This case report discusses a diagnosis of traumatic subcapsular opacity in the setting of preexisting central nuclear lamellar opacity in a male patient aged 56 years who presented with progressive visual deterioration.
Importance A confirmed visual field progression event in glaucoma typically prompts intensification of intraocular pressure (IOP)–lowering therapy, yet the factors associated with recurrent progression after that first event remain poorly characterized. Objective To evaluate the incidence of recurrent visual field progression after an initial Guided Progression Analysis (GPA) likely-progression event and the factors associated with a recurrent event. Design, Setting, and Participants This cohort study was conducted among patients receiving routine ophthalmic care between 1998 and 2025 at a single tertiary academic center (Bascom Palmer Ophthalmic Registry). Data were analyzed from February 2026 to August 2026. Main Outcomes and Measures The primary outcomes were the cumulative probability of recurrent visual field progression and hazard ratios (HRs) for factors associated with recurrence. Results A total of 7457 eyes of 5086 patients with open-angle glaucoma or suspected glaucoma were included, with a mean (SD) follow-up of 12.4 (4.6) years. Mean (SD) patient age was 60.5 (13.1) years, and 4468 eyes (59.9%) were from female patients. By self-reported race and ethnicity, 203 eyes (2.7%) were from Asian patients, 1718 (23.0%) from Black patients, 1677 (22.5%) from Hispanic patients, and 5536 (74.2%) from White patients. A total of 1951 eyes (26.2%) developed initial GPA likely progression; 635 eyes had adequate follow-up after first progression and IOP data. Among those, 167 (26.3%) recurred. Kaplan-Meier cumulative recurrence was 13.8% at 3 years (95% CI, 11.6%-17.1%) and 43.5% at 10 years (95% CI, 35.8%-52.1%). In multivariable Cox analysis, faster mean deviation (MD) loss before first progression (HR, 1.73 per 1 decibel [dB]/y; 95% CI, 1.39-2.15), higher mean IOP after the first event (HR, 1.09 per 1 mm Hg; 95% CI, 1.05-1.13), less negative MD at first progression (HR, 1.08 per 1 dB; 95% CI, 1.04-1.12), and older age (HR, 1.11 per 5 years; 95% CI, 1.03-1.19) were independently associated with recurrence. Each 10% greater IOP reduction was associated with lower hazard (HR, 0.89; 95% CI, 0.83-0.94). Among eyes with pre-event MD slopes faster than −1.0 dB/y, recurrence occurred in 42.7% of eyes vs 23.4% in slower-progressing eyes (difference, 19.3%; 95% CI, 8.8%-29.9%). Conclusions and Relevance Findings from this cohort study suggest that recurrent visual field progression after a first GPA progression event is common; eyes at highest risk had faster pre-event visual field loss, less advanced damage at first progression, higher postevent IOP, and older age. These results may help target intensified monitoring and IOP lowering toward higher-risk eyes.
Importance US ophthalmology residency programs are divided between traditional resident clinic-based models with a separate faculty practice, and universal practice-based models. Little data exist comparing these educational models. Objective To evaluate the association of changing a traditional resident clinic training model to a universal practice plus urgent eye clinic–based residency training model with sociodemographic disparities and resident education. Design, Setting, and Participants This was a cross-sectional study conducted at a US academic medical center. All patients presenting to the University of Rochester Flaum Eye Institute between the period July 1, 2017, to June 30, 2019, and the period July 1, 2022, to June 30, 2024, were divided into 4 cohorts for retrospective analysis as follows: resident clinic 2017-2019, faculty practice 2017-2019, urgent eye clinic 2022-2024, and universal practice 2022-2024. Exposures The resident clinic was transitioned to urgent eye clinic in July 2022. All former patients from resident clinic were reassigned to the new universal practice. Main Outcomes and Measures Patient cohorts were compared regarding insurance payor(s) and self-identified race. Level of disease acuity in resident clinic and urgent eye clinic were compared. Graduating resident procedural volumes were compared. Results Participants were divided into the following 4 cohorts: resident clinic 2017-2019 (6819 patients), faculty practice 2017-2019 (61 847 patients), urgent eye clinic 2022-2024 (5124 patients), and universal practice 2022-2024 (79 001 patients), for a total of 118 459 patients (mean [SD] age, 47 [25] years; 65 186 female [55%]). Pretransition, compared with faculty practice patients, greater proportions of resident clinic patients used Medicaid insurance (62.1% vs 19.4%; difference, 32.0%; 95% CI, 30.9%-33.1%; P < .001) and identified as Asian, Black or African American, multiracial, native (ie, American Indian or Alaska Native), or other (51.9% vs 23.6%; difference, 28.3%; 95% CI, 27.1%-29.5%; P < .001). Posttransition, compared with universal practice patients, similar proportions of urgent eye clinic patients used Medicaid insurance (26.8% vs 27.8%; difference, 0.4%; 95% CI, −0.7% to 1.6%; P = .42) and identified as Asian, Black or African American, multiracial, native, or other (29.6% vs 26.8%; difference, 2.8%; 95% CI, 1.5%-4.1%; P < .001). A greater proportion of urgent eye clinic patients presented with high-acuity disease (37.6%) compared with resident clinic patients (20.9%; difference, 16.7%; 95% CI, 15.0%-18.4%; P < .001). Median graduating resident primary cataract surgery volume increased from 148 to 228 cases (difference, 80; 95% CI, 49 to 122; P < .001). Conclusions and Relevance Results of this cross-sectionals study show that transforming resident clinic into urgent eye clinic was associated with reduced sociodemographic disparities, enhanced resident exposure to high-acuity disease, and increased resident procedural experience. These results suggest that changes in resident clinic structure may improve both health equity and resident education.
