From the Editor-in-Chief

This issue of the Journal of VitreoRetinal Diseases contains a fascinating article by Drs Masumi Asahi, Haig Pakhchanian, Christine Doepker, Rahul Raiker, and Ron Gallemore—a bibliometric analysis of the 100 top-cited papers in the retinal detachment (RD) literature published between 1900 and 2019. Although the authors present additional trends and metrics, the article list alone makes for very interesting reading and includes many iconic studies as well as unexpected discoveries.

Topping the citation list is Dr Robert Machemer’s landmark 1975 paper on pigment epithelial proliferation in RD, a condition he initially termed massive periretinal proliferation (MPP). Remarkably, but unsurprisingly, he also authored the second-most-cited paper: his 1991 updated classification of RD with proliferative vitreoretinopathy (PVR, now MPP renamed).

The combination of Machemer’s work on aberrant cellular proliferation as a mechanism of recurrent detachment after RD repair, followed by his committee’s presentation of a meaningful clinical classification, provided a pivotal advance in our understanding of RD and its management. That he would also develop innovative and transformational instrumentation to treat these reattachment failures is nothing less than astonishing.

The top-cited author overall—just edging out Dr Machemer—is Dr Steven K. Fisher for his experimental studies of RD, particularly his definitive studies in the cat. Much of what we understand about the complexity of the cellular, inflammatory, degenerative, and reparative processes in detachment derives from the elegant studies of Dr Fisher and his many collaborators. Today, optical coherence tomography allows us to examine correlations of these experimental findings in patients with RD.

For example, we have learned that 1) a microscopic blister of subfoveal fluid may persist for months and reduce vision after otherwise uneventful surgery; 2) the detached retina rapidly develops extensive cystoid edema and often outer-retinal corrugations; 3) subtle but visually significant outer-retinal folds may persist in the reattached retina; and 4) these folds’ occurrence may depend on the manner of surgical reattachment.

Although reattaching a retina remains the best thing that can be done to restore its function, these discoveries open the way to refinements and adjuncts in treatment. Continued pursuit of these new findings, followed by their practical exploitation, may permit visual results superior to those already achieved by prompt anatomic reattachment.

Photo courtesy of Kevin Caldwell Photography.

The interesting relationships within the world of these 100 top-cited authors and coauthors (shown as Figure 3 in their article and on the cover) demonstrate a web of interactions between the basic science research on RD—represented by the influence of Dr Fisher on the right, and the translation/clinical contributions by Dr Machemer, as shown on the left—with many notable additional nodes and subnodes of author and coauthor connections. The harmonious and densely intertwined relationships depicted in this illustration affirm the power of bench-to-bedside research and remind surgeons and laboratory investigators of the necessity of seeking out new collaborations as new challenges arise.

Bibliometrics is the statistical study of literature impact and distribution; its processes and methods have become increasingly refined. Such analyses have definite limitations, and the authors freely acknowledge many of them. For example, older articles clearly have had a longer time to accumulate citations; some articles, authors, and keywords may not be discovered easily in older databases; self-citation is not controlled; and newer measures of scientific effect are not included.

The most-cited article in medical literature is the Lowry method of protein determination, ¹ a 1951 paper that has been cited hundreds of thousands of times, unassailably leading a group of laboratory method papers that dominate the list and, like the tortoise in the race with the hare, eclipse many Nobel prize–winning discoveries.

A deeper dive into the science of bibliometrics quickly reveals an evolving discipline replete with nuanced observations and steady progress in analytical refinement. As with the process of fine-tuning an internet item to achieve a higher priority in Google searches, there is a surprising amount of information regarding which features of an article’s title make it more attractive for citation.

For example, shorter and result-descriptive titles tend to attract more citations, whereas longer titles or those including geographic location tend to be cited less frequently, although these findings may depend on the discipline at hand. Despite the maxim that you can’t tell a book by its cover, aspiring authors would do well to offer concise, informative titles. Although the data are not conclusive, many analyses also suggest that titles containing a question mark or hyphen—or most injuriously, a colon—fare relatively poorly in citation.

Ranking by popularity or usage is a familiar method; we have all probably searched for items such as “The most visited attractions in Rome,” “Best pizza in Chicago,” or “Hottest Broadway show.” Many results confirm our expectations and experience; others offer the opportunity to snort and quibble. Yet, taken simply as a point of departure, they can be an opening to new experiences and discoveries.

For example, contrary to popular belief, the most visited city in the world is now Bangkok; it recently surpassed Paris, and both remain immensely popular destinations. A Midsummer Night’s Dream has climbed over the centuries to become Shakespeare’s most performed play (although the British prefer Romeo and Juliet), while for everyone—alas!—poor Hamlet has declined.

You are invited to explore in depth the 100 top-cited articles in the RD literature as well as all the offerings in this issue of JVRD. Although some of these foundational authors have passed, many are still active and will find themselves happy readers of this article. This canon is clearly fluid; our vibrancy as a field will be measured by the number of new classics that join, and the rapidity of their ascent. Younger authors can be guided by the excellence of these seminal papers and can deepen their understanding of what constitutes an exceptional article as they prepare to perform their own studies and submit their manuscripts. Just remember to be a bit more careful with the title.

Donald J. D'Amico
Editor-in-Chief
Journal of VitreoRetinal Diseases