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National trends in surgical subspecialisation in ophthalmology in the USA
  1. Cindy X Cai1,
  2. Jiangxia Wang2,
  3. Sumayya Ahmad3,
  4. Janek Klawe3,
  5. Fasika Woreta1,
  6. Divya Srikumaran1,
  7. Nicholas R Mahoney1,
  8. Pradeep Ramulu1
  1. 1 Johns Hopkins Medicine Wilmer Eye Institute, Baltimore, Maryland, USA
  2. 2 Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  3. 3 Icahn School of Medicine at Mount Sinai, New York, New York, USA
  1. Correspondence to Dr Cindy X Cai, Johns Hopkins Medicine Wilmer Eye Institute, Baltimore, Maryland, USA; ccai6{at}


Background/aims To assess surgical patterns in ophthalmology by subspecialty in the USA.

Methods Ophthalmic surgeons were categorised as comprehensive/subspecialist based on billed procedures in the 2017–2018 Medicare Provider Utilization and Payment Data. Poisson regression models assessed factors associated with physicians performing surgeries in the core domain (eg, cataract extractions) and subspecialty domain. Models were adjusted for provider gender, time since graduation, geographical region, practice setting and hospital affiliation.

Results There were 10 346 ophthalmic surgeons, 74.7% comprehensive and 25.3% subspecialists. Cataract extractions were performed by 6.0%, 9.9%, 21.0%, 88.1% and 95.3% of specialists in surgical retina, neuro-ophthalmology/paediatrics, oculoplastics, glaucoma and cornea, respectively. Retina specialists were more likely to perform cataract surgery if they were 20–30 or>30 years in practice (relative risk: 2.20 (95% CI: 1.17 to 4.12) and 3.74 (95% CI: 1.80 to 7.76), respectively) or in a non-metropolitan setting (3.78 (95% CI: 1.71 to 8.38)). Among oculoplastics specialists, male surgeons (2.71 (95% CI: 1.36 to 5.42)), those in practice 10–20 years or 20–30 years (1.93 (95% CI: 1.15 to 3.26) and 1.91 (95% CI: 1.11 to 3.27), respectively) and in non-metropolitan settings (3.07 (95% CI: 1.88 to 5.02)) were more likely to perform cataract surgery. Only 26 of the 2620 subspecialists performed surgeries in two or more subspecialty domains.

Conclusions There is a trend towards surgical subspecialisation in ophthalmology in the USA whereby some surgeons focus their surgical practice on subspecialty procedures and rarely perform surgeries in the core domain.

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Data availability statement

Data are available upon reasonable request. See above.

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Data availability statement

Data are available upon reasonable request. See above.

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  • Contributors CXC designed the study, performed the data analysis, drafted and critically reviewed the manuscript, and is responsible for the overall content of the article. PR assisted with study design, interpreted the data and critically reviewed the manuscript. FW/DS/NRM assisted with study design and critically reviewed the manuscript. JW assisted with data analysis and critically reviewed the manuscript.

  • Funding This study was supported by an unrestricted departmental grant to the Wilmer Eye Institute from Research to Prevent Blindness (CC, FW, DS, NRM and PYR) and the Wilmer Biostatistics Core Grant P30EY01765 (JW).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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