Editorial Affiliation and Subconscious Bias in High-Impact Ophthalmology Journals

Background: Editorial leadership plays a critical role in shaping the scientific literature. Transitions in editors-in-chief (EICs) may introduce subconscious biases, particularly favoring their home institutions, potentially influencing publication patterns. Purpose: To evaluate whether editorial transitions are associated with increased institutional publication representation in major ophthalmology journals and to assess the potential for subconscious or reciprocal editorial bias. Methods: A retrospective bibliometric analysis of four high-impact ophthalmology journals, JAMA Ophthalmology, Ophthalmology, American Journal of Ophthalmology (AJO), and British Journal of Ophthalmology (BJO), was conducted over a 15-year period (2010-2024). Institutional affiliation data were extracted from Scopus and analyzed using two-tailed t tests to compare mean institutional publication percentages before and after EIC transitions. BJO, a UK-based journal employing single-blind peer review, was included to increase generalizability beyond U.S. journals. Results: Significant increases in institutional representation following EIC transitions were observed in JAMA Ophthalmology for Johns Hopkins/Wilmer (2.5% to 11.34% p = 0.03), Bascom Palmer (0.62% to 4.53% p = 0.003), Cleveland Clinic (0.47% to 2.62% p = 0.009), and University of Washington (0.31% to 1.51% p = 0.03). In Ophthalmology, increases were observed for Mayo Clinic (1.47% to 3.17% p = 0.045), Cleveland Clinic (0.98% to 2.92% p = 0.01), and University of Washington (0.30% to 1.38% p = 0.003). BJO demonstrated a significant increase in publications from Moorfields Eye Hospital after an EIC transition (4.12% to 6.80%; p < 0.001). AJO showed no significant changes. Evidence of reciprocal publication bias was identified, including significant increases for Johns Hopkins/Wilmer (p = 0.017) and UCSF (p < 0.001) in JAMA Ophthalmology during corresponding EIC tenures at Ophthalmology. Conclusion: Editorial transitions are significantly associated with increased institutional representation, particularly for the EIC’s home institution. This effect appears more pronounced in journals employing single-blind peer review. These findings support the need for double-blind peer review, diverse editorial boards, and transparent editorial policies to reduce subconscious bias and promote equity in academic publishing.