Factors influencing ophthalmology trainees' decision to pursue vitreoretinal surgery fellowship in Saudi Arabia: a cross-sectional study.

Background: The demand for vitreoretinal surgery (VRS) specialists is increasing globally due to the rising prevalence of retinal diseases such as diabetic retinopathy and age-related macular degeneration. In Saudi Arabia, the burden of retinal diseases is particularly high, with diabetic retinopathy affecting about one-third of diabetic patients. Despite this, factors influencing ophthalmology trainees' decisions to pursue VRS fellowship remain underexplored. This study aimed to identify the key factors shaping career decisions among ophthalmology trainees in Saudi Arabia.

Methods: A cross-sectional study was conducted between July and December 2024, targeting senior ophthalmology residents and vitreoretinal surgery fellows across Saudi Arabia. A purposive sampling method was used, and data were collected via an online survey adapted from a validated tool and assessed for content validity. The survey explored exposure to VRS, research opportunities, mentorship, and career motivations using a 5-point Likert scale. Descriptive statistics and nonparametric Mann-Whitney U tests were applied.

Results: A total of 61 trainees participated, of whom 35 (57.4%) reported pursuing a VRS fellowship. Male trainees were significantly more likely to pursue VRS than females (88.6% vs. 46.2%, p < 0.001). Most VRS pursuers reported deciding during residency years R2-R3, and 40% had performed over 100 cataract procedures. Major motivators included strong interest in complex surgeries (74.3%), advanced technology (51.4%), and the perceived prestige of VRS (54.3%). Exposure to VRS, research opportunities, and program match success were significantly associated with career choice, while mentorship and work-life balance played a lesser role.

Conclusion: The decision to pursue vitreoretinal surgery among ophthalmology trainees in Saudi Arabia is primarily influenced by early exposure, surgical complexity, and perceived prestige. Gender disparities remain evident, with male trainees more likely to enter VRS, partly due to limited female mentorship. Enhancing mentorship opportunities and fostering early exposure may help address these disparities and sustain interest in the subspecialty.