Jonathan A. Micieli

Twitter as a tool for ophthalmologists

Twitter is a social media web site created in 2006 that allows users to post Tweets, which are text-based messages containing up to 140 characters. It has grown exponentially in popularity; now more than 340 million Tweets are sent daily, and there are more than 140 million users. Twitter has become an important tool in medicine in a variety of contexts, allowing medical journals to engage their audiences, conference attendees to interact with one another in real time, and physicians to have the opportunity to interact with politicians, organizations, and the media in a manner that can be freely observed. There are also tremendous research opportunities since Twitter contains a database of public opinion that can be mined by keywords and hashtags. This article serves as an introduction to Twitter and surveys the peer-reviewed literature concerning its various uses and original studies. Opportunities for use in ophthalmology are outlined, and a recommended list of ophthalmology feeds on Twitter is presented. Overall, Twitter is an underutilized resource in ophthalmology and has the potential to enhance professional collegiality, advocacy, and scientific research.

Retinal blood flow in response to an intravitreal injection of ranibizumab for neovascular age-related macular degeneration

Purpose:  To assess the hemodynamic response of retinal arterioles and venules following a single intravitreal injection of ranibizumab in neovascular age‐related macular degeneration (NV‐AMD) patients and to assess the influence of the number of prior injections on this response.

Impact of visors on eye and orbital injuries in the National Hockey League.

OBJECTIVE Eye and orbital injuries are a significant risk to professional hockey league players and have resulted in career-ending injuries. The goal of this study was to determine the incidence, value lost, mechanism, and effect of visors on eye and orbital injuries over the last 10 National Hockey League (NHL) seasons: 2002-2003 to 2012-2013. DESIGN Retrospective case-control study. PARTICIPANTS Participants were 8741 NHL players who had played at least 1 game during the last 10 seasons. METHODS Using The Sports Network (TSN), ProSportsTransactions, and the Sporting News Hockey Register, NHL players were searched to identify eye and orbital injuries. The mechanism of injury was obtained from media reports and direct observation from online videos. The number of players wearing visors each year was obtained from The Hockey News annual visor survey. RESULTS A total of 149 eye or orbital injuries over the last 10 seasons resulted in an overall incidence of 2.48 per 10 000 athlete exposures. A total of 1120 missed games led to a lost financial value of more than

Ophthalmology on social networking sites: an observational study of Facebook, Twitter, and LinkedIn.

33 million. Visor use among players grew from 32% in 2002-2003 to 73% in 2012-2013, and there was a significantly increased risk for having an eye or orbital injury when a visor was not worn (OR 4.23, 95% CI 2.84-6.30). Most injuries were a result of being hit by a deflected or direct puck (37%) followed by being struck by a high stick (28%). Players who did not wear a visor were found to be involved in more fights, hits, and penalty minutes (p < 0.001). CONCLUSIONS Eye and orbital injuries are mostly accidental in nature and represent a significant risk and cost to the NHL and its players. Eye and orbital injuries are significantly more likely in players who do not wear visors.

Geographic distribution of ophthalmologists in Ontario: a 10-year review

Background The use of social media in ophthalmology remains largely unknown. Our aim was to evaluate the extent and involvement of ophthalmology journals, professional associations, trade publications, and patient advocacy and fundraising groups on social networking sites. Methods An archived list of 107 ophthalmology journals from SCImago, trade publications, professional ophthalmology associations, and patient advocacy organizations were searched for their presence on Facebook, Twitter, and LinkedIn. Activity and popularity of each account was quantified by using the number of “likes” on Facebook, the number of followers on Twitter, and members on LinkedIn. Results Of the 107 journals ranked by SCImago, 21.5% were present on Facebook and 18.7% were present on Twitter. Journal of Community Eye Health was the most popular on Facebook and JAMA Ophthalmology was most popular on Twitter. Among the 133 members of the International Council of Ophthalmology, 17.3% were present on Facebook, 12.8% were present on Twitter, and 7.5% were present on LinkedIn. The most popular on Facebook was the International Council of Ophthalmology, and the American Academy of Ophthalmology was most popular on Twitter and LinkedIn. Patient advocacy organizations were more popular on all sites compared with journals, professional association, and trade publications. Among the top ten most popular pages in each category, patient advocacy groups were most active followed by trade publications, professional associations, and journals. Conclusion Patient advocacy groups lead the way in social networking followed by professional organizations and journals. Although some journals use social media, most have yet to engage its full potential and maximize the number of potential interested individuals.

