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BJO Online: has the future just happened?
  1. BJO website editor bhisit{at}

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    Is the internet over? Lately, we've been deluged on a daily basis with bad news on the internet front, with much collective anguish over the die-off and the tech stock collapse. The exuberance of the past few years for all things online has been replaced seemingly overnight by pervasive pessimism. The bubble has burst, and burst resoundingly.

    So what can all this mean for scientific publishing on the web and forBJO Online in particular? Is the bankruptcy of, say, the online dog food retailer a sign that the internet apocalypse is near? Will the electronic medical journal go the way of all start-ups?

    We're inclined, here at the eBJO, to believe otherwise. At the same time that the internet consumer business model is disintegrating, overall web traffic continues robust growth. As the economy retreats to bricks and mortar, the audience for online news and information sites is expanding. As a conduit for the dissemination of medical information, the internet is inexorably strengthened by faster internet connections, more extensive web infrastructure, and gigahertz PC power. With dogged optimism, theBJO's online incarnation continues to move forward in a number of ways.

    For example, website visitors will by now have noticed that we've renovated our cyberspace. Webmaster Dominic Mitchell and the specialist journals website group have recently redesignedBJO Online for enhanced usability and features, to say nothing of its jaunty new look. Navigation of the site is easier, the layout more clear, the graphics pleasing to the eye. The signature BJO cover photographs from Ivan Schwab's ophthalmological menagerie feature largely in the redesign of the website. Each issue of the eBJO is posted with the month's new cover photo in all its JPEG glory. What's more, with a few clicks readers can stroll through a unique photographic gallery of archived BJO cover images depicting screech owls, solar eclipses, ommatidia, and cuttlefish—any of which, by the way, make fine ophthalmology desktop “wallpaper”.

    But beyond the new digital aesthetics lie some editorial innovations that are exclusive to the electronic version of theBJO. One recent development is the “Editor's choice,” a new feature highlighting one article in each online issue that is culled by editor in chief Creig Hoyt for its particular impact, quality, and relevance. A link from the redesigned home page takes readers directly to each month's editor's choice article. More democratically, another neweBJO feature is the “Top 10 papers,” compiled by eBJO readers themselves. This link identifies those articles from recentBJO issues receiving the most “hits” in the previous month, in effect the result of theeBJO reader voting with his or her mouse.

    After its first year, the “Video Reports” feature is garnering an array of articles unique to the electronicBJO. With web videos, audio narratives, and short text articles on a variety of subjects, ranging from the surgical (phaco at the forefront with David Chang), to the scientific (tumbling leucocytes in mouse retinal vasculature identified by Xu and colleagues), to the downright macabre (subconjunctival invasion by the nematode Dipetelonema as visualised by Huynhet al).

    The move towards free full text articles online is gaining momentum. As more and more medical and scientific journals make available “toll free” links to full text articles or abstracts, online readers increasingly find that they can go directly to a reference cited in a given eBJO article without leaving the comfort of their desktops, not only to articles from theBJO but from many other journals as well. Such information sharing has arisen through affiliations like High Wire Press, which numbers the British Journal of Ophthalmology, Ophthalmology,IOVS, and Scienceamong its 293 participating journals, offering over 300 000 free articles. Hundreds of thousands of free articles are also accessible at the digital archives at PubMed Central and BioMed Central. The internet may yet deliver on its promise to give us a new standard of medical information services and frictionless, open access scholarship.

    On another fundamental issue in electronic publishing, a recent editorial1 in this journal by Alex Williamson of the BMJ Publishing Group reaffirmed the longstanding commitment at theBritish Medical Journal and its sister journals (BJO included) to provide free online subscriptions to readers and institutions in the developing world. This summer, at the urging of the World Health Organization, six of the major medical publishing houses also agreed to offer developing countries free or discounted online access to about a thousand of the world's top medical periodicals. The initiative has been likened by a WHO official to creating “a top flight US library” for doctors, researchers, and institutions in poor countries plagued by diminishing funds in the face of spiralling journal expenses.

    With the recognition of the “digital divide” in internet access and technology that exists between industrial and developing regions, theBJO's move to an online version has held the risk of neglecting portions of our global readership. Happily, experience over the first years of the onlineBJO seems to be proving otherwise. Access and use in developing nations is active and growing. Tracking hits on the eBJO website by the address of origin reveals that our global digital readership is significant. While the staunch .uk domain retains the distinction of having the largest base of readers (about 14% of total online readers), many arrive at theeBJO site via far flung listing domains (internet addresses comparable to “.com”)—from .np (Nepal) to .na (Namibia); from .ye (Yemen) to .yu (Yugoslavia); from .kh (Cambodia) to .ke (Kenya). Sixty six countries defined by the World Bank as low income economies are included on the list of those entitled to free online access to the eBJO. Bangladesh, Benin, Congo, Gambia, Ghana, Indonesia, Malawi, Nigeria, Sudan, Tanzania, Togo, Uganda, and Zimbabwe are just some of the countries with active subscriptions.

    As another index of accessibility, theBJO website's eLetters feature, the online rapid response function, is well represented by letters and comments from readers in developing countries, confirming the inclusive nature of the medical information exchange on the net. The next challenge in this initiative to improve global access to medical research publications will be to expand the internet infrastructure in these countries, with wider availability of hardware and internet service. But, even in the face of economic and structural obstacles, open online access to medical journals is fulfilling the potential of the web to extend the global distribution of medical information.

    For internet medical journals, it looks like the future is still happening, and will be for some time.


    Video Reports (

    • Capsule staining and mature cataracts: a comparison of indocyanine green and trypan blue dyes. D F Chang

    • Pearls for implanting the Staar toric IOL. D F Chang

    • An intraocular steroid delivery system for cataract surgery. D F Chang

    • Evaluation of leucocyte dynamics in mouse retinal circulation with scanning laser ophthalmoscopy. Heping Xu, A Manivannan, Garry Daniels, Janet Liversidge, Peter F Sharp, John V Forrester, Isabel J Crane

    • Dipetalonema reconditum in the human eye. T Huynh, J Thean, R Maini

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