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IMPORTANCE Federal policy in the United States prohibits corneal donation by men who have had sex with another man (MSM) in the preceding 5 years, whereas Canada enforces a 12-month ban. The potential consequences of these policies on corneal donations should be evaluated. OBJECTIVE To estimate the number of potential corneal donations associated with MSM deferral policies in the United States and Canada. DESIGN, SETTING, AND PARTICIPANTS A nonvalidated telephone survey study was conducted of all 65 eye banks in the United States and Canada to investigate how many potential corneal donors were disqualified in 2018 because of federal MSM restrictions. Published demographic data were also used to arrive at a separate estimate. Survey data were gathered from May 2019 to February 2020. MAIN OUTCOMES AND MEASURES Eye banks were asked if they keep records of referrals disqualified specifically because of the federal MSM restrictions and, if so, how many referrals they disqualified in 2018 owing to MSM status. RESULTS Fifty-four of 65 eye banks (83%) responded to the survey, with 30 eye banks reporting they do not keep specific records of MSM deferrals. The remaining 24 eye banks reported disqualifying 360 referrals in 2018 because of MSM status, equating to 720 corneas. The 24 eye banks accounted for 46.2% of corneal donations in the United States and Canada in 2018, yielding an estimate of approximately 1558 corneas rejected that year because of MSM status. A separate estimate using published MSM demographic data indicates that up to 3217 potential corneal donations may have been disqualified in 2018 because of these federal policies. CONCLUSIONS AND RELEVANCE Findings suggest that between 1558 and 3217 corneal donations were disqualified in 2018 because of federal regulations prohibiting corneal donation by men who have had sex with another man in the preceding 5 years in the United States or 1 year in Canada. With modern virologic testing that is reliable within days of HIV exposure and given the global shortage of corneal tissue, these policies should be reevaluated using current scientific evidence to increase the availability of vision-restoring surgery worldwide.

Background:Anterior lens opacities (ALO) are found in 3-14% of pediatric patients with cataracts. No clear guidelines exist in the management and treatment of these cataracts.Objective:To evaluate pediatric patients with anterior lens opacities and assess rate of amblyopia and need for surgery over time.Methods:A retrospective chart review was performed on patients with unilateral and bilateral anterior lens opacities (ALOs) seen between January 2008 and December 2014. Size, location, and type of ALO were noted. Refractive error, necessity for treatment of amblyopia, and interventions were recorded.Results:A total of 31 patients were included in the study. 17 patients had unilateral ALOs and 14 had bilateral ALOs. The majority of the cataracts (90.3%) were centrally located. The most common type of cataract was the polar type of cataract and the vast majority (48.4%) was < 1mm in size. 38.7% of patients had concurrent ocular conditions and 9.7% had systemic associations. 28.6% of patients with bilateral cataracts and 35.3% of the patients with unilateral cataracts were treated for amblyopia. Three patients required cataract surgery.Conclusion:About half of anterior lens opacities are less than 1mm in size and the majority are of the polar type. Risk of amblyopia in these patients is higher than in the general population. Anisometropia is the most common cause of amblyopia. Ocular associations are seen at a relatively high frequency and systemic associations can occur but are uncommon. The need for surgical intervention is infrequent; however, growth of ALOs and associated cortical changes may be risk factors for surgery.

We demonstrate differences in cataract outcomes in patients with limited English proficiency compared with their English proficient counterparts. Further research is needed to understand the root causes of those differences.

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Hemmerich et al 1 highlight that the ophthalmology literature is beginning to call more attention to ophthalmologic health disparities that disproportionately affect people based on their race, sex, sexual orientation, zip code, income, education level, or employment status. These disparities include unequal access to ophthalmologic care, disproportionate incidence of ophthalmologic disease, and differences in treatment outcomes. The authors identified 75 such articles since 2016, yet their review concluded that far more research is still needed-particularly to evaluate disparities for people in rural communities and for people who are lesbian, gay, bisexual, transgender, queer or questioning (LGBTQ+); American Indian/Alaska Native; and Asian or Pacific Islander. This type of research is vitally important for our field. Identifying these disparities allows us as ophthalmologists to focus our profession's resources in areas where they can be most impactful in protecting sight and empowering lives, and more importantly, making these resources and advancements accessible to the people who need them the most.Much of the effort to address the inequities and research gaps highlighted by Hemmerich et al 1 is focused on increasing the diversity of our ophthalmology workforce. Studies have repeatedly shown that patient-physician concordance in race and ethnicity or sex can improve health outcomes and patient satisfaction. 2,3 We also know that ophthalmologists from racial and ethnic groups underrepresented in medicine are more likely to care for these same underserved communities, yet ophthalmology is one of the least diverse specialties in all of medicine, further widening the gap. 4 Only 6% of practicing ophthalmologists identify as Alaskan Native, American Indian, Black, Hispanic, Native Hawaiian, or Pacific Islander (compared with 30.7% of the US population at large). 4 To adequately address health disparities affecting these populations, ophthalmology itself needs to diversify.Similarly, a survey of all US allopathic medical school graduates from 2016 to 2019 found that ophthalmology had the second-lowest percentage of new trainees identifying as LGBTQ+ in all of medicine (ahead of only orthopedic surgery). 5 Hemmerich et al 1 were unable to find a single article addressing LGBTQ+ health disparities in ophthalmology. One distinct obstacle to conducting such research about the LGBTQ+ community is the lack of available demographic information about patients' sexual orientation in electronic health records. This is partly due to inadequate methods of collection or patient willingness to disclose. Many LGBTQ+ patients choose not to disclose gender identity or sexual orientation to their physician, sometimes out of fear of discrimination or simply because the question was not asked. 6 Improving LGBTQ+ representation in the ophthalmology workforce could reduce stigma and increase the attention paid to this understudied