Gender Disparities in Mentorship and Career Outcomes in Ophthalmology

Abstract

Background:

Gender disparities in the field of ophthalmology have been increasingly recognized. Although mentorship has been proposed as a contributing factor, there are limited data on the differences in mentorship experiences by gender among ophthalmologists.

Objective:

The purpose of this study was to evaluate gender disparities in mentorship experiences among ophthalmologists, and the impact of mentorship disparities on career outcomes.

Design:

Prospective, cross-sectional study.

Setting:

Web-based survey distributed through ophthalmology listservs.

Participants:

Ophthalmologists and ophthalmologists-in-training who completed the survey.

Exposure:

Training and practicing in the field of ophthalmology.

Main Outcome Measures:

Mentorship score based on 10 items from a previously published scale of mentorship quality and self-reported career outcomes (income, job satisfaction, achievement of career goals, and support to achieve future career goals).

Results:

We received survey responses from 202 male and 245 female ophthalmologists. Female ophthalmologists reported significantly lower mentorship satisfaction and worse quality of mentorship (p < 0.03). Female ophthalmologists also reported significantly lower income, worse job satisfaction, and lower rates of goal achievement and support to achieve future goals; all of these career outcomes, except income level, were partly mediated by mentorship score (mediation effect ranged from 29% to 68%, p < 0.014).

Conclusions and Relevance:

Gender-based inequities in achievement of career goals and job satisfaction are partly mediated by disparities in mentorship. Therefore, focused mentorship of women in ophthalmology at all career stages is imperative to reduce these inequities.

Introduction

Gender disparities in the field of ophthalmology have been increasingly recognized.¹ Although approximately half of U.S. medical school graduates are women, the percentage of women ophthalmologists is only 25–30%.² Notably, the percentage of females is higher among ophthalmology residents (39% in 2019),³ but this percentage declined by 2.5% from 2011 to 2019, in contrast to a 2.3% increase across all surgical subspecialties during the same period.³ Furthermore, female ophthalmologists, similar to women in other fields of medicine and science,^4,5 experience inequities in leadership positions, academic achievement, and income.¹ For example, in 2021, women held only 16.7% of chair positions and 37.7% of residency program directorships in U.S. academic ophthalmology departments.⁶

Between 2015 and 2019, 38% of first authors and 27% of last authors of articles in ophthalmology journals were female.⁷ Finally, women ophthalmologists receive lower compensation; in 2012, the average female ophthalmologist collected $0.58 for every dollar collected by a male ophthalmologist, with differences remaining even when clinical activity was equal.⁸ More recently, data from a 2020 survey indicated that a 10% gender gap in salary existed among ophthalmologists in the first year of practice, even after adjusting for factors such as practice type, fellowship, and number of workdays.⁹

Although gender disparities in ophthalmology are likely multifactorial, one potential contributor is mentorship inequality.¹ The importance of mentorship on career advancement and satisfaction in medicine was underscored by a survey of faculty in the Department of Medicine at Massachusetts General Hospital.¹⁰ The authors found that faculty who rated their mentors highly were 3.5 times more likely to progress through academic promotion and nearly 4 times more likely to report high job satisfaction.

In the field of ophthalmology, Jain et al.¹¹ found that 57% of women ophthalmologists in Australia reported difficulty receiving mentorship, compared with 40% of men. This was cited as an obstacle for women pursuing careers in academic ophthalmology. The importance of mentorship in promoting gender parity has been recognized by organizations devoted to the support of women in the field (Women in Ophthalmology, Women Professors of Ophthalmology). However, there are limited data on gender-based disparities in mentorship quality and their relationship to career outcomes.

This study aims to characterize differences in mentorship experiences among male and female ophthalmologists and to evaluate the impact of mentorship on career satisfaction and success.

Methods

This study was approved by the local institutional review board (IRB) and adhered to the tenets of the Declaration of Helsinki¹² and the U.S. Health Insurance Portability and Accountability Act of 1996.¹³ We developed a 29-question survey eliciting self-reported demographics, ophthalmology background and practice, job satisfaction, achievement of career goals, and mentorship experiences (Supplementary Data S1). Mentorship quality was scored using a 10-item scale previously published by the Department of Medicine at Massachusetts General Hospital.¹⁰

Respondents graded their primary or most influential mentor on 10 attributes (such as providing advice about work–family balance and opportunities for career advancement), using a 5-point Likert scale (question 24 a through j, Supplementary Data S1). The mentorship score was calculated as the average of these 10 grades. Respondents were advised to consider a mentor as “someone who serves as a career role model and who advises, guides, and promotes his or her mentee’s career or training.”¹⁰

