Accuracy and Utility of Internet Image Search as a Learning Tool for Retinal Pathology.

Purpose Ophthalmology residency training heavily relies on visual and pattern recognition-based learning. In parallel with traditional reference texts, online internet search via Google Image Search (GIS) is commonly used and offers an accessible fund of reference images for ophthalmology trainees seeking rapid exposure to images of retinal pathology. However, the accuracy and quality of this tool within this context is unknown. We aim to evaluate the accuracy and quality of GIS images of selected retinal pathologies. Methods A cross-sectional study was performed of GIS of 15 common and 15 rare retinal diseases drawn from the American Academy of Ophthalmology residency textbook series. A total of 300 evaluable image results were assessed for accuracy of images and image source accountability in consultation with a vitreoretinal surgeon. Results A total of 377 images were reviewed with 77 excluded prior to final analysis. A total of 288 (96%) search results accurately portrayed the retinal disease being searched, whereas 12 (4%) were of an erroneous diagnosis. More images of common retinal diseases were from patient education Web sites than were images of rare diseases ( p < 0.01). Significantly more images of rare retinal diseases were found in peer-reviewed sources ( p = 0.01). Conclusions GIS search results yielded a modest level of accuracy for the purposes of ophthalmic education. Despite the ease and rapidity of accessing multimodal retinal imaging examples, this tool may best be suited as a supplementary resource for learning among residents due to limited accuracy, lack of sufficient supporting information, and the source Web site's focus on patient education.

Female Editorial Authorship Trends in High-Impact Ophthalmology Journals.

IMPORTANCE: Individuals with perceived experience and expertise are invited by editorial boards to provide commentary through editorials. Female representation among editorialists is not yet defined. OBJECTIVE: To determine female representation as editorial authors in 3 high-impact general ophthalmology journals. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study investigates the proportion of female authorship in editorials published between 2005 to 2009 and 2015 to 2019 in 3 journals: Ophthalmology, JAMA Ophthalmology, and American Journal of Ophthalmology. Data were collected from April to June 2020. MAIN OUTCOMES AND MEASURES: Proportions of female first and senior (last or solo) authors between 2005 to 2009 compared with 2015 to 2019. Secondary outcome measures include representation by sex across degree types and subspecialties. Comparisons were made for all editorialists and ophthalmologist editorialists. RESULTS: Of 814 editorial articles, there were 1179 (first and senior) authors identified. Women held 301 (25.5%) of these authorships, including 116 of 365 first authorships (32.9%) and 185 of 814 senior authorships (23.9%). Overall, female first and senior authorships grew by 68.0% between 2005 to 2009 and 2015 to 2019 (85 of 469 [18.1%] vs 216 of 710 [30.4%]; difference, 12.3%; 95% CI, 7.4-317.2; P < .001). Between 2005 to 2009 and 2015 to 2019, first and senior authorships by women increased (first: 33 of 133 [24.8%] vs 83 of 232 [35.8%]; difference, 11.0%; 95% CI, 1.4-320.6; P = .03; senior: 52 of 336 [15.5%] vs 133 of 478 [27.8%]; difference, 12.3%; 95% CI, 6.8-317.9; P < .001). JAMA Ophthalmology most substantially contributed to the increase in female first and senior authorships (13.8% and 16%), although the test for homogeneity among the 3 journals was not significant. The proportion of female ophthalmologist first authors was greater than the proportion of American Board of Ophthalmology-certified female ophthalmologists (81 of 281 [28.9%] vs 123 of 672 [18.3%]; difference, 10.6%; 95% CI, 5.3-315.9; P < .001). CONCLUSIONS AND RELEVANCE: The proportion of female senior authors increased by 68.0% between 2005 to 2009 and 2015 to 2019, but female authors represented only 25.5% of editorialists. Compared with male ophthalmologists, female ophthalmologists were more commonly first than senior authors. Additionally, female authors were more likely to be nonophthalmologists or to hold nonmedical, non-PhD degrees. While the swelling rank of female editorialists has paralleled the rising proportion of female ophthalmologists over time, parity by sex has yet to be attained. Greater awareness of disparities and strategies to mitigate them may help equalize representation.

