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Physician Sex, Clinical Activity, and Medicare Payments
Although the number of women in ophthalmology is rising, little is known about their clinical activity and collections. Reddy and coauthors evaluate how earnings and clinical activity of men and women in ophthalmology compared. Using the database from the Centers for Medicare & Medicaid Services for payments to ophthalmologists in 2012 and 2013, they found that the average female ophthalmologist collected $0.58 for every dollar collected by a male ophthalmologist; comparing the medians, women collected $0.56 for every dollar earned by men. Women also had lower levels of clinical activity. These findings indicate that women in ophthalmology collect less than men in part associated with lower clinical activity. Further studies would be needed to explore root causes for these differences.
Patient Self-report vs Medical Record of Symptoms
Given the rise in the use of electronic medical records (EMRs), accurate documentation of patient symptoms in the EMR would seem to be important for high-quality patient care. Valikodath and coauthors determine whether eye symptoms were reported differently in the EMR vs patient report on an Eye Symptom Questionnaire (ESQ). They found large inconsistencies, with participants having discordant symptom reporting between the ESQ and EMR, including blurry vision, glare, pain or discomfort, and redness. These data suggest that symptom reporting varies between methods, with patients tending to report more symptoms on self-reported questionnaires.
Recovery After Iatrogenic Macular Detachment
As the early decline and recovery of retinal structure and function following iatrogenic macular detachment for retinal gene therapy is not well characterized in those with relatively preserved central visual function, Simunovic and coauthors investigate whether limited iatrogenic detachment of the macula had a detrimental short-term effect on retinal structure and function. In a prospective interocularly controlled study of 5 patients who underwent gene therapy for choroideremia, structural recovery occurred within 1 week of iatrogenic retinal detachment, while functional recovery occurred within 1 month. However, subtle functional changes to color matching—consistent with reduced cone photopigment optical density—persisted at 1 month in 1 patient. These results suggest that retinal structure and function appears to recover rapidly following iatrogenic macular detachment.
Imaging Parameters and Incident Gonioscopic Angle Closure
Because angle-closure glaucoma is an important condition for ophthalmologists to manage, Nongpiur and coauthors try to identify anterior segment imaging parameters at one visit, which subsequently were associated with incident gonioscopic angle closure. They wanted to know what quantitative anterior segment optical coherence tomography imaging parameters predicted the development of incident gonioscopic angle closure in eyes with gonioscopically open angles initially. They found that a smaller angle opening distance at 750 µm and a larger lens vault were associated with development of incident gonioscopic angle closure by the 4-year follow-up visit. These findings suggest that anterior segment optical coherence tomography imaging parameters can predict the development of future incident gonioscopic angle closure. An angle opening distance of 750 µm and lens vault measurements may serve as effective screening tools to identify eyes at risk of angle-closure glaucoma prior to the onset of clinically apparent disease.
Highlights. JAMA Ophthalmol. 2017;135(3):181. doi:10.1001/jamaophthalmol.2016.3722
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