The survey was distributed electronically through ophthalmology listservs. We contacted the following organizations for approval to post the survey link: American Academy of Ophthalmology (AAO), American Association for Pediatric Ophthalmology and Strabismus (AAPOS), American Glaucoma Society, American Society for Cataract and Refractive Surgery, American Society of Ophthalmic Plastic and Reconstructive Surgery, American Society of Retina Specialists (ASRS), Association for Research in Vision and Ophthalmology (ARVO), Association of University Professors of Ophthalmology (AUPO), Cornea Society, North American Neuro-Ophthalmology Society, American Uveitis Society, International Society of Ocular Oncology, and Women in Ophthalmology.

Approval was given by all societies, except for AAO, ASRS, and AUPO. AAO and ASRS do not permit solicitation of survey responses through their listserv, and AUPO was unable to reach a decision about the study after 10 weeks. Therefore, the survey link was not posted on AAO, ASRS, or AUPO listservs. The survey was open for 11 weeks. Survey data were collected anonymously, but respondents were given the option of providing contact information to enter a raffle for five $100 Amazon gift cards. Data collection for the gift card raffle was separate from the mentorship survey, and identifying information from the raffle could not be linked to survey responses. The survey was administered using Qualtrics^XM (Provo, UT), which monitored IP addresses to prevent multiple submissions.

Surveys were considered incomplete if respondents did not answer at least one nondemographic question. Incomplete surveys were excluded. In addition, surveys from non-ophthalmologists were excluded (if respondents selected “No” when asked “Are you an ophthalmologist or ophthalmologist in training?” then the survey automatically ended).

Male and female respondents were compared using a Mann–Whitney test for ordinal variables (e.g., age-groups) and a chi-square test for dichotomous or categorical variables (e.g., practice setting). Mentorship experiences were compared between genders using multiple regression analysis to adjust for years since completing training, fellowship training, race and ethnicity, and LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual, and more) status. Secondary analysis compared mentorship scores by gender within ophthalmological subspecialties, adjusting for the same variables listed above. Structural equation modeling (SEM) with bootstrapping was used to estimate effects of demographics, mentorship, and practice characteristics on career outcomes (income level, job satisfaction, achievement of current career goals, and support to achieve short- and long-term career goals). The specific factors evaluated included mentorship score, gender identity, years since completing training, race and ethnicity, LGBTQIA+ status, subspecialty training, and practice setting.

Current income level was included as a predictor in models evaluating satisfaction and achievement metrics. The SEM technique also estimated the percentage of these effects mediated by mentorship scores. The percentage of mediation was calculated as the indirect effect divided by total effect of each factor on the outcome of interest, multiplied by 100. All SEM techniques used maximum likelihood with robust standard error estimation and were bootstrapped with 1,000 replications. In secondary analyses, ordered logistic regression was used to evaluate which attributes of mentorship (i.e., individual items on the mentorship scale) were most strongly associated with career outcomes. All data analyses were performed using Stata software (version 15.1; Stata Corp, College Station, TX). p-Values less than 0.05 were considered significant.

Results

Background and demographics

We received 571 survey responses, of which 60 were non-ophthalmologists and an additional 54 were incomplete, resulting in a total of 457 ophthalmologists and ophthalmologists-in-training included in this study. Of these, 202 (44%) identified as male, and 245 (54%) identified as female; 10 (2%) declined to answer, but none identified as nonbinary or other. The demographics and backgrounds of male and female respondents are provided in Table 1. Women were significantly younger (p < 0.0001) and were more likely to be in training or have recently completed training (p < 0.0001). Race and ethnicity differed between groups (p = 0.015), with more Asians and fewer Whites and Hispanics among females. Men were marginally more likely to have pursued fellowship training (p = 0.049).

Table 1.

