• Journal Highlights

    JAMA Ophthalmology

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    Representation of Women With Industry Ties in Ophthalmology

    June 2016

    There is a growing number of women in ophthalmology, and they are making strides in professional achievement. Reddy et al. examined how industry partnerships—a potential means of career advancement and income—compared between male and female ophthalmologists. The authors found that women had fewer partnerships and received less financial compensation from industry than men did.

    In this retrospective observational study, the authors reviewed the Centers for Medicare & Medicaid Services Open Payments database for payments to ophthalmologists by biomedical companies in 2013 and 2014. The pri­mary outcome measures were percent­age representation of women versus men overall and in industry research, consulting, speaking roles, royalties and licenses, grants, services other than consulting, and honoraria. Secondary outcome measures included mean and median payments from industry to female versus male ophthalmologists.

    In 2013, 4,164 of 21,380 ophthal­mologists (19.5%) were women. Of 1,204 ophthalmologists analyzed for industry ties, 176 were women (14.6%) and 1,028 were men (85.4%); overall, 4.2% of women and 6.0% of men had at least 1 industry tie (p < .001). Mean payments to women were $11,419 compared with $20,957 to men, and median payments were $3,000 and $4,787, respectively. Women were underrepresented among ophthalmol­ogists receiving industry payments in the following areas: research (49/462), consulting (96/610), honoraria (3/47), industry grants (1/7), royalties and licenses (1/13), and faculty/speaker roles (2/48).

    In 2014, 4,352 of 21,531 ophthal­mologists (20.2%) were women. Of 1,518 ophthalmologists analyzed for industry ties, 255 were women (16.8%) and 1,263 were men (83.2%); overall, 6.0% of women and 7.4% of men had at least 1 industry tie (p < .001). Mean payments to women were $14,848 versus $30,513 to men, and median payments were $3,750 and $5,000, respectively. Women were underrepresented among ophthalmologists receiving industry payments in the following areas: research (25/241), con­sulting (145/921), honoraria (14/111), industry grants (3/25), royalties and licenses (1/22), and faculty/speaker roles (21/189).

    The authors concluded that there is a disparity between male and female ophthalmologists in industry partner­ships, both in terms of percentage of representation and compensation. The reasons are multifactorial and could not be determined in this study.

    Effect of Laser PRP on Retinal Sensitivity and Driving Eligibility in Diabetic Retinopathy

    June 2016

    In a study conducted in the United Kingdom, Subash et al. assessed the ef­fect of bilateral multispot laser panret­inal photocoagulation (PRP) on retinal sensitivity and driving visual fields in patients with proliferative diabetic retinopathy (PDR). They found that although there was a mild loss of retinal sensitivity at 6 months after PRP, it was likely that treated patients would retain their driving eligibility.

    This prospective nonrandomized interventional cohort analysis included 43 laser-naive patients (38 completed the study) with PDR that required bilateral PRP. Multispot laser treatment was applied using standard parameters, until neovascularization regressed or complete retinal coverage was achieved. At baseline and 6-month follow-up, pa­tients underwent perimetry, microper­imetry, optical coherence tomography, widefield color fundus photography, and fluorescein angiography. Change in retinal sensitivity was assessed by com­paring the mean global retinal sensitiv­ity before and after laser treatment and by comparing the volumetric measure of a modeled hill of vision. At baseline and 6 months, participants also took the Esterman binocular visual field test for driving in the U.K. (at least 120-de­gree horizontal field with no significant defects within the central 20 degrees).

    Before treatment, 41 of 43 patients (95%) passed the Esterman test; after completion of laser treatment, 35 of 38 patients (92%) passed—only 1 of the 38 who completed the study and had passed at baseline lost driving eligibility after treatment. The mean (SD) change in retinal sensitivity on static perimetry was −1.4 (3.7) dB OD and −2.4 (2.9) dB OS. Mean (SD) 4-degree macular sensitivity decreased by 3.0 (5.2) dB OD and 2.6 (5.4) dB OS.

    The authors concluded that almost all patients retained their visual field el­igibility for driving after multispot PRP, despite a small loss of retinal sensitivity. They added that this information could be useful in counseling patients regard­ing treatment options.

    Cost-effectiveness of School-Based Eye Exams in Preschoolers Referred for Follow-up

    June 2016

    Lowry and de Alba Campomanes sought to determine the follow-up rates and cost-effectiveness of referral to community-based eye care profes­sionals compared with a mobile eye examination unit (mobile follow-up) among children with failed visual screening in preschool. The results suggest that community-based eye care professionals provide more cost-effective care than mobile follow-up at the preschool for these children.

    This retrospective cohort cost-effec­tiveness study included 3,429 children in 37 public preschools in San Francisco who underwent visual chart screening during the 2009-2012 academic years and 1,524 children in the same schools who underwent autorefraction screen­ing during the 2012-2013 academic year. Of the first group, 175 children were referred for community-based comprehensive eye examinations, while 204 in the second group were referred for preschool-based mobile follow-up.

    Of the 175 children referred for community-based follow-up (91 boys; 84 girls; mean [SD] age, 3.8 [0.7] years), 104 attended (59.4%). Of 204 children referred for mobile follow-up (89 boys; 115 girls; mean [SD] age, 4.1 [0.6] years), 112 attended (54.9%). Costs per case detected were $664 and $776, respectively. In univariate analysis, mobile follow-up was equally cost-effective if it increased the follow-up rate to 73% or if its costs were re­duced by at least 27%. In multivariate analysis with Monte Carlo simulation, community-based follow-up was more cost-effective than mobile follow-up in 88% of simulated cases and had typical savings of $112 per case detected.

    The authors noted, however, that the substantial variations in cost estimates allowed within the sensitivity limits of these analyses suggest a 12% possibility of increased cost-effectiveness with mo­bile follow-up. Further, programmatic changes to increase the follow-up could potentially improve the cost-effective­ness of mobile follow-up.

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    JAMA Ophthalmology summaries are written by Peggy Denny and edited by Neil M. Bressler, MD.

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