When ophthalmology goes virtual amid a pandemic: content analysis of the 2020 #ASCRSVirtualMeeting.

PURPOSE: To assess the use and impact of the social media platform Twitter during the 2020 ASCRS Virtual Meeting. SETTING: Social media platform Twitter.com. DESIGN: Retrospective review. METHODS: Retrospective analysis of Twitter use during the ASCRS Virtual Meeting in May 2020. All tweets and associated metadata pertaining to the conference were compiled starting from when the virtual meeting was announced (April 8, 2020) to 2 weeks postconference (May 31, 2020). Two coders independently coded all tweets and excluded tweets if they were irrelevant or no longer available. RESULTS: A total of 501 tweets were reviewed, of which 48.5% of tweets came from private accounts, 23.1% from academic institutions, 14.4% from ASCRS accounts, 12.4% from industry, and 1.6% from professional organizations; 146 tweets (29.1%) were shared before, 303 tweets (60.5%) during, and 52 tweets (10.4%) after the conference. A total of 315 tweets (62.9%) promoted conference events, 137 tweets (27.3%)) were about research studies, 136 tweets (27.1%) were social posts, 115 tweets (23.0%) were from industry sponsors, 22 tweets (4.4%) were self-promotion, and 5 tweets (1.0%5) were not categorized. Twitter impressions on the ASCRS account increased by 79% in 2020 compared with the 2019 annual meeting. CONCLUSIONS: To the author's knowledge, this is the first study to describe how Twitter users engaged with a virtual ophthalmology meeting through social media during the coronavirus pandemic. Findings from this study offer insight into how the ophthalmology community can use social media during conferences and highlight opportunities for networking through social media for both virtual and in-person conferences in the future.

Multidisciplinary care in Stevens-Johnson syndrome.

Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are potentially fatal mucocutaneous diseases that can involve many organ systems. Manifestations of SJS/TEN outside of the skin, eyes, and oral mucosa are not well defined or well recognized, and, therefore, are often not addressed clinically. As supportive care improves and mortality from SJS/TEN decreases, chronic complications in affected organ systems are becoming more prevalent. Recognition of the manifestations of SJS/TEN in the acute phase is critical to optimal care. In this review, we review the organ systems that may be involved in SJS/TEN, provide an overview of their management, and propose a list of items that should be communicated to the patient and family upon discharge. The organ systems discussed include the pulmonary, gastrointestinal/hepatic, oral, otorhinolaryngologic, gynecologic, genitourinary, and renal systems. In addition, the significant psychosocial, nutritional, and pain consequences and management of SJS/TEN are discussed.

Facebook and Twitter vaccine sentiment in response to measles outbreaks.

Social media posts regarding measles vaccination were classified as pro-vaccination, expressing vaccine hesitancy, uncertain, or irrelevant. Spearman correlations with Centers for Disease Control and Prevention-reported measles cases and differenced smoothed cumulative case counts over this period were reported (using time series bootstrap confidence intervals). A total of 58,078 Facebook posts and 82,993 tweets were identified from 4 January 2009 to 27 August 2016. Pro-vaccination posts were correlated with the US weekly reported cases (Facebook: Spearman correlation 0.22 (95% confidence interval: 0.09 to 0.34), Twitter: 0.21 (95% confidence interval: 0.06 to 0.34)). Vaccine-hesitant posts, however, were uncorrelated with measles cases in the United States (Facebook: 0.01 (95% confidence interval: -0.13 to 0.14), Twitter: 0.0011 (95% confidence interval: -0.12 to 0.12)). These findings may result from more consistent social media engagement by individuals expressing vaccine hesitancy, contrasted with media- or event-driven episodic interest on the part of individuals favoring current policy.

Characterization of pediatric golf cart injuries to guide injury prevention efforts.

