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Alexander C Lieu,1,2 Benton G Chuter,1,2 Niloofar Radgoudarzi,1,2 Evan H Walker,2 John H Huang,2 Nathan L Scott,2 Natalie A Afshari2 1School of Medicine, University of California San Diego, La Jolla, CA, USA; 2Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, CA, USACorrespondence: Natalie A Afshari, University of California, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, 9415 Campus Point Drive, La Jolla, San Diego, CA, 92037, USA, Tel +1-858-534-6290, Email naafshari@health.ucsd.eduPurpose: To study geographic patterns of supply and demand for uveal melanoma and other ocular oncology healthcare by ocular oncology physicians in the United States.Methods: Google search interest data was obtained through trends.google.com. The combined-state density of ocular oncology physicians was calculated by dividing the number of practicing ocular oncologists in each state and its surrounding states by the state population. Relative search volume (RSV) values were divided by ocular oncology physician density to calculate the Google relative demand index (gRDI) for each state. Medicare (mRDI) and IRIS® Registry (iRDI) relative demand indices were calculated using prevalence data obtained through the Vision and Eye Health Surveillance System (VEHSS). Data from the US Census Bureau and Centers for Disease Control (CDC) databases were also utilized to analyze associations with poverty rates, percent living in urban or rural areas, vision screening rates, and ocular neoplasm rates.Results: Alabama showed the highest RSV (100), while the lowest was reported in New Mexico (20). Vermont had the highest density of combined-state ocular oncology ophthalmologists (1.85 per 100,000 residents). New Mexico had the lowest RDI (0.013 gRDI, 0.015 mRDI, 0.018 iRDI) with 32 combined-state ocular oncologists and a population of 2,114,371. Ocular neoplasm prevalence rates ranged between 1.32% and 5.40% and significantly correlated with RSV. Single-state gRDI correlated with rural status and negatively correlated with urban areas (≥ 50,000 individuals). Single-state ophthalmologist density correlated positively with percent living in urban areas and vision screening rates, and negatively with rural status.Conclusion: This study uncovered significant heterogeneity in the geographical distribution of ocular oncology physicians and RDI throughout the United States, highlighting potential undersupply scenarios. This may guide efforts to increase ocular oncology physician and surgeon availability in areas of need.Keywords: ocular oncology, google trends, medicare, IRIS® Registry, uveal melanoma

Clinical Relevance: Glaucoma is a complex eye condition with varied morphological and clinical presentations, making diagnosis and management challenging. The lack of a consensus definition for glaucoma or glaucomatous optic neuropathy further complicates the development of universal diagnostic tools. Developing robust artificial intelligence (AI) models for glaucoma screening is essential for early detection and treatment but faces significant obstacles. Effective deep learning algorithms require large, well-curated datasets from diverse patient populations and imaging protocols. However, creating centralized data repositories is hindered by concerns over data sharing, patient privacy, regulatory compliance, and intellectual property. Federated Learning (FL) offers a potential solution by enabling data to remain locally hosted while facilitating distributed model training across multiple sites., Methods: A comprehensive literature review was conducted on the application of Federated Learning in training AI models for glaucoma screening. Publications from 1950 to 2024 were searched using databases such as PubMed and IEEE Xplore with keywords including "glaucoma," "federated learning," "artificial intelligence," "deep learning," "machine learning," "distributed learning," "privacy-preserving," "data sharing," "medical imaging," and "ophthalmology." Articles were included if they discussed the use of FL in glaucoma-related AI tasks or addressed data sharing and privacy challenges in ophthalmic AI development., Results: FL enables collaborative model development without centralizing sensitive patient data, addressing privacy and regulatory concerns. Studies show that FL can improve model performance and generalizability by leveraging diverse datasets while maintaining data security. FL models have achieved comparable or superior accuracy to those trained on centralized data, demonstrating effectiveness in real-world clinical settings., Conclusions: Federated Learning presents a promising strategy to overcome current obstacles in developing AI models for glaucoma screening. By balancing the need for extensive, diverse training data with the imperative to protect patient privacy and comply with regulations, FL facilitates collaborative model training without compromising data security. This approach offers a pathway toward more accurate and generalizable AI solutions for glaucoma detection and management., Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references in the Footnotes and Disclosures at the end of this article., (Copyright © 2024 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To investigate the relationship between public demand for pediatric ophthalmology services and the accessibility of such services on a statewide basis in the United States, focusing on strabismus care., Methods: Using Google Trends data, search volumes for "strabismus" were analyzed from January 2014 to December 2023. Pediatric ophthalmologist availability was assessed via the American Academy of Ophthalmology directory, normalized for state population size to create a relative demand index. Additional metrics from the United States Census Bureau and Centers for Disease Control and Prevention provided socioeconomic and health data. Correlation coefficients were used to explore relationships between search volumes, specialist availability, vision screening, socioeconomics, and demographic factors., Results: The data revealed variability in public interest in pediatric ophthalmology across states, with Alaska showing the highest relative search volume for strabismus. The data also indicated notable disparities in pediatric ophthalmologist density, with North Dakota, Vermont, and Wyoming having no pediatric ophthalmologists. A significant correlation was identified between pediatric ophthalmologist availability and vision screening (R = 0.486, p < 0.001). Negative correlations were observed between the relative demand index and urbanization (R = -0.388, p = 0.007), as well as the strabismus prevalence (R = -0.455, p = 0.001), indicating that urbanization and specialist distribution influence eyecare demand and access., Conclusion: The findings highlight disparities in accessibility and demand for pediatric ophthalmology services across the US, influenced by urbanization and distribution of healthcare professionals. The study underscores the need for targeted interventions to improve access to care and bridge gaps in pediatric ophthalmology service provision.

Purpose of Review: We summarize evidence-based considerations regarding the use of intracameral antibiotics during cataract surgery., Recent Findings: The use of intraoperative intracameral antibiotics reduced the incidence of postcataract surgery endophthalmitis 3.5-fold, with an odds ratio ranging from 0.14 to 0.19. A survey of the American Society of Cataract and Refractive Surgery showed usage of intracameral injections of antibiotics increased by 16% in the United States between 2014 and 2021. The frequency of vancomycin usage has sharply dropped to 6%, while moxifloxacin is now the dominant choice at 83% among respondents. One analysis showed that 2500 patients need to be treated with intracameral antibiotics to prevent one case of endophthalmitis. A 500 μg intracameral moxifloxacin at $22 dollars per dose is cost-effective, including for patients with posterior capsular rupture (PCR)., Summary: Studies substantiate the safety and efficacy of intracameral antibiotics for endophthalmitis prophylaxis. Intracameral moxifloxacin and cefuroxime are the most common choices. While vancomycin shows potential for efficacy, further studies evaluating clinical outcomes are needed. Adverse events are rare and commonly due to errors in preparation. Topical antibiotics do not provide additional prophylactic benefits to intracameral regimens. Intracameral antibiotics given alone are cost-effective., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)