Comparison between the Recommendations of Glaucoma Specialists and OCT Report Specialists for Further Ophthalmic Evaluation in a Community-Based Screening Study.

PURPOSE: To compare glaucoma referral patterns between glaucoma and OCT report specialists and to determine what influence, if any, a designated OCT reading could have on a glaucoma specialist's judgments. DESIGN: Retrospective, exploratory study. SUBJECTS: We included 483 eyes (243 individuals) from high-risk New York City neighborhoods screened as part of a mobile van glaucoma screening study from July 2017 to October 2017. METHODS: All participants underwent comprehensive testing, including visual acuity, commercial OCT imaging, gonioscopy, intraocular pressure, frequency-doubling testing, and funduscopic assessment. Three glaucoma specialists independently evaluated all the collected data to determine whether a further glaucoma workup referral was recommended. Two OCT report specialists evaluated only the OCT image for each eye using the commercial report as well as a specialized, customized report. In phase II, the glaucoma specialists then re-evaluated a subset of these eyes, this time with an OCT report specialist's judgments made available. MAIN OUTCOME MEASURES: Comparison of glaucoma specialist referrals made by glaucoma specialists versus OCT report specialists. RESULTS: Intergrader agreement between glaucoma specialists was 60% (κ = 0.43) and between report specialists was 95% (κ = 0.77). There was an agreement between a single OCT report specialist and the consensus (2 of 3) of glaucoma specialists in 74% of eyes (κ= 0.32). Of the eyes studied, 25% were referred for further glaucoma evaluation by the glaucoma specialists alone and 1% were referred for further glaucoma workup by only the report specialist. With the addition of the report specialist's judgments, referral pattern changes varied by glaucoma specialist but overall agreement increased to 85% (κ = 0.53). CONCLUSIONS: There was a fair level of agreement regarding glaucoma referral recommendations between glaucoma specialists with access to comprehensive screening data and OCT report specialists with access to only OCT data. Overall agreement increased when the designated OCT evaluation was made available to the glaucoma specialists. These results may aid in the design of future large-scale glaucoma screening studies.

Late-onset angle closure in pseudophakic eyes with posterior chamber intraocular lenses.

Two patients presented with angle closure many years after cataract extraction. The first patient presented with acute intraocular pressure (IOP) elevation and closed iridocorneal angle that resolved with a laser iridotomy. The second patient presented with an insidious course of high IOP and progressive narrowing of the iridocorneal angle, ultimately requiring a pars plana vitrectomy and glaucoma valve implant, with subsequent normalization of pressure and angle anatomy. Although rare, angle closure in eyes with posterior chamber intraocular lenses is a dangerous complication that can occur many years after cataract extraction. Retained lens fragments, and perhaps repeated intravitreal injections, might place susceptible patients at risk.

Gender differences in promotion and scholarly impact: an analysis of 1460 academic ophthalmologists.

OBJECTIVES: In recent years, gender differences in academic promotion have been documented within surgical fields. To the best of our knowledge, gender discrepancies in association with scholarly productivity have not been well assessed among academic ophthalmologists. Because research productivity is strongly associated with academic career advancement, we sought to determine whether gender differences in scholarly impact, measured by the h-index, exist among academic ophthalmologists. DESIGN: Academic rank and gender were determined using faculty listings from academic ophthalmology departments. h-index and publication experience (in years) of faculty members were determined using the Scopus database. SETTING: Academic medical center. RESULTS: From assistant professor through professor, the h-index increased with subsequent academic rank (p < 0.001), although between chairpersons and professors no statistical difference was found (p > 0.05). Overall, men had higher h-indices (h = 10.4 ± 0.34 standard error of mean) than women (h = 6.0 ± 0.38 standard error of mean), a finding that was only statistically significant among assistant professors in a subgroup analysis. Women were generally underrepresented among senior positions. When controlling for publication range (i.e., length of time publishing), men had higher h-indices among those with 1 to 10 years of publication experience (p < 0.0001), whereas women had scholarly impact equivalent to and even exceeding that of men later in their careers. CONCLUSION: Women in academic ophthalmology continue to be underrepresented among senior faculty. Although women surpass men in scholarly productivity during the later stages of their careers, low scholarly impact during the earlier stages may impede academic advancement and partly explain the gender disparity in senior academic positions.

Management of sinonasal teratocarcinosarcoma: a systematic review.

PURPOSE: Sinonasal teratocarcinosarcoma (SNTCS) is a rare and highly malignant neoplasm that often involves the anterior skull base. This study reviews the published literature related to SNTCS. Clinical presentation, demographics, radiographic diagnosis, pathology, treatment, and management outcomes of this uncommon disease are reported. METHODS: A systematic review in the published English literature was conducted. A MEDLINE/PubMed search and bibliographic examination of articles pertaining to SNTCS were performed. Each case was analyzed for patient demographics, clinical presentation, tumor location, diagnosis, treatment, and survival outcome. RESULTS: A total of 49 journal articles were included. Individual patient data were reported in 86 cases. The average age of the patients was 54.5 years (range, 0.1 to 85 years), with a strong male predilection (7:1). Average follow-up was found to be 38.9 months (range, 2 to 372 months). The most common treatment method was surgery with radiation therapy, utilized in 59.3% of patients. Out of 71 cases with reported outcome and follow-up, there were 21 cases of recurrence, 8 cases with metastasis, and 6 cases reporting both recurrence and metastasis. Forty-two out of 71 (59.2%) patients survived at the time of follow-up. CONCLUSIONS: This study describes the largest pool of SNTCS patients to date. SNTCS is a rare and aggressive malignant skull base tumor with a poor prognosis with frequent recurrence and metastasis. Although a variety of treatment paradigms have been reported in the literature, radical surgical resection followed by radiation therapy appears to be the most commonly used treatment option.

