The American Journal of Ophthalmology (The Journal ) is an international journal, which is also true of the other leading general ophthalmology journals. A review of the manuscripts submitted over the past 1-year period provides an opportunity to highlight the achievements of international ophthalmology and also to characterize, for the authors and readers, a glimpse into the previously unknown processes, activity, and decisions made during the peer review process of the Journal Editorial Board. Just as we demand of the authors and their manuscripts, the Journal strives to provide transparency in the publication process to the extent possible.
There were 1042 full-length original manuscripts submitted to the Journal between October 1, 2009 and September 30, 2010, with 740 sent out for full peer review; the remainder were rejected prior to full peer review by the Editor in Chief or by the executive section editor for various reasons, especially as it has become necessary to conserve the resources of our reviewers. Medical journals, in general, are experiencing more difficulty obtaining timely and satisfactory peer review, in part related to the proliferation of both print and online-only ophthalmology journals. The copyediting provided by the publisher is modest and therefore the Journal staff does not have the luxury or patience to rewrite articles; manuscripts must be in polished, publishable format when submitted and the process should not be used as a teaching experience for novice authors. In fact, 41% of initially submitted manuscripts are not even ready for peer review and must be returned to the authors by the office for formatting or content corrections before they can be sent to the peer reviewers; peer reviewers have already demonstrated that they are not willing to review poorly prepared or incomplete manuscripts.
The number of manuscripts submitted to the Journal has increased steadily over the past few years. The majority of the 1042 full-length manuscripts submitted during that 1-year window were from the United States (273), followed by Japan (141), China (91), and the Republic of Korea (63), but including 49 other countries. The 17 countries with most submitted manuscripts are listed in Supplemental Table 1 (available at AJO.com ).
The Journal assigns the manuscripts into subspecialty areas for peer review. This is an artificial classification as many manuscripts may have overlap or do not fit well in the specific area. Over the past several years, the Journal has received the largest number of manuscripts in the area of retina and glaucoma, but it has a broad range of submissions in all the clinical fields ( Supplemental Table 2 , available at AJO.com ).The Journal does not attempt to balance each issue among the specialties but accepts manuscripts with the highest priority scores and publishes the articles in the order accepted, except for the expedited articles and the occasional special focus journal issue.
The content experts in the subspecialty fields of ophthalmology from the Journal Editorial Board selected and invited reviewers to perform peer review on the 740 full-length manuscripts. In the Journal manuscript system, there are over 3500 individuals who have agreed to review manuscripts (and authors or reviewers can suggest others that we can try to solicit for reviews). The Journal submission system also permits the Editorial Board or peer reviewers access to robust scientific search engines (Scopus, Scirus) that lead to other articles related to the same topic or by the same authors. Reviewers function under a voluntary, non-reimbursed system depending on professional courtesy.
The 740 manuscripts sent for complete peer review were associated with 4468 invitations to review in an attempt to attain 3 reviews of each manuscript (the Editor in Chief is always a fourth reviewer). The majority of peer reviewers were from the United States (3030), with the next most frequent from India, Japan, and the United Kingdom, and then 49 other countries ( Supplemental Table 3 , available at AJO.com ). About 42% of reviewers accepted the invitation to review and completed the review, 21% of reviewers declined the invitation, and 37% did not reply to the invitation to review within 7 days. There were 89 reviewers who accepted the invitation to review but never completed the review in a timely fashion so were later uninvited (in order to move the manuscript along the peer review process). The invitation to review is extended for 7 days and the review is expected to be completed within 15 days following acceptance of the invitation. About 57% of manuscripts are reviewed within the requested time frame. The 43% delayed peer reviews are a source of frustration for the Board as well as the authors, and this percentage has been increasing in the last few years. Automated reminders were sent to 1157 reviewers after they failed to provide the review in the requested time. The average number of days until the author is notified of the decision is 45.8, but authors take an average of 50 days to reply to the revision requests; these numbers have been fairly constant over the past several years. As might be anticipated, the outside peer reviewers were more likely to recommend revision or acceptance compared to the more experienced Board Member, but it is the Editor in Chief, by virtue of knowing the full range of available manuscripts and available print space, who prunes the acceptable manuscripts even further.
