Abstract Purpose To analyze the characteristics and trends of ophthalmic surgeries in public and private hospitals, as well as sex-disparities. Methods A nationwide multicenter retrospective observational trend study encompassing surgeries in 9 different hospitals from 2017 to 2022. The retrieved data, which produced an anonymized database, was further divided into sub-specialties, before implementing descriptive and trend analyses. Results A total of 97,325 surgeries were analyzed. Private hospitals had a higher female predominance (p < 0.001). A slight non-significant increase was noted in private hospitals over the years (0.9% annual increase, p = 0.07). Cataract and oculoplastic surgeries were the most common procedures in both domains. In private hospitals, male predominance was noted in cataract, glaucoma, corneal, retinal, and strabismus surgeries, whereas female predominance was noted in oculoplastic surgeries (p < 0.001 for each). In public hospitals, however, male predominance was only observed in glaucoma, corneal, and retinal surgeries, and female predominance was observed in cataract surgeries (p < 0.001 for each). Conclusion Privatization seems to be an increasing trend in ophthalmology as well, and cream skimming is not as prevalent in this cohort. Sex differences were evident in both the public and private domains in different sub-types of eye surgery.

To study and assess the association of various eye disorders with the development of attention-deficit hyperactivity disorder (ADHD/ADD). A nationwide, retrospective cohort-study, utilising anonymised electronic medical records (EMR) data on all insured individuals aged 5–30 in Maccabi Health Services (MHS), the second largest health maintenance organisation in Israel, during 2010–2022. The final analysis included 665,121 individuals from an initial cohort of 1,686,128 after applying selection criteria and propensity score matching. Of these, 68,976 (10.4%) developed ADHD/ADD. ADHD/ADD was more common and developed faster in those with eye disorders (HR = 1.40, 95% CI: 1.38–1.42 and 4.5 versus 4.9 years, p < 0.001, respectively). All evaluated eye disorders served as significant risk factors (strabismus: HR = 1.64, 95% CI: 1.49–1.80; hyperopia: HR = 1.52, 95% CI: 1.47–1.56; astigmatism: HR = 1.52, 95% CI: 1.48–1.56; amblyopia: HR = 1.40, 95% CI: 1.27–1.54; myopia: HR = 1.30, 95% CI: 1.28–1.33). Similar findings were evident when assessing combinations of eye disorders. These associations were far more pronounced in females and the paediatric population (p < 0.001 and p = 0.044, respectively). Eye disorders serve as risk factors for the development of ADHD/ADD, particularly in females and in the paediatric population.

PurposeTo analyze wait time (WT) trends at Pediatric Ophthalmology and Strabismus (POS) service clinics.MethodsRetrospective observational study utilizing MDClone and electronic health records (EHRs) on 19,018 patients from POS clinics at a tertiary university-affiliated hospital in Israel, during April 2016-June 2023. Data were collected by the qFlow real-time patient tracking system. Primary outcome measures were WTs trends.ResultsData consisted of 19,018 patients, and the final cohort was 11,320 patients (49.51% female). Median age was 6 (IQR: 7) and median WT was 34.14 (IQR: 16.52-60.35) minutes. WT decreased during the pandemic (p < 0.001). WT across different eye clinics at the POS service differed (p < 0.001). Average WTs differed throughout the day: gradually decreasing from front desk opening until accepting patients, gradually increasing before noon, and followed by a gradual decrease. WTs fluctuated throughout the year with no clear pattern (31 min in May vs. 37 min in July, p < 0.001). There was a significant, weak, negative correlation between patients' lateness and WT, suggesting late arrivals were admitted quicker (p < 0.001). Median WT was not associated with gender (p = 0.93) or religion (p = 0.11) and with age (R = 0.02, p = 0.14).ConclusionWTs remained stable over the years. WTs at the POS service were significantly influenced by the time of day, month, type of clinic, and arrival time relative to the set appointment. WTs were significantly decreased during the COVID-19 epidemic. Personalized clinic schedules and adjusting for the complexity of needing both an orthoptist and ophthalmologist, may shorten WTs and encourage patients to avoid early arrivals.