Background and Demographics of Male and Female Survey Respondents

	Male n = 202	Female n = 245	p-value
Age-group			<0.0001*
<25 years	0	1 (0.4%)
25–30 years	3 (1.5%)	11 (4.5%)
31–40 years	47 (23%)	89 (36%)
41–50 years	49 (24%)	78 (32%)
51–60 years	36 (18%)	37 (15%)
>60 years	67 (33%)	28 (11%)
Years since completing training			<0.0001*
Currently in training	9 (4.5%)	30 (12%)
0–5	39 (19%)	51 (21%)
6–10	24 (12%)	56 (23%)
11–20	39 (19%)	49 (20%)
>20	91 (45%)	57 (23%)
Race and ethnicity			0.015*
Asian	34 (17%)	70 (29%)
Black/African American	5 (2.5%)	10 (4.0%)
Hispanic/Latino	22 (11%)	18 (7.4%)
Native Hawaiian/Pacific Islander	1 (0.5%)	1 (0.4%)
White	123 (62%)	135 (56%)
Other	16 (8%)	8 (3.3%)
LGBTQIA+	14 (7.0%)	9 (3.7%)	0.23
New child during career	132 (66%)	144 (59%)	0.11
Fellowship training	193 (96%)	223 (91%)	0.049*
Subspecialty training program			0.28
Cornea	51 (25%)	46 (19%)
Glaucoma	20 (10%)	21 (8.6%)
Neuro-ophthalmology	33 (16%)	39 (16%)
Ocular oncology	3 (1.5%)	10 (4.1%)
Ocular pathology	2 (1.0%)	2 (0.8%)
Oculoplastics	35 (17%)	34 (14%)
Pediatric ophthalmology	46 (23%)	53 (22%)
Refractive	23 (11%)	13 (5.3%)
Retina	10 (5.0%)	17 (6.9%)
Uveitis	12 (5.4%)	16 (6.5%)
Multiple subspecialties	50 (25%)	47 (19%)
Practice setting			0.07
Academic/university	96 (48%)	120 (49%)
Nonuniversity hospital	11 (5.5%)	20 (8.2%)
Insurance company	3 (1.5%)	4 (1.6%)
Physician-owned private practice	78 (39%)	68 (28%)
In training	7 (3.5%)	21 (8.6%)
Retired	4 (2.0%)	4 (1.6%)

*p < 0.05.

The distribution of subspecialties did not differ by gender. However, some subspecialties were disproportionately overrepresented (particularly pediatric ophthalmology) or underrepresented (especially retina). There was no significant difference between men and women in practice setting. Academic or university practice was reported by 48% of men and 49% of women. The second most common practice type in both genders was physician-owned private practice.

Disparities in mentorship experiences

The disparities in mentorship experiences among ophthalmologists by gender identity are provided in Table 2. Women were more likely to report having a current mentor (54% vs. 39%, respectively, p = 0.04); however, there was no difference between women and men in the total number of mentors over the course of their careers (p = 0.10). Women also reported lower satisfaction with their mentors (p = 0.03) and received lower quality mentorship (p = 0.004), based on the mentorship score calculated from the Massachusetts General Hospital scale (Supplementary Data S1, question 24).¹⁰

Table 2.

Mentorship Experiences of Male and Female Ophthalmologists and Ophthalmologists-in-Training

	Male	Female	Adjusted p-valuea
Currently mentored	77 (39%)	131 (54%)	0.04*
Total number mentors during career	2.7 ± 0.78	2.6 ± 0.84	0.10
Overall mentorship satisfaction (1–5, 1 = best)	1.4 ± 0.69	1.6 ± 0.89	0.03*
Mentorship score (1–5, 1 = best)	1.9 ± 0.80	2.3 ± 1.0	0.004*

^a Adjusted for years since completing training, fellowship training, race and ethnicity, and LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual, and more) status. 

*p < 0.05.

When mentorship scale responses were compared by gender within ophthalmological subspecialties, there was no significant difference, except among neuro-ophthalmologists (average mentorship score was lower [better] in male neuro-ophthalmologists: 1.9 ± 0.80 vs. 2.7 ± 1.1, p = 0.003). The lack of gender difference among other subspecialties may be related to inadequate sample size.

Supplementary Table S1 provides the ratings of male and female ophthalmologists on each individual question of the 10-item mentorship scale. Female ophthalmologists’ ratings of their mentors were significantly worse on all questions, except for a borderline difference in “advice about work–family balance.”

Additional regression analysis, including gender matching (i.e., mentor and mentee with same gender identity) as a variable, revealed that gender matching was significantly associated with mentorship satisfaction (p = 0.0083) but not mentorship score (p = 0.85). Among mentees with gender-matched mentors, mentorship satisfaction was significantly higher in males compared with females (p = 0.0001).

