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Objective: To determine the rate of Medicare opt-out among optometrists and ophthalmologists and to contrast the differences in the characteristics and geographic distribution of these populations., Design: A retrospective cross-sectional study., Setting: Using a publicly available Centers for Medicare & Medicaid Services (CMS) data set, we collated data for ophthalmologists and optometrists who opted out in each year between 2005 and 2023. We calculated the rate of opt-out annually in each year window and cumulatively from 2005 to 2023. Comparative analysis was used to identify clinician characteristics associated with opt-out., Main Outcomes and Measures: Both annual and cumulative rate of ophthalmologist and optometrist opt-out from Medicare., Results: The estimated prevalence of Medicare opt-outs was 0.52% (77/14,807) for ophthalmologists and 0.38% (154/40,526) for optometrists. Ophthalmologists opting out were predominantly male (67.5%), had a longer practice duration (average 31.8 years), and were more often located in urban areas (83.1%), compared to optometrists (53.2% male, average 19.6 years in practice, 59.1% in urban areas, p = 0.04, p<0.001, p<0.001 respectively). Approximately 83% of ophthalmologists were either anterior segment or oculoplastics specialties, while the majority (52.1%) of optometrists were in optometry-only practices; >75% of identified clinicians were in private practice. Geographical distribution across the US showed variable opt-out rates, with the top 3 states including Oklahoma (3.4%), Arizona (2.1%), and Kansas (1.6%) for ophthalmology and Idaho (4.3%), Montana (3.1%), and Wyoming (1.4%) for optometry., Conclusions and Relevance: Few ophthalmologists and optometrists opt-out of Medicare but this trend has significantly increased since 2012. Of those who disenrolled from Medicare, 83% of ophthalmologists were in urbanized areas while 41% of optometrists were in non-urbanized areas. Because reasons for Medicare opt-out cannot be solely determined by administrative data, further investigation is warranted given the potential impact on healthcare accessibility., Competing Interests: We have read the journal’s policy regarding competing interests and the authors of the manuscript have no financial support for this work that could have influenced its outcome. The following general competing interests are as follows: Michael Maywood: none Harris Ahmed none Ravi Parikh: Financial disclosures: Consultant fees from GLG, Health and Wellness Partners, Axon Advisors LLV; Funding from AAO for AAO-related work with Relative Value Update Committee Tedi Begaj: Financial disclosures: Consultant fees from Regenxbio, Eyepoint, (Copyright: © 2024 Maywood et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Most cases of optic neuritis (ON) occur in women and in patients between the ages of 15 and 45 years, which represents a key demographic of individuals who seek health information using the internet. As clinical providers strive to ensure patients have accessible information to understand their condition, assessing the standard of online resources is essential. To assess the quality, content, accountability, and readability of online information for optic neuritis. This cross-sectional study analyzed 11 freely available medical sites with information on optic neuritis and used PubMed as a gold standard for comparison. Twelve questions were composed to include the information most relevant to patients, and each website was independently examined by four neuro-ophthalmologists. Readability was analyzed using an online readability tool. Journal of the American Medical Association (JAMA) benchmarks, four criteria designed to assess the quality of health information further were used to evaluate the accountability of each website. Freely available online information. On average, websites scored 27.98 (SD ± 9.93, 95% CI 24.96-31.00) of 48 potential points (58.3%) for the twelve questions. There were significant differences in the comprehensiveness and accuracy of content across websites ( p  < .001). The mean reading grade level of websites was 11.90 (SD ± 2.52, 95% CI 8.83-15.25). Zero websites achieved all four JAMA benchmarks. Interobserver reliability was robust between three of four neuro-ophthalmologist (NO) reviewers (ρ = 0.77 between NO3 and NO2, ρ = 0.91 between NO3 and NO1, ρ = 0.74 between NO2 and NO1; all p  < .05). The quality of freely available online information detailing optic neuritis varies by source, with significant room for improvement. The material presented is difficult to interpret and exceeds the recommended reading level for health information. Most websites reviewed did not provide comprehensive information regarding non-therapeutic aspects of the disease. Ophthalmology organizations should be encouraged to create content that is more accessible to the general public., Competing Interests: No potential conflict of interest was reported by the author(s) except for the following: Professor Mollan reports consultancy fees (Invex 555 Therapeutics); advisory board fees (Invex therapeutics;Gensight) and speaker fees (Heidelberg engineering; Chugai-Roche Ltd; Allergan; Santen; Chiesi; and Santhera), all outside the submitted work., (© 2024 Taylor & Francis Group, LLC.)