Incidence trends and long-term survival analysis of sinonasal rhabdomyosarcoma.

PURPOSE: Sinonasal rhabdomyosarcoma (SNRMS) is a rare malignancy which often presents with nasal obstruction, rhinorrhea and epistaxis. It is the most common sarcoma in children. In this study, we analyze the incidence and long-term survival for SNRMS using a national population-based database. METHODS: The United States National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry was utilized to calculate incidence and survival trends for SNRMS between 1973 and 2009. In addition, data were grouped by age, gender, race, and histopathological subtype. RESULTS: A total of 181 cases of SNRMS were analyzed for incidence trends, showing a 1.23:1 female to male ratio. While the overall incidence of SNRMS increased by 1.02% annually over the last 20years, this pattern was not equal amongst gender and racial groups. The incidence in males has increased, while in females incidence has decreased. An increase in incidence was noted in white and "others," but decreased in blacks. Using a total of 314 cases for survival analysis, we found that the rate in the white population has been consistently highest with a 5-year survival of 49.45%, 10- and 20-year survival of 48.81%. Survival rates in cases of embryonal SNRMS were also consistently higher than in cases of alveolar SNRMS. CONCLUSION: Overall incidence of SNRMS is increasing. Histologic subtype and race are important considerations in the long-term prognosis of SNRMS. Future studies will further elucidate gender and race related trends.

Readability assessment of the American Rhinologic Society patient education materials.

BACKGROUND: The extensive amount of medical literature available on the Internet is frequently accessed by patients. To effectively contribute to healthcare decision-making, these online resources should be worded at a level that is readable by any patient seeking information. The American Medical Association and National Institutes of Health recommend the readability of patient information material should be between a 4th to 6th grade level. In this study, we evaluate the readability of online patient education information available from the American Rhinologic Society (ARS) website using 9 different assessment tools that analyze the materials for reading ease and grade level of the target audience. METHODS: Online patient education material from the ARS was downloaded in February 2012 and assessed for level of readability using the Flesch Reading Ease, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook (SMOG) Grading, Coleman-Liau Index, Gunning-Fog Index, FORCAST formula, Raygor Readability Estimate, the Fry Graph, and the New Dale-Chall Readability Formula. Each article was pasted as plain text into a Microsoft® Word® document and each subsection was analyzed using the software package Readability Studio Professional Edition Version 2012.1. RESULTS: All healthcare education materials assessed were written between a 9th grade and graduate reading level and were considered "difficult" to read by the assessment scales. CONCLUSION: Online patient education materials on the ARS website are written above the recommended 6th grade level and may require revision to make them easily understood by a broader audience.

Readability analysis of healthcare-oriented education resources from the American Academy of Facial Plastic and Reconstructive Surgery.

OBJECTIVES/HYPOTHESIS: Deficient health literacy remains a widespread public issue. As such, the National Institutes of Health (NIH) recommends that all patient resources should be written around a sixth-grade level. The authors evaluate healthcare-oriented resources specified for patient use on the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) Web site in order to identify potential areas of improvement and highlight those sections that may serve as paradigms for future revisions. STUDY DESIGN: Descriptive and correlational design. METHODS: Seventeen healthcare-oriented resources specifically for patients were downloaded in February 2012 from the American Academy of Facial Plastic and Reconstructive Surgery Web site. Readability assessments of each article were performed using Readability Studio Professional Edition Version 2012.1. These tests included the Flesch Reading Ease, Flesch-Kincaid Grade Level, SMOG Grading, Coleman-Liau Index, Gunning-Fog Index, the New Fog Count, the New Dale-Chall Readability Formula, FORCAST formula, Raygor Readability Estimate, and the Fry Graph. RESULTS: Patient health education material found on the AAFPRS Web site has been found to be written at an average grade level of 12th grade using 10 different readability scales. CONCLUSIONS: Modifications of the patient education section of the AAFPRS Web site can increase the readability of the literature, and allow greater comprehension among a wider audience.

Readability analysis of internet-based patient information regarding skull base tumors.

Readability is an important consideration in assessing healthcare-related literature. In order for a source of information to be the most beneficial to patients, it should be written at a level appropriate for the audience. The National Institute of Health recommends that health literature be written at a maximum level of sixth grade. This is not uniformly found in current health literature, putting patients with lower reading levels at a disadvantage. In February 2012, healthcare-oriented education resources were retrieved from websites obtained using the Google search phrase skull base tumors. Of the first 25 consecutive, unique website hits, 18 websites were found to contain information for patients. Ten different assessment scales were utilized to assess the readability of the patient-specific web pages. Patient-oriented material found online for skull base tumors was written at a significantly higher level than the reading level of the average US patient. The average reading level of this material was found to be at a minimum of eleventh grade across all ten scales. Health related material related to skull base tumors available through the internet can be improved to reach a larger audience without sacrificing the necessary information. Revisions of this material can provide significant benefit for average patients and improve their health care.