Hasil untuk "Ophthalmology"

Liang Wang, Manhong Li, Guorui Dou et al.

Abstract Background Leber congenital amaurosis (LCA) is one of the earliest-onset and most severe forms of inherited retinal disease, and Bardet-Biedl syndrome (BBS) is a rare non-motile primary ciliopathy with a diverse multi-organ phenotype. To our knowledge, we present the first reported genetically confirmed case of LCA10 co-occurring with isolated postaxial polydactyly type A1 harboring CEP290 and GLI3 mutations, which was initially misdiagnosed as BBS. Case presentation A 6-month-old female infant presented with no visual tracking, nystagmus, and postaxial polydactyly. Targeted gene panel testing identified compound heterozygous pathogenic variants in CEP290, leading to a preliminary diagnosis of BBS. Over a 6-year follow-up, the patient developed progressive pigmentary retinopathy with non-recordable electroretinography but did not develop any other systemic features of BBS. A critical, previously overlooked family history of polydactyly in the father prompted further investigation. Whole-exome sequencing revealed an additional likely pathogenic variant in the GLI3 gene, which was paternally inherited and responsible for the isolated polydactyly. The ocular phenotype was definitively attributed to the CEP290 mutations. A final diagnosis of LCA Type 10 (LCA10) with postaxial polydactyly type A1 was established. Conclusions This case illustrates the novel co-occurrence of two distinct genetic disorders: CEP290-associated LCA10 and GLI3-associated isolated polydactyly. The initial diagnostic challenge underscores the complexity of pediatric inherited retinal diseases and highlights several critical lessons. The importance of longitudinal phenotyping, the necessity of a detailed family history, and the superior diagnostic utility of comprehensive genetic testing like whole-exome sequencing over targeted panels in complex presentations. Accurate differentiation between LCA and syndromic ciliopathies like BBS is crucial for prognostic counseling and management, as LCA10 carries a more favorable systemic prognosis and is now a target for emerging gene therapies.

Laura M. Periman, Darrell E. White, Douglas Katsev

Abstract Perfluorohexyloctane ophthalmic solution (Miebo) and water-free cyclosporine ophthalmic solution 0.1% (Vevye) are recently approved treatments for dry eye disease (DED). Perfluorohexyloctane (PFHO) uses a novel approach to treat evaporative DED, whereas water-free cyclosporine (CsA 0.1%) is formulated to increase ocular delivery of its active ingredient to improve tear production. The two medications utilize the distinctive properties of two different semifluorinated alkanes (SFAs) to elicit their therapeutic effects. PFHO consists of 100% active ingredient and forms a monolayer on the surface of the tear film to inhibit evaporation. CsA 0.1% utilizes a vehicle consisting of perfluorobutylpentane (PFBP) and ethanol to facilitate delivery of cyclosporine to ocular tissues. The structure of these SFAs determines their differing behaviors and functions. The longer chain length of PFHO results in a slower evaporation rate and facilitates formation of a stable monolayer on the ocular surface. In vitro, PFHO demonstrated a substantially lower evaporation rate versus PFBP or human meibum, as well as a significantly longer ocular surface residence time. Ex vivo, PFHO demonstrated a longer ocular surface residence time than PFBP. The shorter chain length of PFBP enables it to better solubilize cyclosporine and improve drug delivery to ocular tissues. Although both of these ophthalmic drops utilize SFAs, their differences—in physicochemical properties and the mechanisms by which they are understood to intervene in the DED cycle—are important considerations in treatment selection for patients with DED.

Minghui Zhao, Juan Li, Jiali Liu et al.

