Peer Review in Ophthalmology: A Collaborative Approach to Training the Next Generation of Reviewers

Whether vision care providers and vision researchers recognize it or not, they likely have benefited directly and indirectly from the peer-review process in medicine. Peer-reviewed literature has taught providers and scientists about clinical and basic science advances and influences nearly every clinical decision health care providers make daily. Peer-reviewed publications have been the cornerstone for reporting and disseminating scientific advancements. Policies developed by advisory groups that affect the general public often are based on peer-reviewed science.¹ Despite the many individual ways peer review has affected professional careers, the peer review process is perceived by many individuals as improving clinical care and quality of science by allowing those with experience and expertise in the field of a report to scrutinize and critique clinical studies or other scientific results before publication. 

Despite its successes, peer review has also had its challenges. To better understand the current challenges in peer review and to help shape its future direction, we need to understand its past. One of the earliest examples of peer review was discussed by Plato when he described the work of eminent physicians as being scrutinized by a Civic Council that included other physicians.² The introduction of the printing press in 1453 led to a relative explosion in written materials, including scientific and medical texts. In the 1870s, the invention of the typewriter and then the copy machine made the distribution of manuscripts to external reviewers easier, and journals such as Science and JAMA began to use external reviewers in the 1940s.² 

The rise of the internet in the current digital era has allowed information to be disseminated more quickly and more broadly, with less reliance on an individual or institution to select which journals to purchase in print or online, based, for example, on the number of citations as reflected by the impact factor. The improved ease of publishing online also has led to the increase of new, for-profit journals, as well as “predatory journals,” whose main interest may be generating income and wherein some articles may be accepted for publication without adequate review or quality control.³ Simultaneously, the perceived improved ease of submitting manuscripts online, as well as peer-reviewed publications being a key metric in academic evaluation, likely has contributed to an upsurge of manuscript submissions. As a result, the number of “extremely productive” authors has increased dramatically, particularly in the field of clinical medicine.⁴ The number of ophthalmology articles indexed in the Web of Science in 2019, just before the coronavirus disease-19 pandemic, was two times the number published in 2010, and then increased further in 2023 to three times the number published in 2010.⁵ 

Hand in hand with the growth of scientific publishing is the increased need for qualified peer reviewers, journal editors, and editors in chief who make decisions on acceptance for publications. However, a major challenge facing all ophthalmic journal editors has been identifying reviewers who are willing to provide time to evaluate manuscripts and return reviews within an expeditious time frame. Additionally, papers subsequently accepted for publication may be reviewed multiple times, so agreeing to review a paper may mean agreeing to review an original submission as well as one or more revisions. Adding to this challenge, the expertise required of some reviewers also has become more specific. In general, editors have experienced the dearth of available and willing reviewers as a major challenge, particularly in emerging research areas. To address these stresses on the peer-review process, the integration of large language models (e.g., ChatGPT) into the journal review workflow has been proposed as a possible solution.⁶ However, concerns with ChatGPT expertise, ethics, lack of human element, and user confidence will likely limit its ability to replace human reviewers,⁶ and its use for peer review is banned by some journals. Furthermore, in response to these new tools, some journals have begun to emphasize to reviewers not to submit confidential manuscripts, abstracts, or other text into a chatbot, language model, or similar tool, because confidentiality no longer can be controlled by reviewers once this material becomes part of the language model's servers.^8,9 

Difficulty with obtaining consistently high-quality evaluations from reviewers probably is another major challenge many journal editors are facing. Editors strongly rely on input from reviewers to help decide whether a submitted manuscript has met a standard of scientific rigor and is suitable for publication. A potential sign of a decrease in the quality of reviews is the increase in the number of retracted research papers. In 2023, more than 10,000 research papers were retracted, which set a new record,¹⁰ although the ability to use various tools, such as searching for duplicate images across publications may be contributing to the ability to detect such issues associated with retractions as well.⁷ 

Reasons people may volunteer to perform peer review include serving our peers, learning new information before it is published based on content within the submission, as well as feedback from other reviewers or editors contained within the decision letter with the review, and gaining general knowledge about one's own field. For trainees and early career faculty in particular, performing peer review has the additional benefits of career development by improving their writing skills for manuscripts and grant proposals and enhancing their understanding of peer review and the academic process. Because they are often closer to the technical aspects of the work or may have strong expertise in parts of the work that are being evaluated, trainees and early career faculty reviewers may be an under-recognized and underused pool of potential reviewers. 

Improving peer review and training the next generation of editors by tapping into the workforce of early career scientists may benefit from considering how peer review is taught. A large-scale, online survey of international biomedical researchers found most biomedical researchers have not received formal training in peer review and indicated that training was difficult to access or not available.⁸ Often, peer review is taught informally by senior mentors to their junior mentees or by learning on the job. There are many online resources for learning peer review, but a journal subscription is sometimes required to access these materials. The good news is that formal teaching in peer review is gaining momentum in medicine and various general medical journals and major publishers offer either teaching tutorials or formal mentoring programs. 

The Council of Vision Editors Fellow (CVEF) Program will launch this year as a novel peer review instruction program. This program is a collaborative effort between editors in chief of leading ophthalmic and optometric journals (American Journal of Ophthalmology, Investigative Ophthalmology & Visual Science, JAMA Ophthalmology, Ophthalmology, Ophthalmology Science, Optometry and Vision Science, and Translational Vision Science & Technology) and National Eye Institute leadership. The program will match early career academic ophthalmologists, optometrists, and vision scientists with vision journals for 2-year terms with the overall goal of providing some formal training and experience in the peer review and editorial process. Some of the specific objectives of the program include (1) mentoring early career faculty in the academic publication, editorial, and peer review process, and (2) potentially expanding the pipeline of future journal reviewers and editorial board members. The CVEF program is competitive, with a limited number of fellow positions each year. Active National Institutes of Health K and R00 awardees have been invited to submit an application for the first year of the program, because that was most feasible to get the program off of the ground promptly; however, the goal is to extend the application process to the broader community of early career individuals in the coming years. 

During their 2 years of program participation, each CVEF will be assigned two different journals for 1-year terms. Fellows will be paired with mentors from the journals’ editorial boards and will review at least four manuscript submissions each year. The review by the fellow is intended to supplement, and not replace, the usual reviews performed by other reviewers as overseen by the editors. Training also will include informal mentoring by the editors along with structured didactic instruction in the academic journal review process through webinars. The hope is that participants in this program will become qualified and prolific reviewers for these and other journals, potentially become future editorial board members, and hopefully become better at writing their own academic papers. 

The CVEF program represents a united effort between editorial leaders to improve peer review training. If successful, the program hopefully will improve peer review and editorial training. Although similar programs have been developed previously by specific journals, CVEF is for the entire eye field. The success of the program hopefully will serve as a model for other fields and thus has the potential for far-reaching impact beyond the fields of ophthalmology, optometry, and other areas of vision science. 

Acknowledgments

The Council of Vision Editors is comprised of the Editors in Chief of the American Journal of Ophthalmology, Investigative Ophthalmology & Visual Science, JAMA Ophthalmology, Ophthalmology, Ophthalmology Science, Optometry and Vision Science, and Translational Vision Science & Technology, including Richard Parrish II, MD, Joseph Carroll, PhD, Neil Bressler, MD, Russ Van Gelder, MD, PhD, Emily Chew, MD, Michael Twa, OD, PhD, and Roy Chuck, MD, PhD, respectively. The Council of Vision Editors and the Director the National Eye Institute (NEI), Michael Chiang, MD, critically revised this editorial for important intellectual content.