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Ophthalmology Sep 2023To quantify trends in ophthalmology practice consolidation in the United States.
PURPOSE
To quantify trends in ophthalmology practice consolidation in the United States.
DESIGN
A retrospective cross-sectional study.
PARTICIPANTS
Providers in the Centers for Medicare and Medicaid Services (CMS) National Downloadable File with a primary specialty designation of ophthalmology.
METHODS
We used the CMS database to determine national practice consolidation trends in ophthalmology on individual physician and group practice levels and analyzed by region, sex, and years spent in practice. We used the Cochran-Armitage test to determine the statistical significance of practice size differences between 2015 and 2022.
MAIN OUTCOME MEASURES
Temporal practice size trends for physicians and practices in ophthalmology and regional, sex-specific, and age-related trends.
RESULTS
Between 2015 and 2022, the number of ophthalmologists decreased from 17 656 to 17 615 (-0.2%), whereas the number of practices decreased from 7149 to 5890 (-18%). The percentage of ophthalmologists in practices of 1 to 2 members decreased from 35% to 28%, whereas those in groups of 50 or more increased from 7% to 11%. The percentage of practices with 1 to 2 members decreased from 75% to 71%, and those with 50 or more increased from 0.2% to 0.4%. Consolidation trends were significant on individual ophthalmologist (P < 0.001) and group practice (P < 0.001) levels. All regions, sexes, and subgroups of years spent in practice demonstrated consolidation (P < 0.001). The Northeast showed the greatest increase in groups of 50 or more physicians (+7%) between 2015 and 2022. Proportionally fewer female than male ophthalmologists were associated with practice sizes of 1 to 2 members in 2015 (29% and 36%, respectively) and 2022 (23% and 30%, respectively). Proportionally fewer ophthalmologists with 0 to 10 years of experience in practice were associated with practice sizes of 1 to 2 members than those with more than 30 years in practice in 2015 (18% and 48%, respectively) and 2022 (14% and 40%, respectively).
CONCLUSIONS
Ophthalmology has undergone practice consolidation from 2015 to 2022. A decrease in the proportion of physicians affiliated with smaller practice sizes seems to have occurred.
FINANCIAL DISCLOSURE(S)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Topics: Aged; Humans; Male; Female; United States; Ophthalmology; Retrospective Studies; Cross-Sectional Studies; Medicare; Ophthalmologists
PubMed: 37169261
DOI: 10.1016/j.ophtha.2023.05.006 -
Journal Francais D'ophtalmologie Feb 2023The current monkeypox virus (MPXV) outbreak, raging since May 2022, is the largest ever observed on a world-wide scale. Despite previously being endemic in west and... (Review)
Review
The current monkeypox virus (MPXV) outbreak, raging since May 2022, is the largest ever observed on a world-wide scale. Despite previously being endemic in west and central Africa with a mortality rate of up to 10%, it remained a neglected tropical disease. Along with other recent pandemics gaining much attention, this MPXV outbreak has provided an opportunity to improve our understanding of its physiopathology and better define management strategies, particularly in patients with more serious disease. From the ophthalmologist's perspective, eyelid involvement and conjunctivitis or keratoconjunctivitis are frequently observed and may precede systemic signs or even remain the major site of involvement. While the course of MPXV keratoconjunctivitis is most often favorable, severe cases pose a functional threat, in particular for immunocompromised patients. This review provides an overview of MPXV pathophysiology, diagnosis and treatment, as well as considerations for prevention of transmission. During such an epidemic, the ophthalmologist can be the first to diagnose MPXV, treat the ocular involvement, and set up adequate preventative measures in collaboration with infectious disease specialists.