BackgroundIntegrated traditional Chinese and Western medicine has shown clear advantages in the management of ophthalmic diseases. However, misalignment between traditional Chinese medicine syndrome differentiation and Western pathological classification, overemphasis on Western diagnostic and therapeutic procedures, and insufficient training in traditional Chinese medicine techniques continue to constrain teaching quality in ophthalmology.MethodsThis single-center prospective interventional study implemented a three-dimensional integrated traditional Chinese and Western medicine teaching model that combined case-based learning and problem-based learning, and compared teaching outcomes in 156 medical students before and after the intervention.ResultsThe new teaching model received a mean satisfaction score of 4.54 ± 0.33 on a five-point Likert scale. Compared with baseline, students showed significantly higher classroom participation (92.0 ± 4.5% compared with 64.0 ± 8.5%, p < 0.001), comprehensive examination scores (92.0 ± 4.0 compared with 77.0 ± 5.5, p < 0.001), and overall autonomous learning ability scores (4.54 ± 0.33 compared with 3.20 ± 0.45, p < 0.001). Additional improvements were observed in independent literature review frequency (3.5 ± 0.4 compared with 1.2 ± 0.3 times per week, p < 0.001), acupuncture point location accuracy (95.0% compared with 84.0%, p < 0.001), and Western medicine examination scores (95.5 ± 3.1 compared with 80.5 ± 4.2, p < 0.001).ConclusionThe three-dimensional integrated traditional Chinese and Western medicine teaching model effectively enhanced ophthalmology teaching quality and helped cultivate medical students with integrated traditional Chinese and Western medicine competencies, as reflected by improved student engagement, autonomous learning, and clinical skill mastery.

Vidya S Mooss, Krishna R Murthy, Kalpana Babu et al.

Purpose: To look at the clinical profile, treatment methods, and outcomes in cases of acute retinal necrosis (ARN) from a tertiary eye care center. Methods: Hospital-based retrospective observational study wherein cases of ARN presented between January 2016 and December 2023 were reviewed. Demographic details, clinical presentation, complications, management, and visual outcome were evaluated. Results: Twenty eyes of 18 cases were included in the study. Mean age was 40.77 ± 16.38 years, male to female ratio was 2:1, and 11.11% had bilaterality at presentation. Mean duration of uveitis was 3.312 ± 0.95 months. The most commonly found organism was VZV (50%), followed by HSV (45%). All cases were given intravitreal ganciclovir in addition to systemic antivirals and oral steroids. The mean number of intravitreal injections was 5.53 ± 3.87. Maintenance dose of oral valacyclovir (500 mg twice daily) was continued in all cases for an average duration of 5.61 ± 3.79 months. The most common complications noted were retinal detachment (50%) followed by optic atrophy (44.44%). No significant association was noted between the extent of retinitis and the development of complications (P = 0.215). However, there was a significant difference seen in the rate of complications between the HSV and VZV groups, with more complication rates seen with the VZV group (P = 0.04). The mean visual acuity was 0.87 ± 0.85 logMAR at presentation and 0.65 ± 0.67 logMAR at the end of the study. Conclusion: Timely diagnosis, aggressive initial treatment with intravitreal ganciclovir along with systemic antivirals and long-term maintenance therapy with systemic antivirals are crucial in ARN to obtain the best visual prognosis achievable and prevent lifelong disabilities.

Jenni Gårdstedt-Berghog, Jenni Gårdstedt-Berghog, Aimon Niklasson et al.

ObjectivesTo explore the timing of menarche, postmenarcheal growth, and to investigate the impact of various variables on menarcheal age and postmenarcheal and pubertal growth.Study DesignThis longitudinal community population-based study analyzed pubertal growth and menarcheal age in 793 healthy term-born Swedish girls, a subset of the GrowUp1990Gothenburg cohort. The timing of menarche and postmenarcheal growth was related to variables from the Quadratic-Exponential-Pubertal-Stop (QEPS) growth model, birth characteristics, and parental height. Multivariable models were constructed for clinical milestones; at birth, age 7 years, pubertal growth onset, and midpuberty.ResultsMenarche aligned with 71.6% (18.8) of the QEPS model's specific pubertal growth function, at a mean age of 13.0 (1.3) years, ranging from 8.2 to 17.2 years. Postmenarcheal growth averaged 8.0 (4.9) cm, varying widely from 0.2 to 31.1 cm, decreasing with later menarche. Significant factors associated with menarcheal age included height at 7 years, childhood body-mass index, parental height, and QEPS-derived pubertal growth variables. Multivariable models demonstrated increasing explanatory power for each milestone, explaining 1% of the variance in menarcheal age at birth, 8% at age 7 years, 44% at onset of pubertal growth, and 45% at midpuberty.ConclusionsThis study underscores the strong link between pubertal growth and age at menarche. Data available at start of puberty explain 44% of the variation in menarcheal age, apparent on average 3.2 years before menarche. In addition, the study shows a previously seldom noticed wide variation in postmenarcheal height gain from 0.2 to 31.1 cm.

