Reply to: Socioeconomic Factors May Affect Diversity in Neuro-Ophthalmology

We thank Dr. Gluckstein for raising the important issue of socioeconomic status before entering the medical field and its impact on subsequent residency and practice decisions.

Letters to the Editor Socioeconomic Factors May Affect Diversity in Neuro-Ophthalmology I commend Drs. Quiros and Gordon on their recent editorial broadly reviewing the literature on gender and racial representation in neurology and ophthalmology. Their article brought together data from a wide range of sources to show that the gender and racial makeup of the workforce and leadership in neurology and ophthalmology does not reflect the population we serve. While data are lacking on diversity within the subspecialty neuro-ophthalmology itself and the authors highlighted the limited data on gender identity, sexual orientation, and disability status, I believe that one particularly important measure of diversity in neuroophthalmology was not highlighted: household socioeconomic status before entering medicine. The top 2 quintiles of the socioeconomic distribution constitute roughly 75% of medical school matriculants (1). Medical students from underrepresented minority backgrounds are much more likely to be raised in households with a low socioeconomic status than their White counterparts and often have more debt (2). Compared with other subspecialties in neurology, the compensation is lower for neuro-ophthalmologists (3), and ophthalmology residents cite the lack of surgery or reduced compensation as reasons to avoid the field (4). In addition, neuro-ophthalmologists often work at academic centers, where recruitment depends (in part) on networking within a small field, pay is typically lower than in private practice, and there is additional pressure on physicians to participate in activities that do not directly generate income. As such, socioeconomic status may not only be an important diversity consideration itself but also be a driver of the reduced presence of underrepresented minorities in highly Reply to: Socioeconomic Factors May Affect Diversity in Neuro-Ophthalmology W e thank Dr. Gluckstein for raising the important issue of socioeconomic status before entering the medical field and its impact on subsequent residency and practice decisions. It was our specific intention to focus on aspects of sex, race, and ethnicity, but there are other important areas of diversity, including the individual's prior socioeconomic status and disability and whether the individual is in the first generation of their family to complete college or have an advanced degree. We welcome this conversation because diversifying neuro-ophthalmology is an important part of continuously enhancing the excellence of our field in education, patient care, research, and community commitment. Letters to the Editor: J Neuro-Ophthalmol 2023; 43: e65 academic subspecialties with lower income potential like neuro-ophthalmology. As Quiros and Gordon make it clear, we are responsible for making neuro-ophthalmology a diverse subspecialty. Although information on socioeconomic representation in medicine is much less available than data on gender or race, I believe that studying socioeconomic representation in neuro-ophthalmology may help us better understand the causes of limited representation in our field. Jeffrey Gluckstein, MD Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, MA The author reports no conflicts of interest. REFERENCES 1. Youngclaus J, Roskovensky BA. An updated look at the economic diversity of U.S. medical students. [Association of American Medical Colleges research website]. 2018. Available at: https://www.aamc.org/data-reports/analysisbrief/report/updated-look-economic-diversity-us-medicalstudents. Accessed September 2, 2021. 2. Castillo-Page L, Eliason J, Zhang K, Wilson C, Poll-Hunter N, Fair M, Bailey C, Johnson S, Cloud StT. Diversity in Medical Education: Facts & Figures 2016: Current trends in medical education. [Association of American Medical Colleges Facts and Figures website]. 2016. Available at: https:// www.aamcdiversityfactsandfigures2016.org/reportsection/section-3/. Accessed September 2, 2021. 3. Neurology compensation and productivity dashboard. [American Academy of Neurology Benchmarking Data]. 2017. Available at: https://www.aan.com/tools-and-resources/practicingneurologists-administrators/benchmarking-data/neurologycompensation-productivity/. Accessed September 3, 2021. 4. Williams R. Neuro-Ophthalmology’s SOS: Save Our Subspecialty. EyeNet Magazine. 2020. Available at: https:// www.aao.org/eyenet/article/neuro-ophthalmologys-sos-saveour-subspecialty?september-2020. Accessed September 12, 2021. Peter A. Quiros, MD Department of Ophthalmology, Doheny Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California; and Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California Lynn K. Gordon, MD, PhD Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California The authors report no conflicts of interest. e65 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited.