Abstract
Purpose:
The research activity in pediatric glaucoma (PG) was qualitatively and quantitatively evaluated using a scientometric approach.
Methods:
The “Web of Science” database was accessed for primary bibliometric data regarding PG using search terms “pediatric glaucoma,” “paediatric glaucoma,” “congenital glaucoma,” and “childhood glaucoma.” The data was analyzed for total research productivity, citations, and scientific output in terms of journals, countries, institutions, and authors. The results were further characterized for coauthorship links and visualized by VOS viewer software. Also, the top 25 cited articles were reviewed with the above bibliometric characteristics.
Results:
One thousand two hundred and sixty-nine items were obtained from our search query from 1955 to 2022; these received 15,485 citations, originated from 78 countries. The top-3 contributing countries were the United States of America (n = 369), India (n = 134), and China (n = 127). LV Prasad Eye Institute (n = 58), Duke University (n = 44), and King Khalid Eye Specialist Hospital (n = 42) were the top-3 productive institutes. The top-3 prolific authors were Mandal AK (n = 53), Freedman, SF (n = 36), and Sarfarazi, M (n = 33). Journal wise, “Investigative Ophthalmology” (n = 187), “Journal of Glaucoma” (n = 92), and “Journal of AAPOS” (n = 68) were the journals in which the most articles were published. The top-25 cited documents received 3564 citations and were published between 1977 and 2016. The key areas of interest were basic sciences (genetics of childhood glaucoma) and surgical management.
Conclusion:
United States of America, LVPEI, Mandal AK, and “Investigative Ophthalmology” were the top rankers as far as the productivity and publications related to PG are concerned. Articles on molecular genetics in PG have received interest among the ophthalmology community.
Keywords: Childhood glaucoma, congenital glaucoma, pediatric glaucoma
Citation by another paper has long been considered a surrogate of the importance of the cited research work. However, it is not the only factor for determining scientific merit. Many articles with citation analysis of previously published papers have been produced in different disciplines to date. The earliest example was probably published in the Journal of the American Medical Association for the most cited articles in the same journal by Garfield in 1987.[1] Fifteen years later, Paladugu et al.[2] reported the 100 citation classics in general surgery journals. This type of study that provides quantitative analysis of publications is named “bibliometric analysis.” Ellegaard and Wallin reported that health sciences create the largest part of the publications by bibliometric methodology.[3] Citation characteristics differ according to disciplines and even a particular subject may have an individual research area “unique microfield” with distinct citation characteristics, for example, genetic analysis may have more citations as compared to emerging fields like oculoplasty in ophthalmology.
Since the bibliometric landscape on pediatric glaucoma (PG) has remained largely unexplored, the current study aimed to systematically review the literature available on PG since 1955 in terms of bibliometric variables, author, and organizational collaborative pattern and also analyze the 25 most cited articles in this field. Advanced data visualization techniques (Infographics) were used for mapping available literature on the subject in addition to bibliometric analysis of scientific publications.
The main objectives of our analysis were:
Quantification and quality assessment of articles published about PG in bibliometric characteristics.
Enumeration of the most influential countries, institutes, authors, and publications in PG research.
Generating collaborative visualization maps in PG research.
Gaining insights into hotspot areas and topics of top-cited articles in PG.
Methods
Study design
A bibliometric analysis of publications until December 2022 in the Web of Science (WOS) was performed. For citation analysis, the cut-off date was December 31, 2022.
Data retrieval
Search strategy
A literature search was conducted by the authors in WOS for publications in the English language on a single day (January 9, 2023), using the following search string: TITLE-ABS-KEY (“Congenital Glaucoma”) OR (Pediatric Glaucoma) OR (Paediatric Glaucoma) OR (Childhood Glaucoma).
The validity of the search strategy was manually analyzed, and data cleaning was done, removing articles not in the domain of PG. Any discrepancies were sorted out by discussion among the authors.