S. Schoenberger, Stephen J. Kim, J. Thorne et al.

Hassan Asadigandomani, Nader Mohammadi, Hamid Riazi-Esfahani et al.

A girl of 8 years old was referred to our clinic with a history of penetrating injury to her left eye 6 years ago with light perception vision and a large traumatic macular hole in her right eye. Her right eye’s vision was 4/10 when she first visited our clinic. Considering the patient’s one-eye status, her parents’ reluctance to undergo surgery, and the possibility of spontaneous closure of traumatic macular holes, it was determined to observe the patient and evaluate her visual acuity and macular hole condition. In 2 years, the final best corrected visual acuity was 8/10 in the right eye, with infratemporal eccentric fixation in visuoscopy. In addition to evaluating and reporting this case as a traumatic macular hole, we will discuss the role of nonsurgical treatment and the possibility of good visual acuity with eccentric fixation in a child with large traumatic macular hole.

Weicong Lu, Zisu Peng, Wenzhi Ding et al.

Background. The change in refraction caused by accommodation inevitably affects the peripheral defocus state and thus may influence the effect of retinal peripheral myopic defocus measures in myopia control. This study investigated accommodation changes in different peripheral retinas under cycloplegia to help improve myopia control. Methods. Fifty-six eyes of fifty-six myopic subjects were recruited for this prospective study. The center and peripheral retina refractions were measured using multispectral refractive topography. The subjects were divided into low-to-moderate myopia group (range: −1.25 D to −6.00 D) and high myopia group (range: −6.25 D to −9.75 D) according to spherical equivalent (SE). The compound tropicamide (0.5% tropicamide and 0.5% phenylephrine) was used to relax the accommodation. The difference between cycloplegia and non-cycloplegia peripheral retinal refraction was analyzed using the t-test. The correlation between eccentricity and changes in peripheral refraction was analyzed using Pearson’s correlation analysis. Results. The manifest refraction of the retina significantly decreased with an increase in eccentricity after cycloplegia. The annular refraction difference value at 50°–53° (ARDV 50–53) showed the largest refraction decrease of 1.31 D compared with the central retinal refraction decrease of 0.84 D. The inferior quadrantal refraction difference value had the least change compared to the other quadrants. The relative peripheral refraction (RPR) changes in refraction difference value (RDV) at 15° (RDV-15), RDV-30, and RDV-45 were less than 0.15 D. When the range of annulus narrowed to 5°, the narrower annulus showed faster change with eccentricity increase in ARDV 30–35, ARDV 35–40, ARDV 40–45, ARDV 45–50, and ARDV 50–53. The RPR was highly correlated with eccentricity (R = 0.938 and P<0.001). The high myopia group had a greater hyperopic shift in the periphery than the low-to-moderate group after cycloplegia. Conclusions. Peripheral refraction showed a significant hyperopic shift after cycloplegia with an increase in eccentricity. The RPR became more hyperopic than the central refraction. The high myopia group showed more hyperopic shifts in the peripheral region. Accommodation should be taken into consideration in peripheral defocus treatment.

I. A. Filatova, Yu. P. Kondratieva, I. M. Mohammad et al.

Purpose: to evaluate the effectiveness of surgical treatment of the floppy eyelid syndrome. Material and methods. The clinical group consisted of 23 patients (46 eyes) with the floppy eyelid syndrome (16 men and 4 women), ave. aged 46,0 ± 2.6 years. Of these 20 patients underwent surgery for floppy eyelid syndrome by vertical and horizontal shortening of the upper eyelid with or without correction of blepharoptosis. The observation period ranged from 1 month to 10 years. Fragments resected during the operation were subjected to histological examination. Results. A histological study revealed a reduced quantity or absence of elastin in the tarsal plate, destruction of collagen fiber beams, malformation of hair follicles accompanied by moderate chronic inflammation, In the postoperative period, the complaints caused by involuntary ectropion of the upper eyelid disappeared in all patients, the palpebral fissures became maximally symmetric. Conclusion. Surgeries performed by our technologies result in the best possible anatomical arrangement of the upper eyelid within a single-stage procedure.

