The survey was completed by 63 physician residents in a US ophthalmology program (across 42 unique programs, comprising 12.4% of the 509 US-based ophthalmology residents) and 69 physicians (9.5% of total contacted) beyond residency training between December 2022 and June 2023 (who graduated from 52 unique programs). A 36.2% (n = 25) majority of the practicing ophthalmologists completed residency in the 1990s. The vast majority reported being part of a group practice (76.8%, n = 53) (Table 1). 27% (n = 17) of resident respondents were on track to complete residency in 2026, 23.8% (n = 15) in 2025, 25.4% (n = 16) in 2024, 15.9% (n = 10) in 2023, and 6.3% (n = 4) in 2022.

Of the practicing ophthalmologists, 81.2% (n = 56) were currently offering premium IOLs, and 68.1% (n = 47) were offering MIGS. When asked about exposure in residency, 26.1% (n = 18) reported being trained on premium IOLs in and 17.4% (n = 12) reported being trained on MIGS. When asked about the level of discussion/training participants received in their residency program on diversity of brands and manufacturers available for product selection, 56.5% (n = 39) percent of practicing ophthalmologists responded that this was “minimally discussed but not emphasized” or “not discussed at all.” When asked about the level of discussion/training participants received in their residency program on newly developed products on the market (premium IOLs, MIGS, etc.), 65.2% (n = 45) responded that this was “minimally discussed but not emphasized” or “not discussed at all.”

Practicing ophthalmologists were asked to rate their perception of exposure to newer surgical and therapeutic treatments and technologies in their own residency as compared to other programs. A total of 40.6% (n = 28) of respondents reported more exposure than other programs, 50.7% (n = 35) same exposure, and 8.7% (n = 6) less exposure when compared to other programs. The majority (55.1%, n = 38) of respondents reported that exposure to new technologies during residency did influence types of technologies employed during practice, whereas 21.7% (n = 15) reported that exposure did not, and 23.2% (n = 16) were uncertain.

Written commentary was elicited on whether respondents believed experience with technology in residency influenced the types of technology used or quantity of certain technologies in practice (Question 11 a.1, Supplementary Fig. 1). Given the low sample size, thematic analysis was performed. Those who reported minimal exposure during residency reported that less exposure made them less willing to try new technology and made them inappropriately think there were not more than one or two options for technology companies to work with. Such exemplary comments included “Less exposure makes you less willing to try new tech”, “You use what you get experience with in residency. If you do not have exposure to newer technologies, you will not feel comfortable using them.” “One brands grip on the VA system made my inappropriately think there were no other options. It was stifling.”

Those who reported same exposure and more exposure during residency when compared to other training programs provided commentary of a similar sentiment. Themes were extracted from individual comments. Respondents reported that exposure to new technologies and pharmaceuticals during residency helped define future habits and practice patterns and made them feel more adaptable and comfortable with a wide variety of techniques (e.g. various MIGS platforms and different IOLS). They also reported that greater exposure made them more open to test out new phacoemulsification machines and equipment and made them more incentivized to familiarize themselves with new cutting edge technologies. Finally, they reported that greater exposure helped them to be more adaptable surgeons with greater confidence in adopting a wide range of surgical techniques. Exemplary comments included; “Using multiple types of technology and wetlabs with industry has allowed me to be comfortable using them when in practice”, “Using them in residency allowed familiarity with it and allowed me to be less inhibited about trying other technologies”, “During residency, we were exposed to the latest phacoemulsification technology and were able to use different phaco platforms. This allowed me to decide which specific phaco platform that I wanted to use in private practice” and “We were privileged to use newer instruments and the latest surgical techniques. This experience taught me to stay ahead with these and advance patient care.”

Among resident respondents, 87.3% (n = 55) planned on pursuing a fellowship, and almost 39.7% (n = 25) planned to eventually join a private practice. 63.5% (n = 40) of respondents planned to treat cataracts, 46% (n = 29) refractive surgery, 38.1% (n = 24) retina, 38.1% (n = 24) cornea/external disease, 36.5% (n = 23) glaucoma, and 19% (n = 12) uveitis.

When asked about their perception of exposure to new technology in their own residency program versus other programs, 52.4% (n = 33) of residents believed that they received the same amount of exposure to newer surgical and therapeutic treatments and technologies in residency, as compared to other programs. 17.5% (n = 11) thought they received less exposure, 14.3% (n = 9) thought they received more exposure, and 15.9% (n = 10) percent were uncertain. When asked about partnerships with industry in terms of training and collaboration, 34.9% (n = 22) reported good or very good exposure and 22.2% (n = 14) reported poor or very poor exposure, with the rest reporting average exposure. A total of 46% (n = 29) reported good or very good training and availability of newer technologies and 12.7% (n = 8) reported poor or very poor exposure, with the rest reporting average exposure. 82.5% (n = 52) percent had been trained on MIGS, and 69.8% (n = 44) were trained on premium IOLs.

When asked about the level of discussion/training participants received in their residency program on diversity of brands and manufacturers available for product selection, 55.6% (n = 35) responded that this “minimally discussed but not emphasized” or “not discussed at all.” When asked about the level of discussion/training participants received in their residency program on newly developed products on the market (premium IOLs, MIGS, etc.), 47.6% (n = 30) responded that this was “minimally discussed but not emphasized” or “not discussed at all.” Only 4.8% (n = 3) reported prioritized discussion/training on diversity of brands and manufacturers available for product selection and 6.3% (n = 4) on newly developed products on the market (premium IOLS, MIGs, etc.).

Responses regarding specific new technologies practicing physicians and current residents have had access to in residency are demonstrated in Fig. 1. Compared to practicing attendings, a greater percent of resident respondents reported training on or access to premium IOLS, MIGS, imaging managing software/PACS, sustained release drug options/implants, dry eye procedures, FLACS, presbyopia drops, and heads up microscope display (Fig. 1). Resident reported plans to offer certain technologies demonstrated a similar trend to the technologies residents reported training in during residency (Fig. 2).

Resident response to assessment of which newer technologies they wish to offer once in practice

Overall, the vast majority resident physicians reported that they enjoyed being trained on newer technology and exposure made them feel more prepared for future changes in the field (95.2%, n = 60). They also reported that having industry partnerships in residency enhances education and training (90.5%, n = 57), and that they were more likely to seek out employment opportunities that value advanced technology because of exposure during residency (81%, n = 51). (Fig. 3) Only 12.7% (n = 8) strongly agreed that they would prefer to focus on the standard procedures and technology they are most likely to use in practice and to increase their comfort level (Fig. 3).

Resident Responses to assessment of importance of engaging with newer technologies and industry exposure