Data analysis
Data were downloaded in.csv format, imported to Microsoft® Excel Version 16.49, and quantitatively and qualitatively analyzed. Manual screening of data by authors for errors in search results in the domain of author name and affiliation were detected and standardized. The primary data, thus, obtained analyzed in terms of annual research trends, total research output, most productive countries, journals, authors, and institutions. Descriptive statistics have been used for the presentation of the data.
Visualization maps
VOSviewer version 1.6.16 software tool was used for viewing and creating the desired bibliometric maps (http://www.vosviewer.com/; Leiden University, Netherlands; van Eck and Waltman, 2010). Country, organization, and author coauthorship links are being presented as network visualization maps. In VOSviewer maps, the size of the label and the circle of an item are proportional to the weight of the item. The higher the weightage, the larger its label and circle. The color of an item depicts the cluster of origin. Lines between items represent links. The distance between two items in the visualization is proportionate to the relatedness of the items in terms of the coauthorship link.
Twenty-five top-cited articles
The top-cited 25 articles (citations >85) were examined in detail and characterized by the journals published, year of publication, and citations received. Citations per year per publication were also calculated (to nullify the effect of article life upon citations accrued). This was calculated by dividing the number of citations by the years since they published till 2022.The primary and secondary topics of research in PG being dealt with by these top-cited articles were noted to get insights into hotspot areas and high-yield topics as far as citation receiving is concerned.
Research ethics
The primary data was downloaded from WOS; the current analysis was meant to generate secondary data from the existing data. As there was no interaction with animal or human subjects, an ethics committee clearance was not sought.
Results
From the WOS database, 1269 manuscripts were retrieved and published from 1955 to 2022, with 15,485 citations received and 3695 authors from 78 countries published in 192 journals. The year-wise distribution of the number of manuscripts is shown in Fig. 1. The average citation per manuscript was 12.43, and the h-index was 55.
Figure 1.
Graph depicting the year-wise distribution of the number of manuscripts
Countries
The top-5 countries were the United States of America (USA) (n = 369), India (n = 134), China (n = 127), United Kingdom (n = 71), and Australia (n = 69). The rankings of countries according to the number of manuscripts, citations, citation per item, citation per item per year (CPIPY), and h-index are depicted in Table 1.
Table 1.
Top-5 countries in terms of their productivity and various bibliometric indices
| Country | No. of manuscripts (% of 1269) | Total citations (Min-Max) | CPI | CPIPY | H-Index |
|---|---|---|---|---|---|
| USA | 369 (29.07)* | 6550 (0-461)* | 17.75† | 1.8‡ | 43* |
| India | 134 (10.56)† | 1561 (0-80)‡ | 11.65‡ | 1.53 | 24† |
| China | 127 (10.01)‡ | 424 (0-54) | 3.33 | 1.35 | 10 |
| United Kingdom | 71 (5.59) | 1576 (0-273)† | 22.1* | 2.10* | 19‡ |
| Australia | 69 (5.44) | 552 (0-202) | 8 | 1.93† | 8 |
*, † ,and ‡ are first, second, and third rank in specific columns, respectively. CPI: Citations per item. CPIPY: Citations per item per year
Organization
LV Prasad Eye Institute (58), Duke University (44), King Khalid Eye Specialist Hospital (42), University of London (39), and All India Institute of Medical Sciences (36) were the top-5 productive institutes. The rankings of institutions according to the number of manuscripts, citations, citation per item, CPIPY, and h-index are depicted in Table 2.
Table 2.
Top-5 institutes in terms of their productivity and various bibliometric indices
| Organization | No. of manuscripts | Total citations (Min-Max) | CPI | CPIPY | H-Index |
|---|---|---|---|---|---|
| LV Prasad Eye Institute | 58* | 880 (0-80)† | 15.17 | 1.5 | 18* |
| Duke University | 44† | 821 (0-114)‡ | 18.65‡ | 2.05* | 17† |
| King Khalid Eye Specialist Hospital | 42‡ | 1004 (0-227)* | 23.9* | 1.67 | 13 |
| University of London | 39 | 804 (0-169) | 20.6† | 1.89† | 15‡ |
| All India Institute of Medical Sciences, New Delhi | 36 | 374 (0-43) | 10.38 | 1.72‡ | 13 |
*, †, and ‡ are first, second, and third rank in specific columns, respectively. CPI: Citations per item. CPIPY: Citations per item per year
Authors
The top-5 prolific authors were Mandal AK (53), Freedman, SF (36), Sarfarazi, M (33), Garcia Feijoo (25), and Sihota R (23). The rankings of authors according to the number of manuscripts, citations, citation per item, CPIPY, and h-index are depicted in Table 3.