Abstract Background Workforce diversity in healthcare has been shown to improve the quality of patient care. A paucity of data exists globally on this subject in ophthalmology. The purpose of this study was to analyze nationwide trends in gender-, ethnic- and country of graduation disparities among ophthalmologists in Israel. Methods Cross-sectional, workforce-based study using data retrieved from the Israeli Ministry of Health. Data included gender, ethnicity, and medical graduation country. Proportions and trends among new residents and board-certified ophthalmologists (BCO) were assessed. Results During 2006–2021, 18,624 medical licenses were issued (41.7% Israeli Medical Graduates (IsrMGs), 42.2% female), average yearly increase (AYI) was 6.9%, females and IsrMGs had an average yearly decrease of 1% and 0.53%, respectively. 561 physicians began ophthalmology residency (57.5% male, 75% Jewish, 69.9% IsrMGs), reflecting a 6.2% total AYI, but 8.1% and 4.8% for female versus male residents, respectively. There were fewer female residents despite population and graduate pool adjustments (p = 0.002 and p = 0.002, respectively), but differences disappeared after 2015 (p = 0.52). Arab and Jewish residents AYIs were 6.4% and 5.7% respectively, with ethnic differences elucidated by adjusting for population sizes (p = 0.097). BCO densities in 2006 and 2021 were 7.5 and 9.06, respectively, with a 1.3% AYI (p < 0.001). Proportions of female and Arab BCO were lower than expected based on population proportions. (p < 0.001 and p < 0.001, respectively). Gender-differences remained after adjusting for population sizes (p < 0.001), but AYIs for female and male BCO were 1.38% and 1.15%, respectively. AYIs for Arab and Jewish BCO were 12% and 0.61%, respectively. Conclusions Jewish and male dominance was seen among Israeli BCOs and was unrelated to population size or graduate distribution. Among new ophthalmology residents, Arab representation was adequate to their population proportion. In early years, male predominance was noted, however this disparity was no longer evident after 2015. These trends are encouraging, and efforts should be made to ensure the field remains inclusive and representative of the broader population.

Background: Syndromic inherited retinal diseases (IRDs) are a clinically and genetically heterogeneous group of disorders, involving the retina and additional organs. Over 80 forms of syndromic IRD have been described. Methods: We aimed to phenotypically and genotypically characterize a cohort of 171 individuals from 140 Israeli families with syndromic IRD. Ophthalmic examination included best corrected visual acuity, fundus examination, visual field testing, retinal imaging and electrophysiological evaluation. Most participants were also evaluated by specialists in fields relevant to their extra-retinal symptoms. Genetic analyses included haplotype analysis, homozygosity mapping, Sanger sequencing and next-generation sequencing. Results: In total, 51% of the families in the cohort were consanguineous. The largest ethnic group was Muslim Arabs. The most common phenotype was Usher syndrome (USH). The most common causative gene was USH2A. In 29% of the families, genetic analysis led to a revised or modified clinical diagnosis. This included confirmation of an atypical USH diagnosis for individuals with late-onset retinitis pigmentosa (RP) and/or hearing loss (HL); diagnosis of Heimler syndrome in individuals with biallelic pathogenic variants in PEX6 and an original diagnosis of USH or nonsyndromic RP; and diagnosis of a mild form of Leber congenital amaurosis with early-onset deafness (LCAEOD) in an individual with a heterozygous pathogenic variant in TUBB4B and an original diagnosis of USH. Novel genotype–phenotype correlations included biallelic pathogenic variants in KATNIP, previously associated with Joubert syndrome (JBTS), in an individual who presented with kidney disease and IRD, but no other features of JBTS. Conclusions: Syndromic IRDs are a highly heterogeneous group of disorders. The rarity of some of these syndromes on one hand, and the co-occurrence of several syndromic and nonsyndromic conditions in some individuals, on the other hand, complicates the diagnostic process. Genetic analysis is the ultimate way to obtain an accurate clinical diagnosis in these individuals.