Factors influencing visor use among players in the National Hockey League (NHL).

OBJECTIVE Previous studies have shown that access to appropriate care is lacking in low-income and rural areas. The goal of this study was to assess the geographic variation in the number of ophthalmologists in Ontario from the 2000 to 2010 fiscal years. DESIGN Population-based analysis of the geographic distribution of Ontario ophthalmologists. PARTICIPANTS All ophthalmologists who held an Ontario license and received payment through the Ontario Health Insurance Plan. METHODS Demographic information was obtained through Intellihealth Ontarios Medical Service Provider data source. Ontario counties were stratified into low-population (<100000), medium-population (100000-400000), and large-population (>400000) groups. RESULTS The ratio of ophthalmologists to population was greatest in low-population counties in 2000 (1:65601) and increased further in 2010 (1:75434). Only medium-sized counties saw an improvement in the ophthalmologist-to-population ratio over the study period. There was no statistical difference in the number of ophthalmologists per 100000 population between small, medium, and large counties. Counties with an ophthalmology residency program had a significantly higher number of ophthalmologists per population compared with those without one (1:18162 vs 1:44245). CONCLUSIONS Geographic disparities exist in the distribution of ophthalmologists in Ontario. The highest ratios of ophthalmologists to population are found in areas with an ophthalmology residency program. New strategies are needed to improve the overall numbers and distribution of ophthalmologists to meet the demands of the aging population and reduce the burden of vision loss in Canada.

Growth of medical and surgical vitreoretinal subspecialization in Ontario over 12 years

Eye, orbital, and facial injuries are significant risks to National Hockey League (NHL) players, and can be mitigated by the use of a partial visor – currently optional for all non-rookie players. The goal of the current study was to determine the overall use of visors among non-rookie NHL players in the 2013–2014 season and assess factors influencing their uptake. This was an observational, cross-sectional study using active NHL rosters and demographic information obtained from the official NHL website. Visor use was determined based on in-game video or images at two different time points in the 2013–2014 season. The use of visors during the 2013–2014 season was 75.2% among non-rookie players. When rookies were included, the overall use of visors was 77.8%. Compared to Canadian-born players, European players were significantly more likely to choose to wear a visor (odds ratio [OR] 3.48, 95% confidence interval [CI] 1.96–6.17). Players in the younger age-groups, particularly those younger than 24 years (OR 5.67, 95% CI 2.52–5.76) and those between 24 and 28 years (OR 2.18, 95% CI 1.23–3.87), were more likely to wear a visor compared to older players. Overall, visor use continues to grow in the NHL independently of new legislation, and is more likely in younger players and those of European origin.

Gender gap and declining surgical activity among new graduates: cataract surgery in Ontario

