Introduction: It is possible that social media use can boost not just articles’ social impact but the number of citations and academic influence as well. If a positive correlation between Twitter usage and citation metrics exists in the ophthalmology literature, it is important to broadcast this information to the ophthalmology community so they can use Twitter to increase academic engagement with their research. There has also been an increase in the number of articles available as open access. Therefore, it is important to evaluate the presence of an open-access citation advantage in the field of ophthalmology. This study aims to evaluate the relationship between Twitter mention and open access status on citation metrics in the ophthalmology literature. Methods: We conducted a retrospective cross-sectional study comparing article citation metrics to Twitter mentions and open access status. We gathered data on ophthalmology research articles from the six highest-ranked ophthalmology journals published as part of a January 2019 issue. Data were collected in April 2022, 38 months after online publication. Data on citations for each article was based on Google Scholar and Scopus websites. The Altmetric Bookmarklet extension was used to determine the amount of social engagement each article received. The open-access status of each article was based on the status listed in its corresponding journal. Two-tailed t-tests were used to compare social media engagement and open access status with the number of Google Scholar and Scopus citations. Results: A total of 102 original research articles were analyzed. 89 (87.3%) articles received a Twitter mention. Articles tweeted at least once had a significantly higher Google Scholar score (27.2 +/- 4) compared to articles not tweeted (16.4 +/- 1.7; 1.7-fold increase, p<0.05). Likewise, the average Scopus score was significantly higher for tweeted articles (18.6 +/- 2.6) compared to articles not tweeted (11.8 +/- 1.6; 1.6-fold increase, p<0.05). Articles listed as open access had a significantly higher number of Twitter mentions (11.8 +/- 1.8) compared to articles that were not open access (5.6 +/- 0.7; 2.1-fold increase, p<0.05). Open-access articles also had higher citation scores compared to articles that are not open access, but this relationship was not statistically significant. Conclusion: This is the first study to evaluate the relationship between article Twitter mention and citation score in the field of ophthalmology. It demonstrates a significant positive correlation between the article Twitter mention and citation score and provides further evidence that social media engagement can be beneficial to the dissemination of academic information. Further studies on the relationship between social media engagement and article dissemination are warranted in the field of ophthalmology.

Introduction: Cataract is the leading cause of blindness worldwide. Phacoemulsification is now the gold standard for cataract extraction and is greatly needed in low socioeconomic status (SES) communities, rural and older patient populations, and patients with poor vision. This greatly increases the importance of high readability for online resources on this topic. This study aims to assess the readability of online information about phacoemulsification based on readability scores for each resource.Methods: We conducted a retrospective cross-sectional study. The term "phacoemulsification" was searched online, and each website was categorized by type: academic, physician, non-physician, commercial, social media, and unspecified. The readability scores for each website were calculated using six different readability tests and a composite score that reflects reading grade level was obtained. To evaluate the difference between the categories of websites, analysis of variance (ANOVA) testing was used. All test scores were compared with the 6 th grade standard recommendation using a one-sample t-test.Results: A total of 20 websites were analyzed. Three websites (3/20; 15%) had a score which is correlated with a 6 th grade reading level or below. Seventeen websites had a score correlated with a college reading level or above (17/20; 85%). None of the readability scores had a mean below a 6 th grade reading level. No category had an average readability score at or below a 6 th grade reading level. None of the mean readability scores resulted in a statistically significant difference across categories. All readability tests had an average score which was significantly different from a 6 th grade reading level (p<0.001).Conclusions: This is the first study to focus on the accessibility of online English resources on phacoemulsification and implement multiple standardized readability scores with regards to cataract surgery resources. It provides further overwhelming evidence that online resources on phacoemulsification are too complex for the average patient to understand. Interventions should be implemented to improve readability.