Career outcomes by gender

Career outcomes in male and female ophthalmologists are compared in Table 3. Multivariate analysis of factors associated with career outcomes, including gender identity, is provided in Table 4. Women had significantly lower annual income (p = 0.001), even adjusted for years in practice and subspecialty training. Women were also less likely to report successful achievement of current career goals (p < 0.0001) and less likely to receive the support required to achieve short-term (less than 5 years) career goals (p = 0.012). On average, female ophthalmologists were moderately satisfied with their jobs (2.0 on a scale of 1 to 5, with 1 indicating greatest satisfaction), which was significantly worse than male ophthalmologists (1.7, p = 0.033).

Table 3.

Career Outcomes of Male and Female Ophthalmologists and Ophthalmologists-in-Training

	Male	Female	p-value
Annual income			0.001*
<$100K	21 (10%)	51 (21%)
$100–250K	35 (17%)	64 (26%)
$250–500K	81 (40%)	107 (44%)
$500–750K	39 (19%)	16 (6.5%)
$750K–1M	19 (9%)	2 (0.8%)
>$1M	7 (3%)	4 (1.6%)
Job satisfactiona	1.7 ± 0.88	2.0 ± 1.0	0.033*
Achievement of current career goalsa	1.6 ± 0.89	2.1 ± 1.1	<0.0001*
Receives support required to achieve short-term career goalsa	1.9 ± 1.0	2.3 ± 1.1	0.012*
Receives support required to achieve long-term career goalsa	2.0 ± 1.0	2.3 ± 1.1	0.086

^a Outcomes were graded on a scale of 1–5, with 1 indicating the best outcome.

*p < 0.05.

Table 4.

Factors Significantly Associated with Career Outcomes and Mediation Effect of Mentorship Score

	Significant factors	Total effect p-value	Indirect effect mediated by mentorship score	Indirect effect p-value
Income group	Mentorship score	0.04	N/A	N/A
	Gender identity	0.001	NSa	NS
	Race/ethnicity	0.047	NS	NS
	Years since completing training	<0.0001	NS	NS
	Fellowship training	<0.0001	NS	NS
Job satisfaction	Mentorship score	<0.0001	N/A	N/A
	Gender identity	0.033	38%	0.014
	Income group	0.002	NS	NS
Achievement of current career goals	Mentorship score	<0.0001	N/A	N/A
	Gender identity	<0.0001	29%	0.005
	Years since completing training	0.005	NS	NS
Support to achieve short-term career goals	Mentorship score	<0.0001	N/A	N/A
	Gender identity	0.012	48%	0.003
Support to achieve long-term career goals	Mentorship score	<0.0001	N/A	N/A
	Gender identity	0.086	68%	0.002
	Income group	0.031	NS	NS

^a Not significant.

Relationship between mentorship score and career outcomes

Mentorship score was significantly associated with all career outcomes evaluated (Table 4). Specifically, better mentorship quality (lower scores) was associated with higher annual income (p = 0.04), higher job satisfaction (p < 0.0001), greater likelihood of achieving goals for current stage of career (p < 0.0001), and more support to achieve short- and long-term career goals (both p < 0.0001). On regression analysis, the specific items of the mentorship scale that most strongly influenced career outcomes were advocacy with leadership (significantly associated with job satisfaction and support to achieve short- and long-term career goals, p ≤ 0.002) and nominations for speakership opportunities (associated with achievement of current goals and support to achieve short- and long-term career goals, p ≤ 0.01). The only item on the mentorship scale significantly positively associated with income level was providing introductions to individuals who could influence professional advancement (p = 0.046).

Impact of mentorship score on career outcomes by gender

The results of mediation analysis to identify the relationships among gender identity, mentorship score, and career outcomes are shown in Table 4. The impact of female gender identity on ophthalmologists’ outcomes of job satisfaction, achievement of current goals, and support to achieve short- and long-term career goals was partially mediated by mentorship scores. The percentage of the total effect of female gender identity significantly mediated by mentorship score ranged from 29% to 68%, suggesting that mentorship quality accounted for 29–68% of gender disparities in these outcomes. Income was the only outcome for which the effect of gender identity was not significantly mediated by mentorship score. Gender identity had significant direct impact on income level, as did years since completing training, fellowship training, and race and ethnicity.

Discussion

Our findings highlight multiple gender disparities in ophthalmology, including differences in income, job satisfaction, and achievement of career goals. The gender compensation gap begins in the first year of clinical practice, with female ophthalmologists earning approximately $30,000 less than male colleagues.⁹ This pay gap is persistent over time; Emami-Naeini et al.¹⁴ found that female academic ophthalmologists were paid a mean of $50,000 less than male counterparts, and the difference was seen at all faculty levels. In this study, the income disparity was particularly evident at the highest levels of compensation. Among ophthalmologists who earned more than $750,000 annually, only 19% were female. The income inequity was significant even after accounting for years in practice and fellowship training.