Ibuki Arizono, Naoki Fujita, Chihiro Tsukahara et al.

Nicotinamide riboside (NR), a precursor of nicotinamide adenine dinucleotide (NAD⁺), has been studied to support human health against metabolic stress, cardiovascular disease, and neurodegenerative disease. In the present study, we investigated the effects of oral NR on axonal damage in a rat ocular hypertension model. Intraocular pressure (IOP) elevation was induced by laser irradiation and then the rats received oral NR of 1000 mg/kg/day daily. IOP elevation was seen 7, 14, and 21 days after laser irradiation compared with the controls. We confirmed that oral NR administration significantly increased NAD⁺ levels in the retina. After 3-week oral administration of NR, morphometric analysis of optic nerve cross-sections showed that the number of axons was protected compared with that in the untreated ocular hypertension group. Oral NR administration significantly prevented retinal ganglion cell (RGC) fiber loss in retinal flat mounts, as shown by neurofilament immunostaining. Immunoblotting samples from the optic nerves showed that oral NR administration augmented the phosphorylated adenosine monophosphate-activated protein kinase (p-AMPK) level in rats with and without ocular hypertension induction. Immunohistochemical analysis showed that some p-AMPK-immunopositive fibers were colocalized with neurofilament immunoreactivity in the control group, and oral NR administration enhanced p-AMPK immunopositivity. Our findings suggest that oral NR administration protects against glaucomatous RGC axonal degeneration with the possible upregulation of p-AMPK.

Daniel T. Hogarty, D. Mackey, A. Hewitt

Artificial intelligence (AI) has emerged as a major frontier in computer science research. Although AI has broad application across many medical fields, it will have particular utility in ophthalmology and will dramatically change the diagnostic and treatment pathways for many eye conditions such as corneal ectasias, glaucoma, age‐related macular degeneration and diabetic retinopathy. However, given that AI has primarily been driven as a computer science, its concepts and terminology are unfamiliar to many medical professionals. Important key terms such as machine learning and deep learning are often misunderstood and incorrectly used interchangeably. This article presents an overview of AI and new developments relevant to ophthalmology.

Fen Tang, Chuan Chen, Yi Zhu et al.

ABSTRACT Background: In recent years, the flipped classroom method of teaching has received much attention in health sciences education. However, the application of flipped classrooms in ophthalmology education has not been well investigated. Objective: The goal of this study was to investigate the effectiveness and acceptability of the flipped classroom approach to teaching ophthalmology at the clerkship level. Design: Ninety-five fourth year medical students in an ophthalmology clerkship were randomly divided into two groups. An ocular trauma module was chosen for the content of this study. One group (FG (flipped group), n = 48) participated in flipped classroom instruction and was asked to watch a recorded lecture video and to read study materials before a face-to-face class meeting. They used the in-class time for discussion. The other group (TG (traditional group), n = 47) was assigned to traditional lecture-based instruction. These students attended a didactic lecture and completed assigned homework after the lecture. Feedback questionnaires were collected to compare students’ perspectives on the teaching approach they experienced and to evaluate students’ self-perceived competence and interest in ocular trauma. Pre- and post-tests were performed to assess student learning of the course materials. Results: More students in the FG agreed that the classroom helped to promote their learning motivation, improve their understanding of the course materials, and enhance their communication skill and clinical thinking. However, students in the FG did not show a preference for this method of teaching, and also reported more burden and pressure than those from the TG. Students from the FG performed better on the post test over the ocular trauma-related questions when compared to those from the TG. Conclusions: The flipped classroom approach shows promise in ophthalmology clerkship teaching. However, it has some drawbacks. Further evaluation and modifications are required before it can be widely accepted and implemented. Abbreviations FG: Flipped classroom group; TG: Traditional lecture-based classroom group; TBL: Team-based learning; PBL: Problem-based learning; ZOC: Zhongshan Ophthalmic Center