Importance Uncovering the genetic basis of inherited retinal diseases (IRDs) can enhance both diagnostic accuracy and the development of targeted treatment strategies. Objective To evaluate the association between a homozygous nonsense variant in CREB3 with IRDs. Design, Setting, and Participants Thirteen patients with a clinical diagnosis of retinitis pigmentosa or cone-rod degeneration were analyzed by whole-genome sequencing (WGS) and whole-exome sequencing (WES). Clinically, patients presented with 2 main phenotypes, rod-cone and cone-rod dystrophies, demonstrating variable electrophysiological and fundoscopic findings. Expression analysis was performed on patient-derived skin fibroblasts using the reverse transcription-polymerase chain reaction and Western blot analysis, and by interrogating previously published retinal single-cell RNA sequence data. Immunohistochemistry staining was performed on wild-type mouse retinal sections using an anti-CREB3 antibody. Patients with variable phenotypes of IRDs were recruited from 3 medical centers in Israel and Italy. Ophthalmologists clinically diagnosed patients at the relevant medical centers and referred them for genetic screening. WES and WGS were performed at different national and international centers, and the findings of the previously unreported gene were shared between investigators. Exposures CREB3 and IRDs. Main Outcomes and Measures The main outcome was evidence supporting an association between CREB3 and IRD. Measures included WES, WGS, and immunohistochemistry staining. Results A founder homozygous nonsense variant in CREB3 (c.881G>A, p.Trp294*) was identified in 13 patients from 4 unrelated families; 12 descendent from North-African Jewish origins and 1 from Italian origins. All patients manifested retinal degeneration with varying ages at onset. In patient-derived fibroblasts, the variant mRNA transcript generated a truncated CREB3 protein. Expression analysis and immunohistochemistry staining revealed CREB3 RNA and protein expression in various retinal cell types, indicating its vital role in photoreceptor function. Conclusions and Relevance This study found an association between CREB3 and IRDs. CREB3 was previously shown to be upregulated following ultraviolet radiation. This might contribute to the extensive clinical variability observed in this relatively large cohort of homozygous patients with the same truncated variant.

To assess retinopathy of prematurity (ROP) practice patterns during the coronavirus (COVID-19) pandemic. A survey on ROP practice patterns during the COVID-19 pandemic was sent to the American Academy of Ophthalmic Executives, the International Pediatric Ophthalmology and Strabismus Council members, and to various national societies on May 19, 2020. The survey closed on the 31st of June 2020. Two hundred ninety-two ophthalmologists from 41 countries responded to the survey. Most replies originated in Asia (48

PURPOSE:To describe and analyze characteristics and trends of pediatric ocular trauma during 2011-2020.METHODS:Retrospective descriptive study. Data were collected on all pediatric ocular trauma cases that presented to a Rambam Health Care Campus during 2011-2020. Data included age, gender, visual acuity, diagnosis, injury mechanism and surgical repair.RESULTS:Median BCVA at presentation was 0.96 (logMAR). Males and non-adolescent males specifically were the most prominent groups (70.6% and 44.7%, respectively). The ratio of ocular trauma cases to total pediatric emergency department (ED) visits was stable during 2011-2020 (p = 0.714) regardless of gender (p = 0.832 and p = 0.545 for boys and girls, respectively). The leading causes were partial thickness eyelid laceration, periorbital hematoma, and extraocular muscle contusion, all of which were stable over the study period (p = 0.678, p = 0.203 and p = 0.398, respectively). Falls and children play were the most common mechanisms (25.8% and 18.4%, respectively), but differed between age groups. Most patients did not require consecutive operation and were treated conservatively (p < 0.01).CONCLUSION:Pediatric ocular injuries to pediatric ED visits ratio remained stable during 2011-2020, regardless of gender. Non-adolescent males accounted for nearly half of all cases, with different mechanisms for each age group. Consecutive surgery was rarely necessary.