Purpose: To evaluate the demographic, educational, and scholarly characteristics of Association of University Professors of Ophthalmology-accredited vitreoretinal surgery fellowship program directors in the United States and Canada. Methods: Demographic, educational, and scholarly profiles of identified program directors were collated from online public resources. Characteristics were compared by sex, program size, ranking, and affiliation. Results: Eighty-one program directors (mean age [±SD] 54.7 ± 11.0 years) from 78 fellowship programs were identified. The minority were women (14.8%), who were on average 6 years younger than their male counterparts ( P  = .07). The majority of program directors had an academic affiliation (90.1%), most commonly professor (54.8%). The mean h-index, 5-year h-index, and m-quotient were 20.9 ± 14.9, 5.9 ± 4.4, and 0.82 ± 0.42, respectively. Compared with their counterparts, program directors of both "top 10" and large programs published more manuscripts ( P  < .05), accrued more citations ( P  < .05), and had a higher h-index ( P  < .05). Fellowship programs with female program directors had a significantly larger proportion of female retina faculty ( P  = .002). Conclusions: The backgrounds of vitreoretinal surgery program directors are diverse. However, women remain underrepresented in this position, highlighting an area with the potential for greater equity in ophthalmology., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Purpose: To examine trends in ophthalmic trauma secondary to five major sports (baseball, soccer, tennis, football, basketball) and identify differences between patient characteristics and time period (pre-COVID vs COVID) of injury., Methods: The National Electronic Injury Surveillance System was queried to extract cases related to the sports of interest from 2011-2020. Entries were analyzed by age, sex, diagnosis, location, and disposition, with narrative descriptions assessed to characterize the mechanism of injury and visual sequelae. National incidence was extrapolated and Pearson's ?2 and Fisher's exact tests were performed., Results: Among 98,995 presentations, most involved male (83.5%) and pediatric patients (59.2%). Contusion/abrasion (57.3%) was the predominant diagnosis, with injuries primarily precipitated by contact with a ball (44.9%) and occurring in the recreational setting (49.0%). Visual sequelae were documented in 6.4% of injuries. Patients were commonly treated/examined and released (95.6%). Between sports, significant differences in diagnosis (p < .001), mechanism of injury (p < .001), location (p < .001), visual sequelae (p < .001), and disposition (p = .005) were observed. Stratification by age indicated significant differences in diagnosis, mechanism of injury, and location (all p < .001). Stratification by sex indicated significant differences in the mechanism of injury (p < .001) and visual sequelae (p = .04). Stratification by time period indicated significant differences in diagnosis (p = .002) and mechanism of injury (p = .001)., Conclusion: There are notable differences in sports-related ocular injuries by patient characteristic, revealing important considerations for their clinical evaluation and the development of safety guidelines.

Purpose: This study aimed to investigate the potential link between methamphetamine use and infectious syphilitic uveitis through a retrospective chart review of four patients with both conditions., Methods: A retrospective chart review was conducted on four patients with a prior history of methamphetamine use and presented with vision loss at an emergency room or clinic that was ultimately diagnosed as syphilitic uveitis., Results: The average age of the four patients was 41.5 ± 9.8 years old, and each presented with symptoms of blurry vision after an average of 3 weeks. Clinical and serologic examinations revealed variable severity of syphilitic uveitis in each patient, and a confirmed history of methamphetamine use was found on a review of social history. Each patient had worsening visual outcomes after the initial presentation and diagnosis., Conclusion: Syphilitic uveitis is a challenging diagnosis due to its similarity with other ocular pathologies. This case series highlights the importance of maintaining a high level of suspicion for syphilis in patients with a history of methamphetamine use and uveitis to enable rapid treatment and prevent visual decline. The poor visual outcomes observed in these four patients underscore the significance of identifying and treating syphilitic uveitis promptly in this population and the barriers to treatment completion., Competing Interests: No author has conflicts or potential conflicts of interest.

