Closing the Transparency Gap in Ophthalmology Society Conflicts of Interest

Bondok and colleagues quantify a transparency gap in American ophthalmology society governance: in 2022, 65.0% of board members across 66 societies had financial relationships reported in the US Centers for Medicare and Medicaid Services (CMS) Open Payments database, yet only 2.5% had any conflict-of-interest (COI) information posted on society websites 1. Among the few societies that posted COI statements, most disclosures aligned with Open Payments; discrepancies were uncommon and mainly reflected ‘no COI’ declarations despite reported payments, suggesting that inconsistent society-level posting practices, rather than universal individual nondisclosure, drive much of the gap. An under-discussed signal in the results may help the field move from describing the gap to fixing it. Societies reporting written COI policies and annual disclosures in US Internal Revenue Service (IRS) Form 990 filings, the annual information return filed by US tax-exempt organisations, had higher, not lower, payment counts and values. One interpretation is that COI policies may be more common in larger, higher-resource organisations that already interact frequently with industry and therefore face a greater need to formalise governance processes. This association is also plausibly confounded by society size and reporting format, since only organisations submitting the long-form IRS Form 990 (rather than abbreviated filings that omit governance items) report these COI items. If so, the mere presence of a COI policy (captured as a binary yes/no item on Form 990) is a weak surrogate for meaningful transparency. The more actionable question is whether stakeholders can readily access, compare, and interpret leadership COIs in a decision-relevant way. Rather than expanding disclosure requirements, the more tractable next step may be to standardise how leadership COIs are generated, displayed and governed, so transparency becomes comparable, current and operational. A feasible way to improve accessibility and comparability is to shift from ad hoc posting to low-burden, standardised disclosure that requires minimal manual updating and leverages infrastructure already used to classify payment data. Rather than static PDFs or manually curated webpages (which are prone to drift, stale entries and inconsistent definitions), societies could adopt an automated, machine-readable disclosure module that links each board member to an unambiguous identifier (e.g., a US National Provider Identifier for clinician board members; ORCID iD when available for researcher board members, or a society-assigned unique board identifier for non-physicians). The module could present a rolling 36-month summary separated into general, ownership and research categories, with clear definitions and a stated update frequency (e.g., quarterly) on the page. Where available, it should indicate whether research payments were made to an institution (with the physician as investigator) and whether any entries are disputed. This separation matters in ophthalmology, where research and research-related payments constituted nearly 80% of reported dollars in the study 1. Presenting only a single aggregated total can imply direct personal benefit even when funds largely support trial infrastructure, although investigator-linked research support can still shape priorities and perceptions. Because patients consult Open Payments and form judgements about physician–industry relationships 2, societies can improve trust by providing standard, plain-language context alongside numeric summaries, rather than leaving the public to infer intent from raw totals. Finally, transparency should be paired with visible management. Disclosure alone does not show whether conflicted leaders recuse themselves from guideline votes, educational programming decisions, or advocacy positions, and declarations are often insufficient to mitigate influence 3. A low-cost next step would be for societies to publish annual ‘COI management’ metadata alongside financial summaries: committee rosters for guideline-writing groups, clear recusal/abstention rules and aggregate counts of recusals for major decisions. Even minimalist process reporting would make COI management auditable without demanding disclosure of confidential deliberations. Bondok and colleagues have measured the problem. The next advance is to standardise how disclosures are generated, displayed and operationalised, so stakeholders can distinguish collaboration from undue industry influence over society priorities, education and recommendations. The author has nothing to report. The author has nothing to report. The authors declare no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.