OBJECTIVE The past decade has seen significant paradigm shifts in the management of many retinal diseases. The goal of this study is to assess the effect these advances have had on the number of retinal specialists, and the differences in output between medical and surgical specialists at the population level. DESIGN Population-based analysis of surgical and medical retina therapeutic and diagnostic procedures among all ophthalmologists in Ontario, Canada, from April 1999 to March 2012. PARTICIPANTS This study included all ophthalmologists with an Ontario license and receiving remuneration from the Ontario Health Insurance Plan (OHIP). Ophthalmologists were categorized as a surgical or medical retina specialist based on the type and volume of retina-specific procedures performed each year. METHODS The IntelliHealth database operated by the Ministry of Health and Long Term Care was used to obtain anonymized physician services, which has excellent accuracy for procedure performance. RESULTS The number of retina specialists grew from 9.7% to 14.4% of the ophthalmology workforce. The proportion of late-career retina specialists (>25 years since graduation) doubled but had no influence on procedure output. Almost all retina specialists (90%) practice in the region they graduated medical school, and most (65%) practice in counties with a population greater than 400,000 people. Over the study period, the mean number of photocoagulation and fluorescein angiography performed was significantly higher among surgical retina specialists. Scleral buckling declined by 55% over the study period, whereas the number of pars plana vitrectomies grew by 49%. CONCLUSIONS The retina subspecialty is a growing area of ophthalmology and is mainly located in urban centres. There has been a dramatic shift in the types of procedures performed to treat medical and surgical diseases over the past decade. To our knowledge, this is the first study to quantify differences in diagnostic and procedure performance between the medical and surgical retina subspecialties.

Proportion of medical-only versus surgical ophthalmology practices: associations and trends

OBJECTIVE To investigate the proportion of ophthalmologists performing cataract surgery; the volume performed; and the influence of career stage, sex, and trends over time. DESIGN Population-based study of cataract surgical practice patterns among all ophthalmologists in Ontario, Canada, from April 1999 to March 2013. PARTICIPANTS All active ophthalmologists in Ontario, Canada, providing government health care for the provincial population of approximately 13 million. METHODS The IntelliHealth database operated by the Ministry of Health and Long Term Care, which has excellent accuracy for procedure performance, was used to obtain anonymized physician services. RESULTS The percentage of ophthalmologists performing cataract surgery decreased (68% to 64%), but the yearly mean number of cataract surgeries performed per person increased 1.5 times (307.7 to 470.2). The percentage of early-career ophthalmologists performing cataract surgery declined from 85% to 62%, and this was accompanied by a decline in the median number of cases performed per early-career surgeon (from 243.0 to 169.5). This decline in surgical activity among new graduates was accompanied by growth in the percentage of high-volume and late-career surgeons. In each of the years studied, males performed more surgeries per person than their female counterparts, and this gap grew from 1.4 times to 1.7 times more cataract surgery from 2000 to 2013. CONCLUSIONS Early-career ophthalmologists are becoming less active with cataract surgery, which may be explained by the increasing surgical activity among late-career and high-volume ophthalmologists. A large sex and volume gap exists among cataract surgeons, which continues to increase.

A review of specialties performing temporal artery biopsies in Ontario: a retrospective cohort study

OBJECTIVE To investigate what proportion of ophthalmologists have medical-only practices and the influence of career stage, sex, and time. DESIGN Population-based study of medical and surgical practice patterns among all ophthalmologists in Ontario, Canada, from April 1999 to March 2013. PARTICIPANTS All active ophthalmologists in Ontario, Canada, providing universal health care for the provincial population of approximately 13 million. METHODS The IntelliHealth database operated by the Ministry of Health and Long Term Care, which has excellent accuracy for procedure performance, was used to obtain anonymized physician services. Ophthalmologists were categorized as surgical or medical-only based on billing claims data. RESULTS The proportion of medical-only versus surgical ophthalmologists changed little over the 14-year period, averaging 30.5% medical-only and 69.5% surgical. Recent graduates showed a decreasing trend toward performing surgery of 1.6% per year, whereas late-career ophthalmologists demonstrated an increasing trend of 1.5% per year. Female ophthalmologists were less likely to perform surgery than male ophthalmologists but showed an increasing surgical trend. Ophthalmologists performing surgery saw on average 1.6 times the number of yearly consultations and assessments than their medical peers. Late-career ophthalmologists saw significantly fewer patients than their younger counterparts in each year studied. CONCLUSIONS A significant number of ophthalmologists have medical-only practices. The large majority of late-career ophthalmologists have transitioned to a medical-only practice. A decreasing trend in the proportion of young ophthalmologists performing surgery coincides with a growth of late-career surgical ophthalmologists, which may be limiting surgical opportunities for new graduates.