BACKGROUND: Golf cart injuries represent an increasing source of morbidity and mortality in the United States. Characterization of the circumstances of these injuries can inform injury prevention efforts. METHODS: This study retrospectively reviews a prospective trauma registry at a level-one pediatric trauma center for golf cart-related injuries in patients under 18years of age admitted to the hospital between 2008 and 2016. RESULTS: The 40 identified crashes were associated with 82 hospital days, 17 ICU days, and more than $1 million in hospital charges over the study period. The median hospital stay was 1.5days, and the median hospital charge was $20,489. Severe injuries with an Injury Severity Score of >15 were identified in 25% of patients, and moderate injuries with scores between nine and 15 were identified in an additional 30%. The most common injures were head and neck (60%) and external injuries to the body surface (52.5%). Only a single child was wearing a seatbelt, and the vast majority was not using any safety equipment. Children as young as nine years old were driving golf carts, and child drivers were associated with the cart overturning (p=0.007). CONCLUSIONS: Golf cart crashes were a source of substantial morbidity at a level-one trauma center. Increased safety measures, such as higher hip restraints, seatbelts, and front-wheel breaks could substantially increase the safety of golf carts. Increased regulation of driving age as well as driver education may also reduce these injuries.

Clinical Age-Specific Seasonal Conjunctivitis Patterns and Their Online Detection in Twitter, Blog, Forum, and Comment Social Media Posts.

Purpose: We sought to determine whether big data from social media might reveal seasonal trends of conjunctivitis, most forms of which are nonreportable. Methods: Social media posts (from Twitter, and from online forums and blogs) were classified by age and by conjunctivitis type (allergic or infectious) using Boolean and machine learning methods. Based on spline smoothing, we estimated the circular mean occurrence time (a measure of central tendency for occurrence) and the circular variance (a measure of uniformity of occurrence throughout the year, providing an index of seasonality). Clinical records from a large tertiary care provider were analyzed in a similar way for comparison. Results: Social media posts machine-coded as being related to infectious conjunctivitis showed similar times of occurrence and degree of seasonality to clinical infectious cases, and likewise for machine-coded allergic conjunctivitis posts compared to clinical allergic cases. Allergic conjunctivitis showed a distinctively different seasonal pattern than infectious conjunctivitis, with a mean occurrence time later in the spring. Infectious conjunctivitis for children showed markedly greater seasonality than for adults, though the occurrence times were similar; no such difference for allergic conjunctivitis was seen. Conclusions: Social media posts broadly track the seasonal occurrence of allergic and infectious conjunctivitis, and may be a useful supplement for epidemiologic monitoring.

Association Between Ophthalmologist Age and Unsolicited Patient Complaints.

IMPORTANCE: Understanding the distribution of patient complaints by physician age may provide insight into common patient concerns characteristic of early, middle, and late stages of careers in ophthalmology. Most previous studies of patient dissatisfaction have not addressed the association with physician age or controlled for other characteristics (eg, practice setting, subspecialty) that may contribute to the likelihood of patient complaints, unsafe care, and lawsuits. OBJECTIVE: To assess the association between ophthalmologist age and the likelihood of generating unsolicited patient complaints (UPCs) among a cohort of ophthalmologists. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study with variable duration of follow-up. The study assessed time to first complaint between 2002 and 2015 in 1342 attending ophthalmologists or neuro-ophthalmologists who had graduated from medical school before 2010 and were affiliated with an organization that participates in Vanderbilt University Medical Center's Patient Advocacy Reporting System. Participants were stratified into 5 age bands and were followed up from the time of their employment to receipt of their first complaint. Trained coders categorized UPCs into 34 specific types under 6 major categories. MAIN OUTCOMES AND MEASURES: Time to first recorded complaint. Multivariable Cox proportional hazards model was used to measure the association between time to first complaint and ophthalmologist age after adjustment for predetermined covariates. RESULTS: The median physician age was 47 years, with 9% who were 71 years or older. The cohort was 74% male, 90% held MD degrees, and 73% practiced in academic medical centers. The mean follow-up period was 9.8 years. Ophthalmologists older than 70 years had the lowest complaint rate (0.71 per 1000 follow-up days vs 1.41, 1.84, 2.02, and 1.88 in descending order of age band). By 2000 days of follow-up (or within 5.5 years), the youngest group had an estimated UPC risk of 0.523. By 4000 days (>10 years), participants in the older than 70 years age band had an estimated risk of UPC of only 0.364. The 2 youngest age bands were associated with a statistically significant shorter time to first complaint. Compared with those aged 71 years or older, the risk of incurring a UPC for those aged 41 to 50 years was 1.73-fold higher (hazard ratio [HR], 1.73; 95% CI, 1.21-2.46; P = .002). Similarly, participants aged 31 to 40 years had a 2.36 times higher risk of incurring a UPC (HR, 2.36; 95% CI, 1.64-3.40; P < .001). CONCLUSIONS AND RELEVANCE: This study suggests that older ophthalmologists are less likely to receive UPCs than younger ones. Although limitations in the study design could affect the interpretation of these conclusions, the findings may have practical implications for patient safety, clinical education, and clinical practice management.