Purpose: Physician turnover is costly to health care systems and affects patient experience due to discontinuity of care. This study aimed to assess the frequency of turnover by ophthalmologists and identify physician and practice characteristics associated with turnover., Design: Retrospective cross-sectional study., Participants: Actively practicing United States ophthalmologists included in the Centers for Medicare and Medicaid Services Physician Compare and Physician and Other Supplier Public Use File between 2014 and 2021., Methods: We collected data for each ophthalmologist that was associated with practice/institution and then calculated the rate of turnover both annually in each year window and cumulatively as the total proportion from 2014 to 2021. Multivariable logistic regression analysis was used to identify physician and practice characteristics associated with turnover. We also evaluated turnover characteristics surrounding the Coronavirus disease 2019 (COVID-19) pandemic., Main Outcome Measures: Ophthalmologist turnover, defined as a change of an ophthalmologist's National Provider Identifier practice affiliation from one year to the next., Results: Of 13 264 ophthalmologists affiliated with 3306 unique practices, 34.1% separated from at least 1 practice between 2014 and 2021. Annual turnover ranged from 3.7% (2017) to 19.4% (2018), with an average rate of 9.4%. Factors associated with increased turnover included solo practice (adjusted odds ratio [aOR], 9.59), university affiliation (aOR, 1.55), practice location in the Northeast (aOR, 1.39), and practice size of 2 to 4 members (aOR, 1.21; P < 0.05 for all). Factors associated with decreased turnover included male gender (aOR, 0.87) and more than 5 years of practice: 6 to 10 years (aOR, 0.63), 11 to 19 years (aOR, 0.54), 20 to 29 years (aOR, 0.36), and ≥ 30 years (aOR, 0.18; P < 0.05 for all). In the initial year (2020) of the COVID-19 pandemic, annual turnover increased from 7.8% to 11.0%, then decreased to 8.7% in the postvaccine period (2021)., Conclusions: One-third of United States ophthalmologists separated from at least 1 practice from 2014 through 2021. Turnover patterns differed by various physician and practice characteristics, which may be used to develop future strategies for workforce stability. Because administrative data cannot solely determine reasons for turnover, further investigation is warranted given the potential clinical and financial implications., Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article., (Copyright © 2023 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Objective/background: To compare the effectiveness of intravitreal injection of triamcinolone acetonide/moxifloxacin (Tri-Moxi) with the standard eye drop regimen for controlling postoperative inflammation, intraocular pressure, infections, macular thickness, and visual acuity (VA) in patients undergoing pars plana vitrectomy for various retinal disorders., Subject/methods: In this retrospective longitudinal study, patients who underwent vitrectomy using intravitreal Tri-Moxi at the end of surgery (Group 1) were compared with those who received standard topical steroid antibiotics (Group 2) in terms of intraocular inflammation, intraocular pressure, macular thickness based on optical coherence tomography, and visual acuity., Results: In total, 162 consecutive eyes (group 1 [81 eyes]; group 2 [82 eyes]) were included. VA improved by two lines in both groups at 90 days. In Group 1, preoperative VA (logMAR) was 0.92 (0.66) compared to 0.92 (0.75) in Group 2 (p = 1), while at 3 months, it was 0.61 (0.3) and 0.57 (0.3), respectively (p = 0.46). Group 1 showed superior outcomes concerning central foveal thickness. The average central foveal thickness CFT (µm) in group 2 preoperatively was 423 (95) and 348 (63) at 3 months compared to group 1 526 (109) and 306 (108) preoperatively and 3 months, respectively (p = 0.042). There was no statistically significant difference in the rate of elevated intraocular pressure between the two groups or anterior chamber cell reaction severity, and no cases of endophthalmitis were observed in either group., Conclusions: Tri-Moxi is effective after vitrectomy and is not inferior to standard postoperative topical therapy., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Chalam and Ahmed.)