Objectives To assess height and weight as possible sex-specific risk factors for bilateral myopia among young adults. Methods We conducted a cross-sectional study including 101,438 pre-enlisted young adult males and females, aged 17.4 ± 0.6 and 17.3 ± 0.5 years, respectively, and born during 1971–1994. Categories of BMI (body mass index) were defined according to sex-related percentiles for 17-year-olds following U.S. Centers for Disease Control and Prevention growth charts, and subjects were divided into five height and weight categories according to sex-adjusted percentiles. Data included best-corrected visual acuity, diverse socio-demographic variables, anthropometric indices, and refractive errors, namely bilateral myopes and emmetropes. Results The prevalence of bilateral myopia in males and females was 19.1% and 26.0%, respectively. Bilateral myopia displayed a J-shaped associated with BMI, achieving statistical significance only among males (p < 0.0001). Weight displayed a U-shaped association with bilateral myopia among both young males (p < 0.0001) and females (p < 0.005). A higher prevalence of bilateral myopia was observed only among males of the lower height category (p < 0.0001), even when controlling for BMI (from normal to obesity). In a multivariable regression model, obesity was associated with higher prevalence of bilateral myopia (OR: 1.21; 95% CI: 1.07-1.38, p = 0.002), only among males. There were no interactions of BMI with height or weight. Bilateral myopia was also associated with prehypertension among males (OR: 1.10, 95% CI: 1.04-1.15, p < 0.001). Conclusions A higher risk for bilateral myopia was associated with either BMI solely or height and weight, as well as pre-hypertension, in males. The possible association with low height requires further research.

We read with great interest the article by Ninghong Chen and associates,1 which explored the relationships between myopia and physical indicators. They concluded that the occurrence of myopia was positively linked to weight (linear relationship) and BMI (non-linear relationship), while height was positively associated with the severity of myopia. Association Between Physical Indicators and Myopia in American Adolescents: National Health and Nutrition Examination Survey 1999-2008American Journal of OphthalmologyVol. 260PreviewMyopia is the most prevalent refractive error, imposing a substantial economic burden. Physical indicators constitute significant influencing factors for myopia. The National Health and Nutrition Examination Survey (NHANES) investigates the health and nutritional status of both children and adults in the United States. This study leveraged NHANES to explore the association between physical indicators and myopia among American adolescents. Full-Text PDF Reply to Comment on "Association between physical indicators and myopia in American adolescents: National Health and Nutrition Examination Survey 1999-2008"American Journal of OphthalmologyPreviewWe express our gratitude to the authors of the comment for their comprehensive analysis of our publication and take the opportunity to reply. Full-Text PDF

ImportanceData regarding the prevalence of various inherited retinal diseases (IRDs) are limited and vary across populations; moreover, nationwide prevalence studies may be limited to a specific IRD phenotype, potentially leading to inaccurate prevalence estimations. Therefore, nationwide prevalence data are needed.ObjectiveTo determine the prevalence of 67 IRD phenotypes in the Israeli population.Design, Setting, and ParticipantsThis cohort study collected nationwide data regarding the number of individuals affected with IRD phenotypes assessed in 10 clinical and academic centers in Israel as part of the research activity of the Israeli inherited retinal disease consortium. Data were collected in May 2023 on 9396 individuals residing in Israel who were diagnosed by an ophthalmologist with an IRD using either electroretinography or retinal imaging where included. Individuals with retinal diseases known to have a nonmendelian basis or without a clear genetic basis and those who were reported as deceased at the time of data collection were excluded from this study.Main Outcomes and MeasuresPrevalence of 67 IRD phenotypes.ResultsAmong the 9396 participants in our cohort, the most common IRD in Israel was retinitis pigmentosa with a disease prevalence of approximately 1:2400 individuals, followed by cone-rod dystrophy (approximately 1:14 000), Stargardt disease (approximately 1:16 000), Usher syndrome (approximately 1:16,000), and congenital stationary night blindness (approximately 1:18 000). The prevalence of all IRDs combined was 1:1043 individuals.Conclusions and RelevanceThe current study provides large prevalence dataset of 67 IRD phenotypes, some of which are extremely rare, with only a single identified case. This analysis highlights the potential importance of performing additional nationwide prevalence studies to potentially assist with determining the prevalence of IRDs worldwide.