mHealth for mental health in the Middle East: Need, technology use, and readiness among Palestinians in the West Bank.

Palestinians in the West Bank are at heightened risk for mental health problems. Limited availability of clinicians and a host of geopolitical, topographical, and infrastructural challenges create significant regional barriers to clinic-based care. The objective of this study was to examine whether mHealth approaches that leverage mobile phones for remote mental health treatment may be viable alternatives. We surveyed 272 Palestinian adults in urban, rural, and refugee camp settings. Most participants (93.4%) reported owning mobile phones. The penetration of mobile devices was high across all study sites. Males and females did not differ in their access to this resource. Among mobile phone owners, 79.9% had smartphones, 32.2% had basic mobile phones, and 12.2% owned both. Respondents reported having reliable access to electricity (99.6%) and Wi-Fi (80.9%). Almost all mobile phone owners (99.6%) reported using social media such as Facebook, WhatsApp, or Twitter. When asked to estimate the prevalence of mental health problems in the region, 61.4% of participants reported that over half of the people in their communities struggled with depression, posttraumatic stress, or auditory hallucinations. Most participants indicated that they would personally be interested in mHealth for Mental Health options such as bi-directional texting with clinicians (68.8%), smartphone applications (66.5%), unidirectional support texts (64.7%), or web-based interventions (64.0%). Given the Palestinian populations' broad access to technology and technological infrastructure, need for care, and openness to engage in mobile interventions, mHealth should be considered a promising strategy for mental health services in the West Bank.

Racial Disparities in Corneal Transplantation Rates, Complications, and Outcomes.

Corneal transplantation is a common type of tissue transplantation that aims to improve vision or relieve pain. Given the immune privilege of the cornea, the primary graft often has a high success rate, approaching 90%. Despite the good overall outcome of corneal transplantation in various studies, the individual graft survival rate varies, depending on the preoperative diagnosis and donor and recipient factors. Race and ethnicity have been shown to be important in other types of organ transplantation. The aim of this study was to review the available ophthalmic literature regarding any differences in rates and outcomes of corneal transplantation based on ethnicity and race. A small body of evidence suggests that race might be an important risk factor for graft rejection and graft failure. More robust studies are needed to clarify these associations.

Disparities in Adherence to Screening Guidelines for Diabetic Retinopathy in the United States: A Comprehensive Review and Guide for Future Directions.

Diabetic retinopathy (DR) is the leading cause of new-onset blindness in American adults aged 20-74 years old. The number of diabetics living with diagnosed DR increased by 89%, from 4.06 million to 7.69 million, between 2000 and 2010. Projected numbers from the Vision Health Initiative by the CDC predict that the rate of DR will triple by 2050, from 5.5 million people living with DR to 16 million. Screening guidelines aim to detect cases early because the treatments for DR can reduce severe vision loss by up to 94%. However, adherence to these guidelines is quite low. It is estimated that more than half of patients with diabetes may fail to receive necessary screening. Risk factors for non-screening discussed in this study include low health literacy, lack of access to care, pregnancy, physician adherence to guidelines, unique factors present in different minority populations, gender and age disparities, and living in rural regions. This paper also aims to address potential interventions that may improve adherence rates.