Objective: To describe the relationship between history of atopic disease on systemic and ocular manifestations of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN)., Methods: Retrospective chart review of patients with SJS/TEN patients. Those with and without prior atopic diagnosis were compared., Results: In total, 200 patients with SJS/TEN were identified. A total of 23 patients also had an atopic diagnosis. Four, 10, and 18 had atopic dermatitis, allergic rhinitis, and asthma respectively. Acute ocular severity was significantly worse in the atopic cohort. No significant differences in overall systemic severity of SJS or mortality were found between the atopic and non-atopic cohorts. Compared to our hospital system's general population, prevalence of an atopic diagnosis was significantly higher in those with SJS/TEN., Conclusion: Patients with a history of an atopic diagnosis appear to have more significant acute ocular involvement during their SJS/TEN hospitalization. Atopic conditions appear to occur more frequently in the SJS/TEN population compared to the general population.

Objective To evaluate the quality and readability of online health content regarding the ocular health effects of blue light. Methods Five commercial and five non-commercial websites with content regarding the ocular effect of blue light were examined. Quality evaluations were conducted using a 14-question assessment composed by the authors and the 16-question DISCERN instrument. Website accountability was evaluated via the Journal of the American Medical Association (JAMA) benchmarks. Readability was determined using an online tool (Readable). Correlational and comparative analyses were conducted where appropriate. Results The average questionnaire score was 84 (standard deviation [SD] ± 17.89, 95% confidence interval [CI] 77.32-90.68) out of 136 points (61.8%). Significant differences in quality were identified between websites (p = 0.02), with Healthline achieving the highest score. Compared to commercial websites, non-commercial websites trended toward having significantly higher median questionnaire scores (p = 0.06). Zero websites achieved all four JAMA benchmarks. The average reading grade level of content was 10.43 (SD ± 1.15, 95% CI 9.60 - 11.25), with differences between websites trending toward significance (p = 0.09). There was no correlation between resource readability and quality (ρ = 0.28; p = 0.43) or accountability (ρ = 0.47; p = 0.17). Conclusions There remain substantial deficiencies in the quality, accountability, and readability of online content concerning the effect of blue light on ocular health. Clinicians and patients must recognize such issues when recommending and consuming these resources., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Patel et al.)

There is limited literature on the characteristics of pediatric ophthalmology leadership. The authors examined the demographics, academic backgrounds, and scholarly output of pediatric ophthalmology fellowship program directors. Despite a positive trend in gender equity in this position, efforts remain to resolve the "leaky pipeline" of women into ophthalmology leadership. [ J Pediatr Ophthalmol Strabismus . 2022;59(6):e69-e72.] .

Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss in the elderly population. AMD is characterized in its late form by neovascularization (wet type) or geographic atrophy of the retinal pigment epithelium cell layer (dry type). Regarding the latter type, there is growing evidence supporting an association between the pathophysiology of dry AMD and key proteins in the complement cascade. The complement cascade works as a central part of the innate immune system by defending against foreign pathogens and modified self-tissues. Through three distinct pathways, a series of plasma and membrane-associated serum proteins are activated upon identification of a foreign entity. Several of these proteins have been implicated in the development and progression of dry AMD. Potential therapeutic targets include C1q, C3, C5, complement factors (B, D, H, I), membrane attack complex, and properdin. In this review, we provide an understanding of the role of the complement system in dry AMD and discuss the emerging therapies in early phase clinical trials. The tentative hope is that these drugs may offer the potential to intervene at earlier stages in dry AMD pathogenesis, thereby preventing progression to late disease.