Table 3.
Top-5 authors in terms of their productivity and various bibliometric indices
| Author | No.of manuscripts | Total citations (Min-Max) | CPI | CPIPY | H-Index |
|---|---|---|---|---|---|
| Mandal AK | 53* | 983 (88-0) † | 18.5‡ | 1.61 | 18* |
| Freedman, SF | 36† | 773 (114-0) ‡ | 21.47† | 1.88‡ | 17† |
| Sarfarazi, M | 33‡ | 1629 (461-0) * | 49.3* | 2.22* | 13‡ |
| Garcia Feijoo | 25 | 307 (59-0) | 12.28 | 1.40 | 11 |
| Sihota R | 23 | 310 (43-0) | 13.47 | 2.13† | 10 |
*, †, and ‡ are first, second, and third rank in specific columns, respectively. CPI: Citations per item. CPIPY: Citations per item per year
Journal
Journal wise, Investigative Ophthalmology (187), Journal of Glaucoma (92), Journal of AAPOS (68), American Journal of Ophthalmology (56), and Acta Ophthalmologica (53) were the top-5 journals out of a total of 192 journals publishing these articles. The journal-wise rankings according to the number of manuscripts, citations, citation per item, CPIPY, and h-index are depicted in Table 4.
Table 4.
Top-5 journals publishing these articles and various bibliometric indices
| Journal | No. of Manuscripts | Total citations (Min-Max) | CPI | CPIPY | H-Index |
|---|---|---|---|---|---|
| Investigative Ophthalmology | 187* | 862 (169-0) ‡ | 4.60 | 0.38 | 12 |
| Journal of Glaucoma | 92†, | 856 (58-0) | 9.30‡ | 1.42‡ | 16‡ |
| Journal of AAPOS | 68‡ | 1088 (125-0) †, | 16†, | 1.39‡ | 20†, |
| American Journal of Ophthalmology | 56 | 1471 (114-0) * | 26.26* | 1.88* | 24* |
| Acta Ophthalmologica | 54 | 250 (34-0) | 4.62 | 1.13 | 9 |
*, †, and ‡ are first, second, and third rank in specific columns, respectively. CPI: Citations per item. CPIPY: Citations per item per year
Visualization maps depicting collaboration
Collaborative links were generated with “country,” “organization,” and “authors” as the units for generating coauthorship link strength in VOSviewer software.
Country-wise coauthorship links
For assessing the collaboration links between countries, the threshold chosen was a minimum number of five documents. Thirty-three countries met the criteria; these countries were arranged in 8 clusters with 104 links and a total link strength of 314 [Fig. 2]. The USA stands out on the map as the most prominent node with the highest international collaboration (documents – 377, link strength – 167), followed by England (documents – 64, link strength – 61) and Saudi Arabia (documents – 43, link strength – 37).
Figure 2.
Visualization map depicting collaboration links between the countries
Organization-wise coauthorship links
For assessing the collaboration links between organizations, the threshold chosen was a minimum number of six documents. Out of 1061 organizations, 77 items in 19 clusters with 189 links and a total link strength of 440 were identified [Fig. 3]. Instituto de Salud Carlos III (documents-19 and link strength-45), Flinders University Australia (documents-15 and link strength-39), and King Khalid specialist eye hospital (documents-42 and link strength-37) were the top-3 collaborators.
Figure 3.
Visualization map depicting collaboration links between the organizations
Collaborative links between authors
The collaboration links between authors were calculated after setting a threshold of a minimum number of five documents. One hundred twenty-one authors met the criteria. These 121 authors were found in 52 clusters with 177 links and a total link strength of 936 [Fig. 4]. Mandal AK, (documents – 49 and link strength – 112), Chakrabarti S (documents – 22 and link strength – 93), and Sarfarazi M, A (documents – 32 and link strength – 91) were the top-3 authors in terms of collaborative links.
