Purpose To characterize the error of OCT measurements of retinal nerve fiber layer (RNFL) thickness when using automated retinal layer segmentation algorithms without manual refinement. Design cross-sectional study Methods Setting glaucoma clinical practice. Study Population 3490 scans from 412 eyes of 213 individuals with a diagnosis of glaucoma or glaucoma suspect. Observational Procedures We used spectral domain OCT (Spectralis, Heidelberg Engineering, Heidelberg, Germany) to measure RNFL thickness in a 6-degree peripapillary circle, and exported the native ‘automated segmentation only’ results. In addition, we exported the results after ‘manual refinement’ to correct errors in the automated segmentation of the anterior (internal limiting membrane) and the posterior boundary of the RNFL. Main Outcome Measures Differences in RNFL thickness and glaucoma classification (normal, borderline, or outside normal limits) between scans with ‘automated segmentation only’ to scans using ‘manual refinement’. Results ‘Automated segmentation only’ resulted in a thinner global RNFL thickness (1.6 μm thinner, P<0.001) when compared to ‘manual refinement’. When adjusted by operator, a multivariate model showed increased differences with decreasing RNFL thickness (P<0.001), decreasing scan quality (P<0.001), and increasing age (P<0.03). Manual refinement changed 298/3486 (8.5%) of scans to a different global glaucoma classification wherein 146/617 (23.7%) of borderline classifications became normal. Superior and inferior temporal clock hours had the largest differences. Conclusions Automated segmentation without manual refinement resulted in reduced global RNFL thickness and overestimated the classification of glaucoma. Differences increased in eyes with a thinner RNFL thickness, older age, and decreased scan quality. Operators should inspect and manually refine OCT retinal layer segmentation when assessing RNFL thickness in the management of patients with glaucoma.

Purpose To determine prevalence of burnout in ophthalmology residents in the United States using the Maslach Burnout Inventory—Human Services Survey and to identify factors associated with burnout and wellness. Methods Anonymous survey distributed to residents via residency program directors. Results Ninety-one programs out of 113 (80.5%) confirmed survey distribution. Of 267 included respondents, 23 (8.6%) met criteria for high burnout, and 169 (63.3%) met criteria for at least one aspect of burnout. Longer work hours, longer hours spent on call, higher number of consults seen on call, fewer hours of sleep on call, and not meeting recommended physical activity minimums were associated with higher emotional exhaustion. Most common factors cited to improve wellness included physical activity, nurturing relationships, and co-resident support, whereas most commonly cited factors that contributed to burnout included sleep deprivation, call, and workload. Conclusion Burnout in ophthalmology residents is common, occurring at similar rates as reported in residencies of other specialties.

IMPORTANCE Corneal opacity is a leading cause of visual impairment worldwide; however, the specific features of corneal scars, which decrease visual acuity, have not been well characterized.OBJECTIVE To investigate which features of a postfungal keratitis corneal scar contribute to decreased visual acuity after an episode of infectious keratitis and evaluate whether any corneal features may be used as outcomes for clinical trials. DESIGN, SETTING, AND PARTICIPANTSIn this ancillary, prospective cross-sectional study, a subset of study participants treated for fungal keratitis (n = 71) as part of the Mycotic Ulcer Treatment Trial I (MUTT I) underwent best spectacle-corrected visual acuity (BSCVA) and best contact lens-corrected visual acuity examination, Scheimpflug imaging, and anterior segment optical coherence tomography at a referral hospital in India approximately 2 years after enrollment.

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Phacoemulsification done by a junior resident or using the divide-and-conquer technique had the highest risk of reoperation.