{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T05:26:27Z","timestamp":1783401987501,"version":"3.54.6"},"reference-count":37,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2024,11,14]],"date-time":"2024-11-14T00:00:00Z","timestamp":1731542400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004326","name":"Bayer","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100004326","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004337","name":"Roche","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100004337","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Ophthalmol"],"accepted":{"date-parts":[[2024,10,28]]},"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>To compare individual ophthalmologists grouped as outliers or non-outliers based on the mean 12-month visual acuity (VA) outcomes for their patients with neovascular age-related macular degeneration (nAMD).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This prospectively designed database study included treatment-na\u00efve eyes with nAMD starting vascular endothelial growth factor inhibitors between July 2018 and April 2023 in Australia. Ophthalmologists were classified into high outliers, non-outliers and low outliers with a funnel plot of the adjusted mean 12-month VA change. The number of injections, last injection interval and proportion of visits where choroidal neovascularisation was active were compared between the groups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>38 ophthalmologists who treated a total of 1266 eyes (male, 35%; mean age, 81 years old) were classified into 1 high outlier, 34 non-outliers and 3 low outliers (mean VA change, 7.5, 5.1 and 2.5 letters, respectively). The high outlier gave significantly more injections than the non-outliers (mean, 8.6 vs 7.7; p&lt;0.001), while the low outliers administered significantly fewer injections than the non-outliers (mean, 7.1 vs 7.7; p=0.009). The last injection interval was shortest in the high outlier\u2019s eyes (9.4 weeks), followed by non-outliers\u2019 (10.8 weeks; p=0.04 (vs high outlier\u2019s)) and low outliers\u2019 (11.8 weeks; p=0.22 (vs non-outliers\u2019)). The low outliers\u2019 patients had more visits with intraretinal fluid (59%) than non-outliers\u2019 (29%; p&lt;0.001) and high outlier\u2019s patients (31%; p&lt;0.001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The low outliers\u2019 eyes had fewer injections, a longer treatment interval and more visits with intraretinal fluid. Building a system through which low outliers are anonymously notified of their performance would help improve general quality of care.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bjo-2024-326024","type":"journal-article","created":{"date-parts":[[2024,11,14]],"date-time":"2024-11-14T13:20:20Z","timestamp":1731590420000},"page":"606-613","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Outlier ophthalmologists in the treatment of neovascular age-related macular degeneration with intravitreal therapy"],"prefix":"10.1136","volume":"109","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7944-6923","authenticated-orcid":false,"given":"Yohei","family":"Hashimoto","sequence":"first","affiliation":[{"name":"The University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6261-4679","authenticated-orcid":false,"given":"Adrian Robert","family":"Hunt","sequence":"additional","affiliation":[{"name":"Ophthalmology, The University of Sydney Save Sight Institute, Sydney, New South Wales, Australia"},{"name":"Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane M","family":"Wells","sequence":"additional","affiliation":[{"name":"Ophthalmology Unit, Canberra Hospital and Health Services, Garran, Australian Capital Territory, Australia"},{"name":"Department of Ophthalmology, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gayatri","family":"Banerjee","sequence":"additional","affiliation":[{"name":"Nepean Valley Eye Surgeons, Penrith, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ross","family":"Ferrier","sequence":"additional","affiliation":[{"name":"Coastwide Eye Surgery, Erina, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Barry","sequence":"additional","affiliation":[{"name":"Blink Eye Clinic, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Field","sequence":"additional","affiliation":[{"name":"Cairns Eye Surgery, Edge Hill, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Game","sequence":"additional","affiliation":[{"name":"Port Macquarie Eye Centre, Port Macquarie, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire Yvonne","family":"Hooper","sequence":"additional","affiliation":[{"name":"Northern Beaches Retina, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Barthelmes","sequence":"additional","affiliation":[{"name":"Universit\u00e4tsSpital Z\u00fcrich Augenklinik und Poliklinik, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark C","family":"Gillies","sequence":"additional","affiliation":[{"name":"Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,11,14]]},"reference":[{"key":"2025071523150780000_109.5.606.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1102673"},{"key":"2025071523150780000_109.5.606.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2012.09.006"},{"key":"2025071523150780000_109.5.606.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2019.10.006"},{"key":"2025071523150780000_109.5.606.4","unstructured":"Australian Commission on Safety and Quality . 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