In addition, women reported lower job satisfaction than men, which was mediated, in part, by worse mentorship quality. Prior studies have found mixed results with regard to career satisfaction in male and female ophthalmologists, with some reporting equal satisfaction^15,16 and others reporting higher levels of happiness with work life in men.¹⁷ Encouragingly, the average female ophthalmologist was “moderately satisfied” with her career, which corresponds to previous research demonstrating a high rate of job satisfaction overall among ophthalmologists.¹⁷

In this study, women were less likely to report successful achievement of current career goals and feeling supported to achieve future career goals. Although we did not collect data on the specific career goals of respondents, possible aspirations include reaching a certain income level,^9,14 achieving promotions,¹⁸ publishing in peer-reviewed journals,^7,19,20 receiving grant or industry funding,^21,22 and being recognized by peers with awards, speakerships, committee appointments, and leadership roles.^23–28 Gender inequities have been demonstrated in each of these measures of career success in ophthalmology. Our analyses suggest that disparities in mentorship are an important factor mediating the gender inequities in achievement of career goals, accounting for 29–68% of the discrepancies.

This study demonstrates the profound impact of mentorship on career outcomes in ophthalmology. Of all the factors considered in this study, mentorship quality had the strongest association with job satisfaction, achievement of current career goals, and receiving support to achieve short- and long-term career goals. Similar to our study, Walensky et al.¹⁰ found that among faculty in the Department of Medicine at Massachusetts General Hospital, high-quality mentorship was associated with increased job satisfaction and fewer career obstacles, as measured by percentage of faculty stalled in academic rank.

Possible factors influencing these positive outcomes include previously demonstrated benefits of effective mentorship, such as facilitation of career decisions and preparation, improvement in balance of work and personal life, and stress reduction.^29,30 The items on the mentorship scale that most strongly influenced career outcomes in this study were advocacy with leadership and nominations for speakership opportunities. Therefore, we recommend that mentors place particular emphasis on these aspects of mentorship for optimal support of mentees.

We found that gender concordance was not a significant factor in mentorship quality, although it did impact mentee satisfaction. In a study of AUPO members, Paul et al.³¹ reported that 56% of female respondents felt that gender matching of mentees and mentors was important, compared with 21% of males. However, a systematic review of mentorship programs for women in academic medicine found no difference in mentee satisfaction between programs with female mentors only and those with mentors of both genders.³² A Canadian survey of female ophthalmologists reported that the availability of female mentors is increasing, with residents strongly agreeing that they had access to female mentors, in contrast to late-career ophthalmologists who disagreed.³³

Our survey did not yield data on the reasons that women were more satisfied with female mentors; however, prior investigators have suggested that psychosocial support and more relatable role modeling are potential benefits of gender matching in mentorship.³⁴ Nonetheless, non-gender-matched mentors did not score lower on mentorship quality. Therefore, both male and female ophthalmologists may provide effective mentorship of women ophthalmologists. Although our study was not designed to identify the most successful means to improve mentorship of women at various career stages, possible strategies include institutional policies to mandate mentors for trainees, to include mentors with the power to advance careers of women and other underrepresented groups (such as departmental chairs and deans), and increased focus on organizational efforts such as the ARVO women’s leadership development program.

Our survey responses are consistent with the overall trend of an increasing proportion of women ophthalmologists over the last several decades.¹ There was a significant age difference in respondents by gender, with 73% of female ophthalmologists ≤50 years of age, compared with 49% of male ophthalmologists. In addition, 77% of female ophthalmologists had been practicing for ≤20 years, compared with 55% of male ophthalmologists. The fact that a greater proportion of women ophthalmologists were younger or earlier in their careers may explain why women ophthalmologists were more likely to report having a current mentor. Many mentorship relationships pair an older, more experienced ophthalmologist with a younger colleague, and some older ophthalmologists may no longer feel the need for mentorship. Moreover, the practice of assigning mentors, especially in academic institutions, has become more common in recent decades.³⁵

Our analysis did not distinguish between assigned mentoring relationships and those that developed more organically. Interestingly, despite being more likely to have a current mentor and reporting a similar number of mentors over their career span, women reported experiencing lower mentorship quality, which translated to worse career outcomes. Our findings suggest that the quality of mentorship is more important than the total number of mentors, and they raise the question of how to achieve higher quality mentorship for women. One possibility for improving mentorship quality is requiring assigned mentors to undergo formal mentorship training programs.³⁶ However, more research is needed to understand how to foster successful mentorship relationships among ophthalmologists in all settings.