The Journal accepted 257 of the 1042 (24%) full-length submitted manuscripts; however, if you include only the 740 manuscripts sent for complete peer review, then the acceptance rate was 257 of 740 (35%). Numbers of manuscripts accepted from the top 17 ranked countries are shown in the third column of Supplemental Table 1 . Since 88 of the 257 accepted manuscripts are from a U.S. corresponding author, the majority (169 of 257 [65%]) of accepted manuscripts came from international authors.
When the Journal stopped publishing Brief Reports a few years ago the acceptance rate for the full-length manuscripts increased slightly (as intended) but then declined as the number of submissions steadily increased. The Journal is limited by its print publication pages each month and also does not wish to have a long lag time between acceptance and publication. The Journal has resisted the trend to publish some articles online-only for various reasons, not the least of which is the continued requirement for good peer review and the proliferation of other alternative options for authors in ophthalmic journals, including online-only journals. The Editorial Board is not convinced that more articles equal a better journal for clinicians, although authors may disagree. The time from acceptance to publication has been less than 5 months over the past few years, with some articles receiving expedited publication; the expedited publication in print is not really necessary since the article draft becomes available to subscribers about 6 weeks after acceptance in the InternetAdvance section at AJO.com (and is rapidly picked up by search engines and the tabloids).
There are very few outright acceptances of manuscripts. About 20% of returned revised manuscripts are accepted in the first revision; 80% of manuscripts undergo repeated requests for revision, with the revision requests usually repeating the initial requests or requesting the authors to actually follow the Author Information at AJO.com . Authors could have their manuscripts published earlier and would save the AJO staff significant time if they would carefully read each revision request the first time; also, many authors do not have sufficient experience with digital figure creation and should seek professional assistance early.
The Journal requests authors to declare if the submitted manuscript has been rejected by a prior journal and what they have done to improve the manuscript since the rejection. Of the 1042 full-length manuscripts received, the authors indicated that 214 were previously rejected; 45 (21%) were later accepted by the Journal , an acceptance rate comparable to the rest of our submissions.
Under the present electronic submission system and because ophthalmology journals all draw reviewers from almost the same pool, and because journal editors occasionally communicate with each other, several irregular behaviors by authors can be easily detected. The peer reviewers each year detect instances wherein articles have been submitted and rejected by other journals but this information was not volunteered by the authors; as indicated above, the Journal does not hold a prior rejection against the manuscript, but it does not sit well with the Editorial Board when the authors deny it and have made no efforts to improve the manuscript after the first journal review and rejection. Another unacceptable scenario, and grounds for immediate rejection, is the simultaneous submission of the same manuscript to several journals; this action requires that the editors take this unethical matter up with the authors’ institution.
The Journal ‘s impact factor, which is calculated yearly for those journals that are indexed in Thomson Reuter’s Journal Citation Reports , has risen each year since 2002, where it was 1.98, to 2009 (the last one available), where it is now 3.83; the Journal continues to be among the elite journals in ophthalmology.
The Journal does not have access to similar data to compare our peer review process with other ophthalmology journals, but the dedicated Journal Editorial Board and staff strive to provide the best and most efficient product under our purview. Despite many attempts to improve or hasten the peer review process of the Journal , similar data regarding the peer review process have been repeatable over the past few years. The real limiting factor is flow through the voluntary peer reviewers and the delayed reply of the authors to revision requests. Like most journals, the Journal does not have a process for rewarding the reviewers, other than the listing in the Journal once a year. The Journal could also institute a more strict revision return policy for authors.
Hopefully this glimpse into the process of the Journal over a 1-year period will stimulate both reviewers and authors to participate more actively in providing the readers important content in ophthalmology. Since 65% of accepted articles were from international authors, the Journal is truly an international journal of high impact.