Figure 4.
Visualization map depicting collaboration links between the authors
Twenty-five top-cited articles
The top-25 cited documents received a total of 3564 citations and were published between 1977 to 2016 [Supplementary Table]. The primary topic dealt with by these articles was basic sciences, specifically, genetics of childhood glaucoma (n = 13), followed by surgical management (n = 8).
Supplementary Table.
Twenty-five top cited articles with their year of publication, bibliometric parameters and primary and secondary subtopics dealt by them
| Title | Journal | Citations | Year of Publication | CPIPY | Primary subtopic | Secondary subtopic (if applicable) | |
|---|---|---|---|---|---|---|---|
| 1 | Identification of three different truncating mutations in cytochrome P4501B1 (CYP1B1) as the principal cause of primary congenital glaucoma (Buphthalmos) in families linked to the GLC3A locus on chromosome 2p21 | Human molecular genetics | 461* | 1997 | 18.44† | Basic sciences | Genetics |
| 2 | Sequence analysis and homology modeling suggest that primary congenital glaucoma on 2p21 results from mutations disrupting either the hinge region or the conserved core structures of cytochrome P4501B1 | American journal of human genetics | 273† | 1998 | 11.37 | Basic sciences | Genetics |
| 3 | Mutations in CYP1B1, the gene for cytochrome P4501B1, are the predominant cause of primary congenital glaucoma in Saudi Arabia | American journal of human genetics | 227‡ | 1998 | 9.45 | Basic sciences | Genetics |
| 4 | Primary infantile glaucoma (congenital glaucoma) | Survey of ophthalmology | 227‡ | 1983 | 5.82 | Basic sciences | |
| 5 | Null Mutations in LTBP2 Cause Primary Congenital Glaucoma | American journal of human genetics | 202 | 2009 | 15.53‡ | Basic sciences | Genetics |
| 6 | Assignment of a locus (glc3a) for primary congenital glaucoma (buphthalmos) to 2p21 and evidence for genetic-heterogeneity | Genomics | 173 | 1995 | 6.40 | Basic sciences | Genetics |
| 7 | Childhood glaucoma - Results with trabeculotomy and study of reversible cupping | Ophthalmology | 171 | 1982 | 4.27 | Surgical management | |
| 8 | The British Infantile and Childhood Glaucoma (BIG) Eye Study | Investigative ophthalmology & visual science | 169 | 2007 | 11.26 | Epidemiology | |
| 9 | Multiple CYP1B1 mutations and incomplete penetrance in an inbred population segregating primary congenital glaucoma suggest frequent de novo events and a dominant modifier locus | Human molecular genetics | 168 | 2000 | 7.63 | Basic sciences | Genetics |
| 10 | A second locus (GLC3B) for primary congenital glaucoma (Buphthalmos) maps to the 1p36 region | Human molecular genetics | 162 | 1996 | 6.23 | Basic sciences | Genetics |
| 11 | Molecular genetics of primary congenital glaucoma | Eye | 134 | 2000 | 6.09 | Basic sciences | Genetics |
| 12 | Identification of a single ancestral CYP1B1 mutation in Slovak Gypsies (Roms) affected with primary congenital glaucoma | Journal of medical genetics | 131 | 1999 | 5.69 | Basic sciences | Genetics |
| 13 | Long-term surgical and visual outcomes in primary congenital glaucoma: 360 degrees trabeculotomy versus goniotomy | Journal of aapos | 125 | 2000 | 5.68 | Surgical management | |
| 14 | Correlation between surgical success rate and severity of congenital glaucoma | British journal of ophthalmology | 120 | 2005 | 7.05 | Surgical management | |
| 15 | 360-degrees trabeculotomy for primary congenital glaucoma | Archives of ophthalmology | 119 | 1995 | 4.40 | Surgical management | |
| 16 | The Ahmed valve in refractory pediatric glaucoma | American journal of ophthalmology | 114 | 1999 | 4.95 | Surgical management | |
| 17 | Angiopoietin receptor TEK mutations underlie primary congenital glaucoma with variable expressivity | Journal of clinical investigation | 113 | 2016 | 18.83*, | Basic sciences | Genetics |
| 18 | The epidemiology of pediatric glaucoma: The Toronto experience | Journal of aapos | 113 | 1999 | 4.91 | Epidemiology | |
| 19 | Trabeculectomy with adjunctive mitomycin C in pediatric glaucoma | American journal of ophthalmology | 107 | 1998 | 4.45 | Surgical management | |