Purpose This study aims to examine the demographic features, academic backgrounds, and scholarly achievements of ophthalmic plastic and reconstructive surgery (OPRS) fellowship program directors (PDs) in the United States. Methods In this cross-sectional analysis, publicly accessible sources were accessed in March 2022 to collate the demographic and academic profiles of PDs of American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS)-accredited OPRS fellowships. Differences by gender and program rank were assessed using the Mann-Whitney Utest. Results Fifty-four PDs were identified, the majority of whom were males (88.89% (n = 48)). The average age was 58.48 years. Of the PDs, 96.3% (n = 53) obtained a medical degree, and all completed residency training in the United States. In addition, 9.26% (n = 5) had another degree, either a Doctor of Philosophy (n = 3) or master's degree (n = 2). A substantial proportion of individuals completed medical school (20.37% (n = 11)), residency (20.37% (n = 11)), or fellowship (31.48% (n = 17)) at an institution affiliated with the program where they were PDs. The most common additional fellowship obtained was neuro-ophthalmology (16.67% (n = 9)). The average h-index was 19.30 (range, 0-60), average five-year h-index was 4.85 (range, 0-36), and average m-quotient was 0.63 (range, 0-2.22). A significant difference in the median five-year h-index was observed between females and males (7 (range, 3-36) versus 4 (range, 0-10); p= 0.038). Conclusions This analysis indicated that OPRS PDs in the United States were principally males with extensive scholarly productivity. As women remain underrepresented in OPRS, increased gender parity at this leadership position should be encouraged in order to expand the recruitment of women into the field., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Patel et al.)

Purpose: To describe the magnitude, party affiliation, temporal trend, and geographic distribution of political contributions made by ophthalmologists in the United States., Methods: This cross-sectional study used public finance data from the Federal Election Commission website to identify political donations from ophthalmologists between 2003-2019. Contributions were filtered for occupation lines matching either "ophthalmologist," or "eye surgeon," and each contribution was cross-referenced to catalogue donations as "Republican," "Democratic," or "Independent.", Results: From 2003-2019, a total of 31,855 political donations were made by self-identified ophthalmologists, totaling $11,603,672. Of all dollars, 10.7%, 19.5%, and 69.8% went to Democratic, Republican, and Independent committees, respectively. Political contributions directed towards the American Academy of Ophthalmology Political Action Committee (OPHTHPAC) constituted the majority (59.8%) of overall contributions. From 2003 to 2019, the total number of unique contributions increased significantly from 1135 to 3208 (? = 0.63; P < .01). In dollars, this translated to an increase from $482,300 donated in 2003 to $640,695 donated in 2019, although this trend was non-significant (? = 0.18; P = .48). Conversely, the average amount of each contribution significantly declined from $425 to $203 (? = -0.35; P < .001). As expected, larger states such as California, Texas, Florida, Illinois, Michigan, and New York had the highest contribution dollars, in that order., Conclusions: Political contributions from ophthalmologists have significantly risen since 2003, however there remain opportunities for growth in engagement with OPHTHPAC. Future analysis of how this involvement translates to representative health policy is warranted.