W. Lu, Y. Tong, Yu H Yu et al.

With the emergence of unmanned plane, autonomous vehicles, face recognition, and language processing, the artificial intelligence (AI) has remarkably revolutionized our lifestyle. Recent studies indicate that AI has astounding potential to perform much better than human beings in some tasks, especially in the image recognition field. As the amount of image data in imaging center of ophthalmology is increasing dramatically, analyzing and processing these data is in urgent need. AI has been tried to apply to decipher medical data and has made extraordinary progress in intelligent diagnosis. In this paper, we presented the basic workflow for building an AI model and systematically reviewed applications of AI in the diagnosis of eye diseases. Future work should focus on setting up systematic AI platforms to diagnose general eye diseases based on multimodal data in the real world.

S. Berkowitz, Jonathan C. Siktberg, Saif A. Hamdan et al.

Importance Health care price transparency legislation is intended to reduce the ambiguity of hospital charges and the resultant financial stress faced by patients. Objective To evaluate the availability, usability, and variability of standard reported prices for ophthalmologic procedures at academic hospitals. Design, Setting, and Participants In this multicenter economic evaluation study, publicly available price transparency web pages from Association of American Medical Colleges affiliate hospitals were parsed for standard charges and usability metrics. Price transparency data were collected from hospital web pages that met the inclusion criteria. Geographic practice cost indices for work, practice expense, and malpractice were sourced from the Centers for Medicare & Medicaid Services. Data were sourced from February 1 to April 30, 2021. Multiple regression was used to study the geographic influence on standard charges and assess the correlation between standard charges. Main Outcomes and Measures Availability and variability of standard prices for Current Procedural Terminology (CPT) codes 66984 (removal of cataract with insertion of lens) and 66821 (removal of recurring cataract in lens capsule using laser). Results Of 247 hospitals included, 191 (77.3%) provided consumer-friendly shoppable services, most commonly in the form of a price estimator or online tool. For CPT code 66984, 102 hospital (53.4%) provided discount cash pay estimates with a mean (SD) price of $7818.86 ($5407.91). For CPT code 66821, 71 hospital (37.2%) provided discount cash pay estimates with a mean (SD) price of $2041.72 ($2106.44). The top quartile of hospitals, prices wise, listed included prices higher than $10 400 for CPT code 66984 and $2324 for CPT code 66821. Usability issues were noted for 36 hospitals (18.8%), including requirements for personal information or web page navigability barriers. Multiple regression analysis found minimal explanatory value for geographic practice cost indices for cash discount prices for CPT codes 66984 (adjusted R2 = 0.54; 95% CI, 0.41-0.67; P < .001) and 66821 (adjusted R2 = 0.64; 95% CI, 0.51-0.77; P < .001). Conclusions and Relevance Despite recent legislature that codified price transparency requirements, some current standard charges remain ambiguous, with substantial interhospital variability not explained by geographic variability in costs. Given the potential for ambiguous pricing to burden vulnerable, uninsured patients, additional legislation might consider allowing hospitals to defer price estimates or rigorously define standards for actionable cash discount percentages with provisions for displaying relevant benchmark prices.

Elizabeth Fairless, K. Nwanyanwu, S. Forster et al.

