American Academy of Ophthalmology Recommendations on Screening for Endogenous Candida Endophthalmitis (2023)

Characterize the impact of frailty on endogenous endophthalmitis (EE) development and clinical outcomes among septicemic patients.

Population-level, retrospective cohort study.

Adult inpatients within the National Inpatient Sample (years 2002–2014) diagnosed with bacterial septicemia.

Septicemic patients were classified as frail or nonfrail using the previously validated Johns Hopkins Adjusted Clinical Groups frailty-defining diagnoses indicator, and diagnosis of EE was abstracted from International Classification of Diseases 9 codes. We used multivariable logistic regression to generate odds ratios (ORs) for rates of EE development and in-hospital mortality based on frailty status. We also examined the association between frailty and blood culture–proven organism class, inpatient length of stay, and total charges billed to insurance.

Incidence of EE among septicemic patients; rates of EE development among frail and nonfrail patients; blood culture–proven microbe type, length of stay, and total charges billed to insurance.

9294 of 18 470 658 (0.05%) inpatients with bacteremia developed EE, 2102 (22.6%) of whom had at least 1 frailty-defining feature (predominantly malnutrition [68%]). Odds of developing EE were 16.7% higher for frail patients (OR, 1.167; 95% confidence interval, 1.108–1.229) when controlling for age, sex, race, concomitant human immunodeficiency virus/AIDS, pyogenic liver abscess, infectious endocarditis, cirrhosis, and diabetes with chronic complications. Frail EE patients had a 27.9% increased odds of in-hospital death, independent of age, sex, race, and Elixhauser comorbidity score (OR, 1.279; 95% confidence interval, 1.056–1.549). Higher rates of methicillin-resistant Staphylococcus aureus bacteremia (14.3% vs. 10.9%, P= 0.000016), gram-negative bacteremia (7.6% vs. 4.9%, P= 0.000003), and concomitant candidemia (10.4% vs. 7.0%, P = 0.0000004) were associated with frailty. Hospital stays were significantly longer (median, 14 days; interquartile range, 19 days; P < 0.00001) and total charges billed to insurance were significantly greater (median, $96 398; interquartile range, $154,682; P < 0.00001) among frail EE patients.

Frailty syndrome is independently associated with development of EE in the setting of bacterial septicemia; frailty-associated EE may occur in patients with malnutrition and particular bacterial subtypes, and it predisposes to higher rates of in-hospital death and health care resource usage.

To examine the gender balance of academic ophthalmology departments by determining the association between the rates of female residents in ophthalmology programs and department chair/residency program director (PD) gender and rate of female faculty within the department.

Retrospective cross-sectional study.

Demographic information on ophthalmology programs, including size, location, and gender distribution of leadership, faculty, and residents was collected from public online resources. Departments with residency programs were included for analyses if they were both Accreditation Council Graduate Medical Education accredited and available for application through the San Francisco Match for the 2020-2021 application cycle. For analyses, a binomial regression was fitted to identify factors associated with the female faculty and resident proportions.

In 117 total programs, 16.7% of chairs and 37.7% of PDs were female. There were more female residents at programs with female PDs (P=.02), with more female faculty (P < .001), and at larger departments (P=.001) and residency programs (P=.04). In multivariate analysis, more female faculty members increased the odds of having more female residents (P < .001). Chair gender did not correlate with the proportion of female faculty or residents. There were the most female residents in the Northeast and the fewest in the Southwest (P=.003).

Although gender of department chair did not correlate with proportion of female faculty or residents, programs with more female faculty members had more female residents. Deans and programs should strive for departmental diversity and the recruitment and success of female residents to ensure the use of their full academic capital.

To estimate the effect of achieving target intraocular pressure (IOP) values on visual field (VF) worsening in a treated clinical population.

Retrospective analysis of longitudinal data.

A total of 2852 eyes of 1688 patients with glaucoma-related diagnoses treated in a tertiary care practice. All included eyes had at least 5 reliable VF tests and 5 IOP measures on separate visits along with at least 1 target IOP defined by a clinician on the first or second visit.

The primary dependent variable was the slope of the mean deviation (MD) over time (decibels [dB]/year). The primary independent variable was mean target difference (measured IOP – target IOP). We created simple linear regression models and mixed-effects linear models to study the relationship between MD slope and mean target difference for individual eyes. In the mixed-effects models, we included an interaction term to account for disease severity (mild/suspect, moderate, or advanced) and a spline term to account for thediffering effects of achieving target IOP (target difference $\le$0) and failing to achieve target IOP (target difference >0).

Rate of change in MD slope (changes in dB/year) per 1 mmHg change in target difference at different stages of glaucoma severity.

Across all eyes, a simple linear regression model demonstrated that a 1 mmHg increase in target difference had a−0.018 dB/year (confidence interval [CI],−0.026 to−0.011; P < 0.05) effect on MD slope. The mixed-effects model shows that eyes with moderate disease that fail to achieve their target IOP experience the largest effects, with a 1 mmHg increase in target difference resulting in a −0.119 dB/year (CI,−0.168 to−0.070; P< 0.05) worse MD slope. The effects of missing target IOP on VF worsening were more pronounced than the effect of absolute level of IOP on VF worsening, where a 1 mmHg increase in IOP had a−0.004 dB/year (CI,−0.011 to 0.003; P > 0.05) effect on the MD slope.

In treated patients, failing to achieve target IOP was associated with more rapid VF worsening. Eyes with moderate glaucoma experienced the greatest VF worsening from failing to achieve target IOP.

The proportions of individuals who are underrepresented in medicine (URiM) in ophthalmology lag behind their proportions within the US population. Diversity trends have been studied in other specialties, but literature examining trends in ophthalmology is lacking. In this study, we investigate trends in the racial and ethnic demographics of ophthalmology residents and residency applicants.

Trend study.

Demographic data of all residency programs across all specialties were extracted from Accreditation Council for Graduate Medical Education yearly reports from 2011 to 2019. Data from 2016 to 2019 on ophthalmology match applicants were analyzed using the 2020 Ophthalmology Residency Match Summary Report and the 2020 Association of University Professors of Ophthalmology Residency Gender & Ethnicity Summary. Linear trends were examined by the Cochran-Armitage test.

From 2011 to 2019, the raw percentage of URiM ophthalmology residents increased from 4.7% (66/1419) to 5.8% (85/1473) (P < .001) whereas that of surgical specialties decreased from 9.9% (2164/21,967) to 9.1% (2370/26,082) (P < .001). The percentage of URiM ophthalmology match applicants increased from 5.9% (43/726) of all applicants to 11.8% (87/741) from 2016 to 2019 (P < .001), and the percentage of URiMs matching into ophthalmology increased from 4.9% (23/467) of all participants to 10.8% (52/484) from 2016 to 2019 (P < .001).

Although there has been a positive trend in the percentage of URiMs applying and matching into ophthalmology, a lack of racial and ethnic diversity relative to other specialties persists. Strategies are needed to increase diversity in the field.