Context: While 90% of former American Osteopathic Association (AOA) residency programs transitioned to Accreditation Council for Graduate Medical Education (ACGME) accreditation, surgical subspecialty programs such as ear, nose, and throat (ENT, 62%) and ophthalmology (47%) struggled to gain accreditation. Doctors of Osteopathic Medicine (DOs) actively participate in serving underserved communities, and the loss of AOA surgical specialty programs may decrease access to surgical care in rural and nonmetropolitan areas., Objectives: To determine the challenges faced by former AOA-accredited surgical subspecialty programs during the transition to ACGME accreditation, particularly ENT and ophthalmology programs in underresourced settings., Methods: A directory of former AOA ENT and Ophthalmology programs was obtained from the American Osteopathic Colleges of Ophthalmology and Otolaryngology-Head and Neck Surgery (AOCOO-HNS). A secured survey was sent out to 16 eligible ENT and ophthalmology program directors (PDs). The survey contained both quantitative and qualitative aspects to help assess why these programs did not pursue or failed to receive ACGME accreditation., Results: Twelve of 16 eligible programs responded, com-prising six ophthalmology and six ENT PDs. Among the respondents, 83% did not pursue accreditation (6 ophthalmology and 4 ENT programs), and 17% were unsuccessful in achieving accreditation despite pursuing accreditation (2 ENT programs). Across 12 respondents, 7 (58%) cited a lack of hospital/administrative support and 5 (42%) cited excessive costs and lack of faculty support as reasons for not pursuing or obtaining ACGME accreditation., Conclusions: The survey results reflect financial issues associated with rural hospitals. A lack of hospital/administrative support and excessive costs to transition to the ACGME were key drivers in closures of AOA surgical specialty programs. In light of these results, we have four recommendations for various stakeholders, including PDs, Designated Institutional Officials, hospital Chief Medical Officers, and health policy experts. These recommendations include expanding Teaching Health Center Graduate Medical Education to surgical subspecialties, identifying and learning from surgical fields such as urology that fared well during the transition to ACGME, addressing the lack of institutional commitment and the prohibitive costs of maintaining ACGME-accredited subspecialty programs in underresourced settings, and reconsidering the Centers for Medicare & Medicaid Services (CMS) pool approach to physician reimbursement., (© 2021 Harris Ahmed et al., published by De Gruyter, Berlin/Boston.)

Background Medical students are applying to dramatically more ophthalmology residency programs than in the past, causing an increased administrative burden for programs and financial harm to students. This study considers the background of this situation and looks at how a lack of transparency surrounding potential residency match filters contributes. Furthermore, this study raises several potential solutions to this lack of transparency that may increase the functionality of the ophthalmology residency match. Objective The purpose of this study was to determine the availability and consistency of potential ophthalmology residency match filters through training program websites and the American Medical Association's (AMA) Residency & Fellowship Database (FREIDA). Methods This study was a cross-sectional observational study of ophthalmology residency program websites and AMA's FREIDA database entries. For 119 ophthalmology residency programs, five potential filters were evaluated for both availability and consistency on individual residency websites and FREIDA. These filters were: (1) whether a program required a minimum United States Medical Licensing Examination (USMLE) Step 1 score; (2) minimum number of letters of recommendation required; 3) whether a minimum USMLE Step 2 score was required; (4) if the program accepts the Comprehensive Osteopathic Medical Licensing Examination (COMLEX) sequence in lieu of the USMLE; and (5) ability of the residency to sponsor a visa (J-1, H-1B, or F-1). Each program's website and FREIDA entry were independently evaluated by two authors to increase validity, with a third author brought in to break the tie in case of a disagreement. Results Only two ophthalmology residency programs had information about all five filters both available and consistent on their website and FREIDA. Inter-reviewer reliability was 92.5%. Conclusions Information about potential filters used in the ophthalmology residency match is neither publicly available nor consistent. This lack of transparency may contribute to the phenomenon of medical students applying to dramatically more ophthalmology residency programs. A standardized database of these filters is needed to increase transparency to applicants, which may reduce the expenses of medical students and the workload of program directors., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Markle et al.)

Among many other things, the novel coronavirus pandemic of 2020 highlighted the significance of physician shortages in the United States. Current projections anticipate a national shortage of up to 122,000 physicians by 2032, with shortfalls in both primary care physicians and specialists. Yet while this figure highlights the magnitude of the problem, it does not capture the distributional aspect of American physician shortages. Though some specialties and geographic areas have a surplus of physicians, others have a chronic undersupply. Appropriately addressing the looming physician shortage therefore requires not only creating more physicians, but also ensuring that those physicians practice in the areas of greatest societal need. This review explores the nature of physician shortages in the United States, identifies the present bottleneck in physician training at the level of graduate medical education, and considers potential legislative and policy solutions to allow strategic and deliberate expansion of graduate medical education and physician practice., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Ahmed et al.)