OBJECTIVE The current demographics of the physician workforce, including ophthalmologists, do not reflect the diverse US population, which has implications for addressing health disparities in the US. The demographics of ophthalmology department faculty may influence the recruitment of under-represented students into the field of ophthalmology. This study sought to determine how the racial/ethnic demographics of ophthalmology department faculty compare to other clinical departments at US medical schools. DESIGN Secondary data analysis of medical school faculty demographic data from the 2019 American Association of Medical Colleges Faculty Roster. PARTICIPANTS Clinical faculty and department chairs at US Medical Schools. METHODS We analyzed the racial/ethnic demographics of clinical department faculty and department chairpersons using data from the 2019 American Association of Medical Colleges Faculty Roster. We calculated the proportion of under-represented minority (URM) faculty in ophthalmology and in 17 other individual clinical departments. We analyzed these data for statistically-significant differences between ophthalmology and other clinical departments. In addition, we compared the percentage of URM physicians among ophthalmology faculty to the proportion of URM persons among graduating US medical students and in the US population using data from the Medical School Graduation Questionnaire and the US census respectively. MAIN MEASURES The proportion of URM persons, defined as Black, Hispanic/Latino, Native American, or Native Hawaiian/Pacific Islander among clinical faculty and department chairs. RESULTS Ophthalmology faculty at US medical schools are less racially/ethnically diverse than graduating US medical students and the general US population. When compared to 17 other clinical departments, ophthalmology has the third-lowest proportion of URM faculty, with only radiology and orthopedic surgery having a smaller proportion of URM faculty. These differences were statistically significant in the majority of departments evaluated (12 out of 18). There was no statistically-significant difference in the proportion of URM department chairs in ophthalmology compared to most other clinical departments, though the absolute number of URM department chairs in ophthalmology is low at only 8 chairpersons. CONCLUSIONS More work must be done to increase the recruitment of URM physicians into ophthalmology faculty positions to obtain parity with other clinical departments and with the diverse patient population that physicians serve.

Juliana Tessari Dias Rohr, Juliana Tessari Dias Rohr, Cassiano Rodrigues Isaac et al.

Despite the various perceptual-motor deficits documented in strabismus, there is a paucity of studies evaluating visual illusions in patients with strabismus. The aim of this study was to examine how the illusionary perception occurs in children/adolescents (10–15 years old) with strabismus with referral for surgery to correct ocular deviations. A controlled cross-sectional study was carried out in which 45 participants with strabismus and 62 healthy volunteers aged 10–15 years were evaluated. The behavioral response to three geometric illusions [Vertical-Horizontal illusion, Müller-Lyer illusion (Bretano version) and Ponzo illusion] and respective neutral stimuli (non-illusory images) regarding the estimation of image size and response time were measured using the Method of Adjustment. To analyze the influence of secondary factors: type of ocular deviation (convergent, divergent or associated with vertical deviation); amount of eye deviation; presence of amblyopia and stereopsis, a one-way ANOVA was performed. Among the tested illusions, children with strabismus showed greater susceptibility (p = 0.006) and response time (p = 0.004) to Ponzo’s illusory images. Children with strabismus and preserved stereopsis, on the other hand, showed similar susceptibility and response time to control group patients to the Ponzo illusion (p &lt; 0.005). Patients with amblyopia showed overcorrection in the estimate of non-illusory Ponzo images (p = 0.046). Children with horizontal ocular deviation (esotropia or exotropia) associated with vertical deviation (hypertropia, DVD and/or alphabetical anisotropy) showed higher susceptibility to vertical adjustment images for the Müller-Lyer illusion (Brentano version) (p = 0.017). Individuals with strabismus tended to overcorrect the length of the straight-line segment adjusted for non-illusory images when testing non-illusory images in the Müller-Lyer test (Brentano version) (p = 0.009), as well as for the neutral images in the Vertical-Horizontal test (p = 0.000). The findings indicated impairment in the perception of geometric illusions and neutral figures, especially for the Ponzo illusion test by children with strabismus. As the behavioral response to illusory images may indirectly reflect the visual and morphofunctional alterations present in these individuals, we suggest that the investigation of visual illusory perception can be used as a new research strategy in the field of investigating the visual function in strabismus.

A. Grzybowski, P. Kanclerz, W. Myers

Ugochi T. Aguwa, Divya Srikumaran, Laura K. Green et al.