Topics: Humans; Mpox (monkeypox); Ophthalmologists; Monkeypox virus
PubMed: 36639339
DOI: 10.1016/j.jfo.2022.11.002 -
Indian Journal of Ophthalmology Aug 2020The aim of this review article is to summarize the available literature on physiologic and pathologic ocular changes during pregnancy and the effect of diseases in... (Review)
Review
The aim of this review article is to summarize the available literature on physiologic and pathologic ocular changes during pregnancy and the effect of diseases in pregnancy. A literature search was conducted using PUBMED, MEDLINE, and Cochrane library in English. In addition, the cited references in the published articles were manually reviewed for the relevant results. Pregnancy encompasses a multitude of changes in all body systems, including the visual system of the female. The changes can be physiological, i.e., changes occurring in the lids and adnexa, cornea, conjunctiva, changes in tear film composition and intraocular pressure, retina, choroid, and visual field. Pathological changes in a pregnant woman's eye include changes related to preeclampsia and eclampsia, central serous chorioretinopathy, retinal artery or vein occlusions, and disseminated intravascular coagulation. Preexisting diseases like diabetic retinopathy, Graves' disease, idiopathic intracranial hypertension, various inflammatory conditions can undergo changes in their course during pregnancy. Ophthalmic medications can have an effect on both mother and the baby and hence should be used cautiously. In addition, intrauterine infections play a major role in causing inflammation in the eye of the baby. Hence, vaccination of the mother prior to pregnancy plays an important role in preventing intrauterine infections in the neonate. A regular eye examination in the perinatal period plays a vital role in recognizing ophthalmic pathologies which might require a prompt medical intervention. Pathological ocular diseases should be discriminated from physiologic changes to establish an individualized treatment or preventive plan. This approach to ocular benefits of treatment to the mother should always weigh against the potential harm to the fetus.
Topics: Eye Diseases; Female; Humans; Infant, Newborn; Intraocular Pressure; Ophthalmologists; Pregnancy; Pregnancy Complications; Visual Fields
PubMed: 32709768
DOI: 10.4103/ijo.IJO_2033_19 -
La Revue de Medecine Interne Mar 2023Sarcoidosis is one of the leading causes of inflammatory eye disease. All ocular structures can be affected, but uveitis is the main manifestation responsible for vision... (Review)
Review
Sarcoidosis is one of the leading causes of inflammatory eye disease. All ocular structures can be affected, but uveitis is the main manifestation responsible for vision loss in ocular sarcoidosis. Typical sarcoid anterior uveitis presents with mutton-fat keratic precipitates, iris nodules, and posterior synechiae. Posterior involvement includes vitritis, vasculitis, and choroidal lesions. Cystoid macular edema is the most important and sight-threatening consequence of sarcoid uveitis. Patients with clinically isolated uveitis at diagnosis rarely develop other organ involvement. Even though, ocular sarcoidosis can have a severe impact on visual prognosis, early diagnosis and a wider range of available therapies (including intravitreal implants) have lessened the functional impact of the disease, particularly in the last decade. Corticosteroids are the cornerstone of treatment for sarcoidosis, but up to 30% of patients achieve remission with requiring high-dose systemic steroids. In these cases, the use of steroid-sparing immunosuppressive therapy (such as methotrexate) is unavoidable. Among these immunosuppressive treatments, anti TNF-α drugs have been a revolution in the management of non-infectious uveitis.
Topics: Humans; Ophthalmologists; Tumor Necrosis Factor Inhibitors; Uveitis; Immunosuppressive Agents; Vision Disorders; Sarcoidosis
PubMed: 36642624
DOI: 10.1016/j.revmed.2022.10.001 -
Indian Journal of Ophthalmology Sep 2018
Topics: Burnout, Professional; Humans; Ophthalmologists; Ophthalmology; Surveys and Questionnaires
PubMed: 30127181
DOI: 10.4103/ijo.IJO_979_18 -
Archivos de La Sociedad Espanola de... Jun 2015
Topics: Attitude of Health Personnel; Electronic Health Records; Forecasting; Humans; Ophthalmologists; Ophthalmology; Patients; Physical Examination; Physician-Patient Relations; Telemedicine
PubMed: 25843696
DOI: 10.1016/j.oftal.2015.03.005 -
Journal of Pediatric Ophthalmology and... 2022To quantify the accessibility of eye care providers from photoscreening centers within the vision screening region in relation to population density and median household...
PURPOSE
To quantify the accessibility of eye care providers from photoscreening centers within the vision screening region in relation to population density and median household income.
METHODS
Driving times between vision screening locations and eye care centers were mapped and analyzed using OpenStreetMap software (Open Street Map Foundation). U.S. Census Bureau data of population density and median household income were linked with screening centers using ArcGIS Online (Esri) to determine correlations with driving times.
