Ophthalmology Residency Program Characteristics and Timing of Commitment to Pediatric Ophthalmology Fellowship

PURPOSE: To characterize pediatric ophthalmology exposure, surgical experience, and mentorship in U.S. ophthalmology residency programs and to describe the timing of subspecialty commitment among pediatric ophthalmology fellowship alumni. METHODS: This was a cross-sectional study of two anonymous surveys (July to October 2025). Survey 1 queried program directors and coordinators from U.S. ophthalmology residency programs regarding curriculum structure, pediatric ophthalmology exposure, and surgical volume, retinopathy of prematurity (ROP) training, and mentorship access. Survey 2 queried pediatric ophthalmology fellowship alumni from Wills Eye Hospital regarding training experiences and timing of subspecialty commitment. Ordinal responses were summarized using medians and interquartile ranges. Categorical ranges were analyzed using midpoint estimation but reported using original response categories. Associations were evaluated using descriptive statistics and nonparametric tests. RESULTS: Survey 1 had a 61.3% response rate (76/124), and Survey 2 had a 72.5% response rate (50/69). Most programs offered dedicated pediatric ophthalmology rotations (93.4%) and formal didactics (97.4%). Median pediatric ophthalmology exposure was 10.5 weeks. Primary surgical volume most commonly ranged from 11 to 20 cases. Programs with ≥3 pediatric ophthalmology faculty members more frequently reported excellent mentorship (84%) than programs with a single faculty member (50%). Availability of ROP training did not differ by geographic setting. Among alumni, 66% reported deciding during residency, including 44% by post-graduate year-2. CONCLUSIONS: Programs with ≥3 faculty and 9 to 12 weeks of exposure more often reported strong mentorship. Despite widespread curricular availability, variation in mentorship capacity may contribute to recruitment gaps. Because most fellows decide during residency, structured exposure and longitudinal mentorship are modifiable factors that may support recruitment and workforce sustainability.