Importance The proportion of women in the field of ophthalmology in the US trails the proportion of women in the general population. Sex diversity trends have been studied in other specialties, but there is a dearth of such literature in ophthalmology. Objective To investigate trends in the proportion of female ophthalmology match applicants, residents, and clinical faculty. Design, Setting, and Participants This cross-sectional study examined data from the San Francisco Match, the Association of University Professors of Ophthalmology, Accreditation Council for Graduate Medical Education, Association of American Medical Colleges, and American Academy of Ophthalmology (AAO) from January 1, 2011, to December 31, 2019. Data from ophthalmology match applicants, residents, clinical faculty at US medical schools, and AAO members were collected. Main Outcomes and Measures The proportion of female applicants, residents, and medical school clinical faculty in ophthalmology. Results Data were obtained from a total of 2807 ophthalmology applicants (35.3% female), 1 004 563 residents (43.8% female), 463 079 clinical faculty members (42.5% female), and 78 968 AAO members (26.1% female). Male ophthalmology residency applicants outnumbered female applicants by a ratio of 1.6:1 from 2016 to 2019. The percentage of female matched applicants in 2016 (41% [168/406]) and 2019 (42% [184/436]) differed by 1% (percent change, 0.99; 95% CI, -1.12 to 3.1; P = .36). There was a 2.3% increase (percent change, 0.34; 95% CI, 0.24-0.43; P < .001) in the percentage of female residents across all surgical specialties from 2011 (39.7% [8710/21 985]) to 2019 (42% [10 951/26 082]) but a 2.5% decrease (percent change, -0.45; 95% CI, -0.84 to -0.06; P = .02) in the percentage of female residents in ophthalmology from 2011 (41.5% [589/1419]) to 2019 (39% [575/1473]). The percentage of female ophthalmology clinical faculty differed by 2% (percent change, 1.02; 95% CI, -0.21 to 2.24; P = .10) from 2017 (38% [1179/3102]) to 2019 (40% [1225/3060]). From 2016 to 2019, male practicing ophthalmologists in the AAO outnumbered female practicing ophthalmologists by a ratio of 3:1. Conclusions and Relevance This study found that the percentage of women in the field of ophthalmology remains lower than percentages in other specialties, and the percentage of female ophthalmology residents has decreased in recent years. More efforts are needed to improve female representation in ophthalmology.

Lokeshwari Aruljyothi, A. Janakiraman, B. Malligarjun et al.

Purpose: There is limited information in literature about the scope and usability of Smartphone Applications (Apps) in ophthalmology. Eye care professionals are therefore skeptical about the benefits of smartphone Apps and are reluctant to adopt it in their day to day practice. The purpose of this study was to provide an updated overview of all Apps exclusive to ophthalmology. Methods: This study was a quantitative analysis of Smartphone Apps exclusively designed for ophthalmic care. The Apple iPhone and Google play store were searched for eye care themed Apps. Any App related to eye treatment and management such as visual acuity screening, eye education, calculators, eBooks, Low Vision Aids were included in the study. Data on the purpose of the Apps, target end-users, validation, App usage, user ratings, and App developer qualifications were documented. Results: As of March 2020, a total of 131 Apps exclusively dedicated for eye care were identified. 53% (69/131) were available in iPhones, 44% (58/131) in Android smartphones, and 3% in both. 32% (41/131) Apps were designed for visual acuity (VA) screening, 13% (17/131) for eye relaxation exercises, 12% (15/131) for professional education, and the remaining for Apps detecting color blindness, low vision aids, and assistance and patient education. Among the 131 Apps, 6 (4.5%) Apps are claimed by the developers as validated. Conclusion: This study unveils a wide range of smartphone Apps exclusive to ophthalmology and suggests guidelines to choose an appropriate App. The study also highlights the importance of interdisciplinary collaboration in the design, development, and validation of such Apps.

Yee Ling Wong, M. Noor, Katherine L. James et al.

The combined effects of fossil fuel combustion, mass agricultural production and deforestation, industrialisation and the evolution of modern transport systems have resulted in high levels of carbon emissions and accumulation of greenhouse gases, causing profound climate change and ozone layer depletion. The consequential depletion of Earth’s natural ecosystems and biodiversity is not only a devastating loss but a threat to human health. Sustainability—the ability to continue activities indefinitely—underpins the principal solutions to these problems. Globally, the healthcare sector is a major contributor to carbon emissions, with waste production and transport systems being amongst the highest contributing factors. The aim of this review is to explore modalities by which the healthcare sector, particularly ophthalmology, can reduce carbon emissions, related costs and overall environmental impact, whilst maintaining a high standard of patient care.