RESULTS
A total of 290 driving times for 145 photo-screening centers, 147 optometrists, and 7 pediatric ophthalmologists were calculated and mapped. Median driving times from a photoscreening center to the nearest optometrist and ophthalmologist were 4.74 and 25.10 minutes, respectively, with 90% of the screening centers residing within 12.46 and 67.19 minutes of the nearest optometrist and ophthalmologist, respectively. Driving times to optometrists are far less than times to pediatric ophthalmologists due to the greater number of optometrists. Decreasing driving times with increasing population and median household income indicate the concentration of optometrists and pediatric ophthalmologists within urbanized areas.
CONCLUSIONS
Most photoscreening centers reside within 5 and 70 minutes of the nearest optometrist and pediatric ophthalmologist, respectively. Driving times indicate the region's greater accessibility to optometrists than to pediatric ophthalmologists. Eye care centers tend to be localized within urbanized areas with higher population densities and higher median household incomes. .
Topics: Humans; Child; Vision Screening; Health Services Accessibility; Optometrists; Ophthalmologists; Optometry
PubMed: 35275779
DOI: 10.3928/01913913-20220210-04 -
Die Ophthalmologie Sep 2023Leadership in healthcare institutions has a direct impact on the practice of the medical and nursing professions. The respective leadership style that is cultivated in... (Review)
Review
Leadership in healthcare institutions has a direct impact on the practice of the medical and nursing professions. The respective leadership style that is cultivated in a medical institution therefore has a direct impact on the personnel and thus a direct impact on the treatment of patients, in both senses of the word. Leadership in healthcare should therefore inspire, motivate, and guide healthcare workers to use their individual and collective skills as well as the available resources in the best possible way for the benefit of patients. This is the task and obligation of all those working in the healthcare system. The German Society of Ophthalmology (DOG) has established a leadership academy for ophthalmologists to meet the requirements of the modern healthcare market for leadership qualifications.
Topics: Humans; Leadership; Ophthalmology; Health Personnel; Delivery of Health Care; Ophthalmologists
PubMed: 37582889
DOI: 10.1007/s00347-023-01909-2 -
Seminars in Ophthalmology 2019New diagnostic and imaging techniques generate such an incredible amount of data that it is often a challenge to extract all information that could be possibly useful in... (Review)
Review
New diagnostic and imaging techniques generate such an incredible amount of data that it is often a challenge to extract all information that could be possibly useful in clinical practice. Machine Learning techniques emerged as an objective tool to assist practitioners to diagnose certain conditions and take clinical decisions. In particular, Machine Learning techniques have repeatedly shown their usefulness for ophthalmologists. The possible applications of this technology go much further than been used as diagnostic tool, as it may also be used to grade the severity of a pathology, perform early disease detection, or predict the evolution of a condition. This work reviews not only the latest achievements of Machine Learning in ocular sciences, but also aims to be a comprehensive and concise overview of all steps of the process, with clear and easy explanation for each technical term, focusing on the basic knowledge required to understand Machine Learning.
Topics: Humans; Machine Learning; Neural Networks, Computer; Ophthalmologists
PubMed: 30500302
DOI: 10.1080/08820538.2018.1551496 -
Die Ophthalmologie Sep 2023Managers in the healthcare system play a critical role in ensuring high quality patient care, optimization of resources, management of complex situations, creation of... (Review)
Review
Managers in the healthcare system play a critical role in ensuring high quality patient care, optimization of resources, management of complex situations, creation of a positive work environment and promotion of continuous progress. They set clear goals, support interdisciplinary collaboration, ensure patient safety and quality care, and assist in the development of future leaders. To accomplish these multiple tasks, important qualities such as integrity, communication skills, self-awareness, ability to learn, influence, empathy, courage, respect, ability to delegate and gratitude are essential. We conducted a survey among the followers and members of the Young-DOG to find out their desired characteristics of leaders. In this survey modern aspects of leadership styles such as communication, loyalty, support, reliability and trust were particularly important to young medical professionals. Classical attributes such as expertise and assertiveness were rated as somewhat less significant. This finding underlines the importance of leadership programs such as the Leadership Academy of the German Society of Ophthalmology (DOG) or the European Leadership Development Program of the European Society of Ophthalmology (SOE). The latter is briefly presented in an excursus.
Topics: Humans; Leadership; Ophthalmologists; Reproducibility of Results; Empathy; Learning
PubMed: 37582890
DOI: 10.1007/s00347-023-01913-6