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Objective The study aimed to investigate factors influencing choice of specialty among ophthalmology and non-ophthalmology residency applicants. Patients and Methods Anonymous, web-based surveys were distributed through REDCap to the 2019 to 2020 residency applicants to the Penn State Department of Ophthalmology and, as a control group, Penn State medical students applying to non-ophthalmology residencies for the 2019 to 2020 cycle. The primary outcome was factors that influenced specialty choice among ophthalmology versus non-ophthalmology applicants. Secondary outcomes include hours of exposure to applicants' selected specialty in the medical school preclinical curriculum, and proportion of ophthalmology versus non-ophthalmology applicants who decided on, or developed a strong interest in, their specialty prior to clinical rotations. Results Surveys were completed by 203/441 (46.0%) ophthalmology and 85/139 (61.1%) non-ophthalmology applicants. Fewer than 20 hours of exposure to an applicant's selected specialty were provided in the medical school preclinical curriculum for 86.7% of ophthalmology and 42.4% of non-ophthalmology applicants (p < 0.001). Ophthalmology applicants decided on, or developed a strong interest in, their selected specialty before clinical rotations at a similar rate to non-ophthalmology applicants (60.6 vs. 58.8%, respectively). Factors influencing specialty choice cited most commonly by ophthalmology applicants include professional satisfaction (94.1%), performing surgeries/procedures (92.6%), personal fit with specialty (91.1%), work-life balance (91.1%), and ability to see patients in a clinic setting (90.6%), compared to personal fit with specialty (95.3%)%, clinical rotation in selected specialty (95.3%), professional satisfaction (91.8%), intellectual stimulation (89.4%), and subinternship or away rotation (89.4%) among non-ophthalmology applicants. Conclusion Professional satisfaction and personal fit with specialty were among the most commonly cited factors influencing specialty choice for both groups. Other factors cited most frequently by ophthalmology applicants include performing surgeries/procedures, work-life balance, and ability to see patients in a clinic setting. Despite limited ophthalmology exposure in medical school preclinical curricula, ophthalmology applicants decided on, or developed a strong interest in, their selected specialty before clinical rotations at a rate similar to non-ophthalmology applicants.

A woman in her 80s complained of mildly distorted vision in both eyes for several months. Best-corrected visual acuity was 20/25 OD and 20/40 OS. Intraocular pressure was 16 mm Hg OD and 17 mm Hg OS. Her medical history included rheumatoid arthritis treated with minocycline, 100 mg twice daily, for more than 10 years. External examination revealed blue-gray discoloration of the nail beds and bilateral sclera (Figure , A). Ophthalmoscopic and optical coherence tomography findings demonstrated a bluish appearance to the macula with associated pigmented retinal pigment epithelium deposits (Figure , B) consistent with minocycline-induced retinal hyperpigmentation. 1 The lack of choroidal hyperreflectivity suggested no associated pigmented choroidal nevus. Given the unknown, long-term visual relevance of minocycline-induced retinal hyperpigmentation, the patient was switched from minocycline to methotrexate, 10 mg weekly, with supplementation of folic acid to manage her rheumatoid arthritis. [2][3][4]

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