Context: While existing data demonstrate that osteopathic physicians (ie, DOs) in primary care are more likely than allopathic physicians (ie, MDs) to practice in rural areas, no data exist on practice patterns of DO surgical subspecialists, such as ophthalmologists. Michigan has a relatively high number of DOs and, formerly, the most osteopathic ophthalmology residency programs in the United States. Analyzing the distribution of ophthalmologists in Michigan may reveal patterns and predict trends about the geographic distribution of DO surgical subspecialists across the country., Objective: To compare geographic distributions of DO and MD ophthalmologists in Michigan and identify differences in community size and type (eg, urbanized area, urban cluster, or rural area) of practice., Methods: A list of Michigan's ophthalmologists practicing in 2018 was developed using the Centers for Medicare and Medicaid Services, the American Osteopathic College of Ophthalmology, and the American Medical Association data sets. DOs and MDs were then analyzed by determining where each ophthalmologist practiced, identifying the size and type of community in which they practiced, and finally by comparing the percentage of DOs and MDs who practiced in various community sizes and each community type as defined by the US Census Bureau. A χ2 analysis was used to determine whether a difference existed in practice locations., Results: A total of 643 ophthalmologists practiced in Michigan in 2018, including 85 DOs and 558 MDs. A greater proportion of DOs worked in rural areas and urban clusters (57 [67%]), whereas a greater proportion of MDs worked in urbanized areas (368 [66%]). Of DOs, 28 (33%) practiced in cities with a population of at least 50,000 vs 371 MDs (66%). Fourteen DOs (16%) practiced in communities with a population of at least 100,000 vs 207 MDs (37%). χ2 analysis showed a significant difference in the geographic distribution of ophthalmologist DOs and MDs (P<.01)., Conclusion: Higher proportions of DOs practice ophthalmology in smaller, more rural Michigan communities compared with MDs, implying that a subgroup exists that tends to serve underserved areas.

Acinetobacter baumannii has become a leading cause of bloodstream infections (BSI) in health care settings. Although the incidence of infection with carbapenem- and ampicillin-sulbactam-resistant (CASR) A. baumannii has increased, there is a scarcity of studies which investigate BSI caused by CASR A. baumannii. A retrospective cohort study was conducted on adult patients with BSI caused by A. baumannii and who were admitted to the Detroit Medical Center between January 2006 and April 2009. Medical records were queried for patients' demographics, antimicrobial exposures, comorbidities, hospital stay, and clinical outcomes. Bivariate analyses and logistic regression were employed in the study. Two hundred seventy-four patients with BSI caused by A. baumannii were included in the study: 68 (25%) caused by CASR A. baumannii and 206 (75%) caused by non-CASR A. baumannii. In multivariate analysis, factors associated with BSI caused by CASR A. baumannii included admission with a rapidly fatal condition (odds ratio [OR] = 2.83, 95% confidence interval [CI] = 1.27 to 6.32, P value = 0.01) and prior use of antimicrobials (OR = 2.83, 95% CI = 1.18 to 6.78, P value = 0.02). In-hospital mortality rates for BSI caused by CASR A. baumannii were significantly higher than those for non-CASR A. baumannii-induced BSI (43% versus 20%; OR = 3.0, 95% CI = 1.60 to 5.23, P value < 0.001). However, after adjusting for potential confounders, the association between BSI caused by CASR A. baumannii and increased risk of in-hospital mortality was not significant (OR = 1.15, 95% CI = 0.51 to 2.63, P value = 0.74). This study demonstrated that CASR A. baumannii had a distinct epidemiology compared to more susceptible A. baumannii strains; however, clinical outcomes were similar for the two groups. Admission with a rapidly fatal condition was an independent predictor for both CASR A. baumannii and in-hospital mortality.