Expeditious publication is an important factor when considering publishing ophthalmic research. We investigated the factors associated with shorter publication times in pediatric ophthalmology and strabismus (POS). We analyzed 2487 POS articles from 8 ophthalmology journals publishing POS articles. Time from submission to acceptance, from acceptance to publication, and from submission to publication were calculated for each article. We compared trends over time of factors affecting the publication times from 2002 to 2007 and those from 2014 to 2018. Median peer review durations were 156 days from submission to acceptance; 79 days from acceptance to publication, and 244 days from submission to publication. The American Journal of Ophthalmology, JAMA Ophthalmology, and Strabismus had the shortest submission to publication time. Authors from Africa, East Europe, Central and South America received the fastest processing time in all time categories, although most authors were based in North America and UK. All-time intervals decreased annually, significantly more during the first decade. In the study's second period, more co-authors and affiliated departments correlated with shorter review times. Manuscripts in higher Impact Factor (IF) journals had faster publication times in the first decade. Female senior authors faced longer submission-to-acceptance times in the first decade. This gender gap disappeared in the second period. A general improvement occurred with most journals, specifically those journals with a higher number of co-authors and affiliated departments, indicating an efficient collaborative authorship. Low-income regions benefited from comparatively shorter time intervals. The gender gap in senior authorship diminished over time.

PURPOSE:To analyze characteristics and trends of strabismus surgeries in an Israeli hospital over 2 decades. METHODS:A descriptive, retrospective study including all strabismus surgeries (666) performed during 2000-2019 at an Israeli tertiary hospital. Electronic medical records (EMRs) were directly retrieved to produce an anonymized database. RESULTS:No trends were evident for age, sex, or ethnicity (p = .294, 0.914 and p = .167, respectively). The mean number of horizontal muscles remained stable, while an increase was noted in the mean number of muscles operated on to repair vertical strabismus (p < .0001). Among acquired cases, a 2.67-fold increase was noted in the proportion of spontaneous strabismus and a decrease of traumatic causes to a third (p < .001). An increase was noted in the proportion of exotropia among horizontal strabismus corrections (p = .022), and esotropia correction techniques distribution changed (p = .004). Reoperations comprised a third of all cases during both decades (p = .198). Reoperations were more prevalent among younger and Jewish patients (p < .001 and p = .024, respectively). Techniques to correct esotropia and exotropia differed significantly between primary surgeries and reoperations (p < .00001 each). CONCLUSIONS:The complexity of surgical techniques increased over time. Ethnic minorities were less prone to reoperations.

The "publish or perish" phenomenon is a reality in medical research, where continuous publication is essential for career advancement and overall success.We investigated the impact of this phenomenon in paediatric ophthalmology and strabismus (POS) for 2022 in 12 leading journals (Supplementary-e-table-1) and identified the ten most prolific authors who had implemented a previous methodology [1].We excluded editorials, letters, or comments.Our search yielded 343 articles including 1786 authors (average 1.19 ± 0.79, median 1, range 1-15 articles per author).Forty percent of the ten most prolific authors were women, twice as many compared to that in general ophthalmology (20%) [1].The narrowing gender gap in POS was previously reported in another publication [2].A full PubMed search revealed an average of 17.4 ± 9.9 (median 14.5) articles, indicating a vast difference from the remaining POS authors.

BACKGROUND:To better understand and analyze various aspects of scientific publication, bibliometric data analysis is useful.OBJECTIVES:An analysis of the factors associated with shorter publication times in pediatric ophthalmology and strabismus (POS) between the years 2002 and 2007, compared to 2014 and 2018.METHODS:In this retrospective bibliometric analysis, we analyzed 2,487 articles related to POS from the official websites of 8 preselected ophthalmology journals. Time from submission to acceptance, from acceptance to publication, and from submission to publication were calculated for each article.RESULTS:Median peer review durations were 156 days from submission to acceptance; 79 days from acceptance to publication, and 244 days from submission to publication. Journals such as the American Journal of Ophthalmology, JAMA Ophthalmology, and Strabismus reported the shortest time from submission to publication. Annually, all time intervals decreased, but in the first decade, the decline was significantly greater. The time between submission and acceptance of female senior authors increased during the first decade; however, this disappeared during the second decade.CONCLUSIONS:There was an improvement in most journals and the gender gap in senior authorship decreased with time.DISCUSSION:Since digital technology has rapidly developed over the past two decades, authors have been able to communicate with editorial and production teams more quickly and efficiently. Journal names and the gender of the last author are the main factors affecting publication times.

