of six pediatric surgical fellowships from 2015 to 2020. During the 6-year interval, a median of 12.2 pediatric ophthalmology fellowship positions (IQR, 12.1-12.4) were offered per 100 graduating residents, 8.7% of ophthalmology residents (IQR, 8.3%-9.3%) pursued pediatric subspecialty training, and 72% of available pediatric fellowship positions (IQR, 69%-74%) were filled. Pediatric general surgery had the highest percentage of available fellowship positions filled, 99% (IQR, 98%-100%), which was significantly higher than for pediatric ophthalmology (P = 0.024). None of the other subspecialties had a significant difference in available positions filled compared to pediatric ophthalmology (P > 0.05).
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Affiliation(s)
- Isdin Oke
- Department of Ophthalmology, Boston Children's Hospital, Massachusetts Eye and Ear Infirmary, and Harvard Medical School, Boston, Massachusetts
| | - Gena Heidary
- Department of Ophthalmology, Boston Children's Hospital, Massachusetts Eye and Ear Infirmary, and Harvard Medical School, Boston, Massachusetts
| | - Iason S Mantagos
- Department of Ophthalmology, Boston Children's Hospital, Massachusetts Eye and Ear Infirmary, and Harvard Medical School, Boston, Massachusetts
| | - Ankoor S Shah
- Department of Ophthalmology, Boston Children's Hospital, Massachusetts Eye and Ear Infirmary, and Harvard Medical School, Boston, Massachusetts
| | - David G Hunter
- Department of Ophthalmology, Boston Children's Hospital, Massachusetts Eye and Ear Infirmary, and Harvard Medical School, Boston, Massachusetts.
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18
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Birch EE, Hudgins LA, Jost RM, Cheng-Patel CS, Morale SE, Kelly KR. Web-based visual acuity testing for children. J AAPOS 2022; 26:61.e1-61.e5. [PMID: 34920136 PMCID: PMC9086078 DOI: 10.1016/j.jaapos.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/10/2021] [Accepted: 11/21/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate a newly developed, web-based system for at-home pediatric visual acuity testing and to compare results with standard in-office visual acuity test results. METHODS Children aged 3-12 years with and without visual deficits were enrolled (N = 65; 130 eyes). Monocular visual acuity was tested in-office using the ATS-HOTV (ages 3-6) or E-ETDRS (ages 7-12) protocol. Each child's family was emailed a link to a web-based version of the same visual acuity test for at-home testing. Equivalence was evaluated by using a linear mixed model to estimate the mean difference between in-office and at-home visual acuity test results and the corresponding two-sided 95% confidence interval. RESULTS For children tested with the ATS-HOTV protocol, the mean difference between in-office and at-home visual acuity test results was 0.01 log MAR (95% CI, -0.06 to 0.09). For children tested with the E-ETDRS protocol, the mean difference was 0.04 log MAR (95% CI, -0.06 to 0.14). CONCLUSIONS At-home, web-based ATS-HOTV and E-ETDRS visual acuity test results had excellent concordance with in-office visual acuity testing. If the burden of travel is significant, at-home testing of children's visual acuity may provide the information needed to continue care when it might otherwise be discontinued or delayed.
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Affiliation(s)
- Eileen E Birch
- Retina Foundation of the Southwest, Dallas, Texas; Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas.
| | | | - Reed M Jost
- Retina Foundation of the Southwest, Dallas, Texas
| | | | | | - Krista R Kelly
- Retina Foundation of the Southwest, Dallas, Texas; Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas
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Zloto O, Souied E, Saeed P, Ben Simon G, Gildener-Leapman J, Vishnevskia-Dai V, Khatib N, Dray JP. Publication trends in clinical ophthalmology journals in the last decade. Eur J Ophthalmol 2021; 32:1406-1410. [PMID: 34096347 DOI: 10.1177/11206721211023725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To examine the absolute number and the proportions of articles published in general high-ranked ophthalmology journals for each ophthalmic subspecialty during the last decade, and to examine the publishing trends over the study period. METHODS All original articles published between January 2010 and December 2019 in the selected general clinical ophthalmic journals were included in the study. All abstracts of original articles were reviewed and deemed to be related to 1 of the 11 ophthalmic subspecialties. RESULTS Six journals and 10,232 abstracts were reviewed. Articles focused on medical retina were the most common in the last decade (35.22%) while articles focused on strabismus were the least common (2.11%). The total number of articles published per year decreased during the last decade (p < 0.01). There was a significant reduction in the number of publications per year focused on anterior-chamber (p = 0.012), cataract and refractive-surgeries (p = 0.014), oculoplastic (p < 0.01), and strabismus (p = 0.011). In each year during the last decade, the highest proportion of publications was focused on medical retina while the lowest proportion of publications in most of the years was focused on strabismus. There was a significant decrease during the years in the proportion of articles focused on oculoplastic (p < 0.01). CONCLUSIONS During the last decade, there have been differences in the proportion of publications of different ophthalmology subspecialties in high impact factor journals. This probably derives from demographic changes and advances in diagnosis and treatment. The proportion of articles focused on medical retina was the highest during all years while the proportion of articles focused on strabismus was consistently the lowest.
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Affiliation(s)
- Ofira Zloto
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil and University Paris Est, 94000 Créteil, France.,Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eric Souied
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil and University Paris Est, 94000 Créteil, France
| | - Peerooz Saeed
- Orbital Center, Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Guy Ben Simon
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Juliana Gildener-Leapman
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vicktoria Vishnevskia-Dai
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nur Khatib
- Orbital Center, Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Jean-Paul Dray
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil and University Paris Est, 94000 Créteil, France
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