Introduction Patients with Usher syndrome (USH) have retinitis pigmentosa (RP) and hearing loss inherited as an autosomal recessive (ar) trait. Mutations in the USH2A gene are the most common cause of Usher syndrome. We report the genotype-phenotype correlation in 10 patients with Usher syndrome from Puerto Rico (PR). This is the first genotype-phenotype analysis of patients with the syndrome in PR. Methods We conducted a chart review of patients who carried an Usher syndrome diagnosis. They underwent a comprehensive ophthalmic evaluation by at least one of the authors. This included best corrected visual acuity (BCVA), visual field mean deviation (VF MD), pattern standard deviation (PSD), and macular optical coherence tomography (mOCT) average volume and thickness. Genotyping was done using the Invitae Inherited Retinal Disease (IRD) Panel. Results Three patients had a logMAR BCVA of 1.0 or worse. The median VF MD was -29.7 dB and -29.2 dB in the OD and OS, respectively. The median PSD was 5.5 dB and 5.7 dB in the OD and OS, respectively. Upon macular OCT, patients had a median volume of 8.4 μm 3 and 8 μm 3 in the OD and OS, respectively. The median thickness was 235 μm and 223 μm in the OD and OS, respectively. All patients had pathogenic USH2A variants, and eight of these were compound heterozygotes. The most common variants were p.Cys575Tyr and p.Glu767Serfs*21, each present in four patients. Patients with the p.Cys759Phe variant had the worst phenotype with the worst BCVA, largest VF MD, and slimmer macular thickness. Conclusion Our findings are compatible with previously reported pathogenic mutations in the USH2A gene. However, the p.Cys759Phe variant has previously been correlated with a mild phenotype. In our study, the p.Cys759Phe variant correlated with the most severe phenotype. This variant has a high prevalence in the Spanish population, and PR was a Spanish colony for 400 years. The presence of this variant could be traced back to Spain. Genotyping patients with Usher syndrome is of utmost importance. Further studies to evaluate the common founder effect of patients with the syndrome in PR are warranted.

We report on a case of focal retinitis as the initial manifestation of cat-scratch disease. A 56-year-old Hispanic woman presented for a routine follow-up examination. A fundus examination of the right eye revealed a white retinal lesion along the inferotemporal artery; this lesion was noted to have progressed after one week of observation. On further inquiry, the patient reported she had seven cats at home, some of which were less than six months old and had recently scratched her. She received empirical treatment for focal retinitis with azithromycin (500 mg daily) and valacyclovir (1 g three times daily), which would cover the most common parasitic, viral, and bacterial etiologies. She was lost to a follow-up examination. However, she continued the same dose of antibiotic and antiviral treatment. Upon her eventual follow-up, three months later, it was noted that the lesion had resolved. The initial work-up revealed that she was positive for Bartonella henselae IgM (1:20) and IgG (1:512), as well as for B. quintana IgG (1:256); however, she was negative for B. quintana IgM. At a four-month follow-up appointment, the B. henselae IgM was negative, the IgG had decreased from 1:512 to 1:64, and the B. quintana antibody test was negative for IgM and IgG, all of which are consistent with an adequately treated case of cat-scratch disease. Focal retinitis can be a rare initial manifestation of cat-scratch disease, which should be considered part of the differential diagnosis in cases of focal retinitis, especially in patients with a history of close contact with young cats. Additionally, oral azithromycin may be considered as a treatment for some cases of cat-scratch-associated focal retinitis.

Background: Previous studies have reported on retinitis pigmentosa (RP) in Puerto Rico. Information on the geographic distribution of RP mutations in Puerto Rico may lead to higher rates of diagnosis and co-management. We aimed to evaluate whether there are areas with increased incidence of genes leading to RP in the Island. Materials and Methods: We conducted a non-concurrent prospective study on the genotype of 241 patients with RP in Puerto Rico. We evaluated their townships to determine whether there are clusters of genes leading to RP. Genetic studies were done using the Invitae inherited retinal diseases panel analyzing 330 genes. Results: A total of 100 patients were evaluated. Clusters of patients with mutations were found in certain townships. As depicted in the map, a cluster of patients with a mutation in the PDE6B gene was found in San Juan (9), those with the BBS1 gene occurred in San Juan (6) and Bayamón (4), mutations on the USH2A gene were found in Toa Baja (5), mutations in the CRB1 gene appeared in Ciales (4), and mutations in the BBS7 were found in Aibonito (2). Other mutations are scattered throughout the Island. Conclusion: Clusters of mutations were identified in several townships including San Juan, Bayamón, Toa Baja, Ciales, and Aibonito. Some of these are isolated geographically. Additional mutations were identified but only the most pertinent were reported. Genetic studies are warranted in all patients with RP in Puerto Rico.