Purpose This study sought to describe the phenotype frequency and genetic basis of inherited retinal diseases (IRDs) among a nationwide cohort of Israeli Jewish patients of Ethiopian ancestry. Methods Patients’ data—including demographic, clinical, and genetic information—were obtained through members of the Israeli Inherited Retinal Disease Consortium (IIRDC). Genetic analysis was performed by either Sanger sequencing for founder mutations or next-generation sequencing (targeted next-generation sequencing or whole-exome sequencing). Results Forty-two patients (58% female) from 36 families were included, and their ages ranged from one year to 82 years. Their most common phenotypes were Stargardt disease (36%) and nonsyndromic retinitis pigmentosa (33%), while their most common mode of inheritance was autosomal recessive inheritance. Genetic diagnoses were ascertained for 72% of genetically analyzed patients. The most frequent gene involved was ABCA4. Overall, 16 distinct IRD mutations were identified, nine of which are novel. One of them, ABCA4-c.6077delT, is likely a founder mutation among the studied population. Conclusions This study is the first to describe IRDs’ phenotypic and molecular characteristics in the Ethiopian Jewish community. Most of the identified variants are rare. Our findings can help caregivers with clinical and molecular diagnosis and, we hope, enable adequate therapy in the near future.

Purpose: To summarize the characteristics and trends of interest in retinoblastoma (Rb) in the last 50 years. Methods: The Web of Science Database was used to find all studies focused on Rb published from 1970 to 2018. The term “retinoblastoma” was used to search for the 100 most cited records. Results: The mean number of citations was 153.55 ± 88.9. The majority were from the United States (US) (n = 68). Drs. Shields authored 38% of the papers. The number of citations per year was positively correlated with the number of authors, r = 0.26 (p = 0.008). The number of patients was significantly associated with the number of citations per year (p = 0.012). Although papers on radiotherapy were the most common, publications about intra-arterial chemotherapy (IAC) were associated with 88.3% more citations per year (p = 0.031) and papers on intravenous chemotherapy (IVC) were associated with 40.3% more citations per year (p= 0.04). Review and meta-analysis studies had a higher median of citations (10.5) than interventional (6.4) or observational (5.2) studies. Conclusions: This study compiles a comprehensive analysis of the most-cited articles on Rb. Studies with a higher number of citations per year were associated with IAC, which emphasizes the significance of the advances in Rb treatments that allow for the saving of eyes and vision as well as lives. Review studies had more citations than observational or interventional studies. More citations were associated with a larger number of authors or more reported patients per paper. These findings highlight the importance of collaborations to achieve relevant, high-quality research of Rb.

PurposeTo investigate and compare the demographics, diagnoses, and surgical procedure types of strabismus repair in public and private hospitals in Israel in order to highlight possible disparities between them.MethodsRetrospective descriptive study included all strabismus surgeries in seven private hospitals, compared with two large public university-affiliated hospitals from June 2016 to June 2021. Electronic medical records were directly retrieved to produce an anonymized database.ResultsDuring the study period 2420 operations were performed. Patients who underwent strabismus surgery in public hospitals were older and had shorter procedures (p < 0.001 and p = 0.004, respectively). The median number of operated muscles and the prevalence of bilateral procedures were higher in private hospitals (p < 0.001 and p < 0.001, respectively). Surgery for common strabismus, especially esotropia, was more prevalent in private (p < 0.001), whereas surgery for vertical strabismus, cranial nerve palsies and complex syndromes were performed more often in public hospitals (p < 0.001, p = 0.008, and p < 0.001, respectively). Rectus recession and inferior oblique (IO) anteriorization were more predominant in private hospitals (p = 0.002 and p < 0.001, respectively), while recuts advancement and IO myectomies were more prevalent in public ones (p = 0.001 and p < 0.001, respectively). Reoperations were far more common in public hospitals (27.2% vs 6.2%, p < 0.0001). This was true across most age groups.ConclusionsCandidates for strabismus surgery in private hospitals in Israel are often younger, with more common diagnoses, and are usually referred for simpler procedures.