| 20 | Loss of function mutations in the gene encoding latent transforming growth factor beta binding protein 2, LTBP2, cause primary congenital glaucoma | Human molecular genetics | 104 | 2009 | 8 | Basic sciences | Genetics |
| 21 | The Ahmed drainage implant in the treatment of pediatric glaucoma | American journal of ophthalmology | 104 | 2003 | 5.47 | Surgical management | |
| 22 | Molecular genetics of primary congenital glaucoma in Brazil | Investigative ophthalmology & visual science | 100 | 2002 | 5 | Basic sciences | Genetics |
| 23 | Congenital glaucoma and its inheritance | Ophthalmologica | 94 | 1980 | 2.23 | Basic sciences | |
| 24 | Novel cytochrome P4501B1 (CYP1B1) gene mutations in Japanese patients with primary congenital glaucoma | Investigative ophthalmology & visual science | 93 | 2001 | 4.42 | Basic sciences | Genetics |
| 25 | Pathogenesis of reversible cupping in congenital glaucoma | American journal of ophthalmology | 93 | 1977 | 2.06 | Basic sciences |
*, †, ‡ are 1st, 2nd and 3rd rank in specific columns, respectively (if applicable). CPI: Citations per item. CPIPY: Citations per item per year
Discussion
Citation indexes like WOS provide linkages between similar research items and output in the form of matched or related scientific literature. The impact of literature in a particular field, or more than one discipline, can be obtained through a citation index. Linking of all the papers citing a specific article gives an idea of the impact of that paper. This helps explore current trends, patterns, and emerging fields of research.
Historically “Impact factor” has been used to assess the impact of published literature, but this is journal-specific metric and is dependent upon several external factors that are modifiable to improve the impact factor purposefully. Various article-level metrics like the number of citations, citations per item (CPI), CPIPY, and h-index can be individually calculated for countries, institute authors, and journals. These have the advantage over the impact factor as they bring out the importance of individual articles and nullify the effect of time since publication (CPIPY).
Our study explored the bibliometric parameters, and the citation counts of the articles related to PG, which are under the ambit of the WoS platform. It is a general understanding that an increase in the number of articles in any field would lead to a parallel rise in the citation counts. A bibliometric study on adult glaucoma showed an increasing trend in terms of the number of publications with a steep slope from 2014 to 2018.[4] Regarding PG, a steep rise in the number of publications has been observed since 1990, and a parallel rise in the number of citations has been observed with a time lag of two years.
From our observations, it would not be wrong to state that pioneering research work in PG has originated from institutes in the USA, followed by centers in India and China. The USA has remained the dominating country in terms of the origin of medical research in various other studies and a study done on glaucoma in adults.[4,5] United Kingdom, though ranked fourth in the number of manuscripts published, had the second-highest citation count after the USA and had the highest CPI AND CPIPY. Country-wise article-level metrics indicated that the USA topped the chart in terms of all parameters except CPI and CPIPY. India was second in terms of the number of manuscripts published and H index, yet lagged in terms of other citation-related indices to USA and UK.
Organization wise LV Prasad Eye Institute had the highest number of manuscripts, followed by Duke University, but King Khalid Eye Specialist Hospital had the highest number of citations and CPI among the top-5 organizations.
The top-5 prolific authors were listed, and Sarfarazi M (n = 33) was found to be leading in all the parameters that we had considered (citations, CPI, and CPIPY), except the “number of manuscripts” and “H-index,” which were the highest for Mandal AK (n = 53).