The main limitation of our study is potential sampling bias. In 2020, there were approximately 18,500 ophthalmologists in practice in the United States,³⁷ but our survey was completed by only 457 ophthalmologists. Individuals with a greater interest in the topics of mentorship and gender disparities may have been more likely to complete the survey. Sampling bias likely explains why there was no significant gender difference in subspecialty training among respondents, even though certain ophthalmological subspecialties have skewed gender distributions.³⁸ We also did not evaluate the impact of practicing part-time. Of the respondents reporting an income of less than $100,000 per year, 33 (7% of total respondents) reported that they had completed training. It is likely that these ophthalmologists were engaging in part-time work. In addition, we included a disproportionate number of fellowship-trained ophthalmologists (93%), likely because our survey was primarily distributed through listservs for ophthalmic subspecialty societies.

Moreover, certain subspecialties were overrepresented (such as pediatric ophthalmology), whereas others were underrepresented (especially retina). Differential responses may be due to name recognition of the study’s lead authors among their colleagues in pediatric ophthalmology, leading to higher rates of survey completion, as well as our inability to access certain listservs to post the survey. Furthermore, academic ophthalmologists were overrepresented in our survey sample, and our scale of mentorship quality contained some items more applicable to academics than private practice, such as “assistance in writing articles and grants.”

We acknowledge that the mentorship scale developed by the Massachusetts General Hospital Department of Medicine has not been validated in a nonacademic setting; however, this was the only published quantitative scale of mentorship quality for physicians that was identified on our literature search. Respondents did have the opportunity to select “not applicable” to any question that was not pertinent to their practice, and these questions were not included in the overall mentorship score.

An additional limitation is that the self-reported outcome measures of job satisfaction and achievement of career goals were entirely subjective. Although it may be possible to objectively quantify certain measures of career success, particularly in academics (e.g., time to promotion or number of successful grant applications), a universally applicable and objective metric remains elusive. Finally, we focused on gender disparities rather than race, ethnicity, and sexual orientation, as the latter factors were not associated with career outcomes in our analysis (except a borderline finding of lower income in underrepresented minorities). This is likely because our study was underpowered to evaluate these factors because of low numbers of underrepresented minority and LGBTQIA+ respondents. However, we did collect qualitative data on discrimination based on race, ethnicity, and LGBTQIA+ status, in addition to gender, and these findings will be reported separately.

Conclusions

In conclusion, better mentorship quality was strongly associated with positive career outcomes in this study. Women reported lower satisfaction with their mentors and lower quality mentorship, even when correcting for years since completing training and subspecialty training. Gender-based inequities in job satisfaction and achievement of career goals are partly mediated by disparities in mentorship quality. Therefore, focused mentorship of women in ophthalmology at all career stages is imperative to reduce these inequities. As gender matching was not associated with higher quality mentorship, both male and female ophthalmologists may serve as mentors and contribute to closing the gender gap.

Authors’ Contributions

The authors confirm contribution to the article as follows:

Study conception and design: Angeline Nguyen, Jesse L. Berry, and Melinda Y. Chang. Data collection: Angeline Nguyen, Jesse L. Berry, Jessica Chang, Jenny Chen, Annie Nguyen, and Melinda Y. Chang. Analysis and interpretation of results: Stephanie L. Cote, Mark Reid, and Melinda Y. Chang. Draft article preparation: Stephanie L. Cote and Melinda Y. Chang. All authors reviewed the results and approved the final version of the article.

Author Disclosure Statement

None of the authors has any relevant financial conflict of interest

Funding Information

National Institutes of Health (NIH) NEI K23EY033790 (M.Y.C.), NIH NCI K08CA232344 (J.L.B.), Saban Research Institute (M.Y.C.), Blind Children’s Center (M.Y.C.), Children’s Eye Foundation of AAPOS (M.Y.C.), Knights Templar Eye Foundation (M.Y.C., J.L.B.), The Wright Foundation (J.L.B.), Children’s Oncology Group/St. Baldrick’s Foundation (J.L.B.), Hyundai Hope on Wheels (J.L.B.), Childhood Eye Cancer Trust (J.L.B.), Children’s Cancer Research Fund (J.L.B.), The Larry and Celia Moh Foundation (J.L.B.), and Research to Prevent Blindness (all authors). None of the funding organizations had any role in the design or conduct of this research or the decision to submit for publication.