The visualization maps for countries showed that the USA has the highest international collaborations, followed by England and Saudi Arabia. In terms of the institutions involved in collaborative work, Instituto de Salud Carlos III, Flinders University Australia, and King Khalid specialist eye hospital were the top-3 organizations that stand out.
The coauthorship maps depict Mandal AK, Sarfarazi M, and Chakrabarti S as the top-3 authors in collaborative links. It may be noted that two out of five authors (Mandal AK, Sarfarazi M) were also among the most prolific authors [Table 3] who featured in the coauthorship map [Fig. 4]. Similar findings on collaboration and productivity have been noted by various authors.[6] Higher collaboration of authors has been linked with a higher h-index indicating higher citation rates and a higher impact of well-connected authors. This emphasizes that collaborative research and its publication have higher chances of adding value to the paper as far as receiving higher citations is concerned, and it has the potential to become a relatively more influential paper as compared to those articles which are authored by a single institution only.[6]
The number of citations an article receives showcases the interests of the researchers in that subject. Studying frequently cited articles provides information on important topics and the attention and growth in research a particular area has received. When the bibliometric analysis of the research pertaining to adult glaucoma was performed, it was noticed that the most frequently cited broad subject areas were intraocular pressure, optical coherence tomography, and retinal ganglion cells. In contrast, articles dealing with genetics and surgical techniques were the most published PG articles.[4] This pattern is not unexpected since the pathogenesis of PG with genetic linkage is among the most researched topics in PG. The surgical technique of PG has evolved from goniotomy to trabeculotomy, and then combined trabeculotomy and trabeculectomy to use shunts and off late with the availability of newer approaches like minimally invasive glaucoma surgery (MIGS), I stent, etc.
When analyzed in-depth, most of the articles (n = 13) on genetics among the top-25 cited articles have dealt with gene mapping and mutations in PG. Molecular genetics in PG dealing with inheritance and its modification by genetic engineering is a frequently researched topic.
Modifications of surgical technique in terms of the use of mitomycin C and shunt devices to increase surgical success have attracted the attention of researchers and surgeons alike and have been, therefore, cited heavily.
The highest number of articles in the list of top-25 PG was published in the “American Journal of Ophthalmology and Human Molecular genetics”. The focus of PG articles is mainly on the developmental and genetic basis of the disease along with the surgical aspect, so genetic journals like AJHM and “Human Molecular Genetics” took the lead along with American Journal of Ophthalmology.
There are some limitations to this study that must be understood. The citation count is a dynamic value, and hence our study is akin to taking a screenshot of the ever-evolving literature. One may also note that a citation count does not take into account whether a citation was made with positive or negative intent in a particular manuscript.[7] It is also logical that the chances that a specific article gets cited depend on the type of article it is; for example, meta-analyses or systematic reviews tend to accrue more citations than others.[8] Also, older articles get more exposure to the scientific community and, therefore, have more probability of accumulating more citations than those which are published recently. Also, the “Web of Science” citation numbers might not be wholly representative of the actual citation count as many available manuscripts may not have been included under its purview. The utilization of multiple databases (like Scopus, Google Scholar, etc.) can generate a higher citation number.[9] Several biases like institutional bias, self-citation, influential person, and language bias have not been factored in this study, which could have affected the manuscript’s rankings. Nevertheless, this bibliometric analysis of PG provides insight into the trends in PG. It is the first study to list the top-25 cited articles dedicated to PG. The research areas and major academic publications pertaining to PG were identified through this study. This analysis of the citation count would provide a reference for quoting the most influential papers in the field of PG in future publications.
Conclusion
Following the USA, India and China stand out as the topmost productive countries in PG. The LV Prasad Eye Institute, Hyderabad, Mandal AK, and the journal “Investigative Ophthalmology” were the top rankers as far as the productivity and publishing articles related to “Pediatric Ophthalmology” is concerned. Collaboration is the bridging force in PG research between productivity and influence on the academic community. Articles in molecular genetics on PG have received interest among the ophthalmology community and have been heavily cited.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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