Outcomes of first cases of DMEK at a Canadian university hospital centreDescemet membrane endothelial keratoplasty (DMEK) provides better visual outcomes and lower rejection rates than Descemet stripping automated endothelial keratoplasty (DSAEK).1,2 However, steep learning curves, higher rebubbling rates, and failure risks have been noted.3–6 This study aimed to report and analyze the outcomes of the first DMEK cases in our university-based centre.
Features and management of strabismus from skull base chordomaChordomas are rare neoplasms derived from primitive notochordal remnants that almost always develop from bone and that can occur anywhere along the spinal axis from the clivus to the sacrum.1,2 Fifty percent of these tumours occur in the sacrococcygeal area, 35% arise from the clivus, and 15% arise elsewhere in the vertebral column.3 Skull base chordomas account for 0.3%–1.0% of intracranial tumours.4 Chordomas can develop at any age, but they typically affect patients in the third, fourth, and fifth decades of life.
Clinical course and poor prognostic factors of Vogt–Koyanagi–Harada disease in a tertiary uveitis clinicVogt–Koyanagi–Harada (VKH) disease is an autoimmune inflammatory disorder that can present with ophthalmic, neurologic, auditory, and dermatologic manifestations.1 In this study, we investigated possible factors that might subsequently result in poor visual function.
Impact of coronavirus disease 2019 (COVID-19) on the ophthalmology training of Canadian medical studentsThe coronavirus disease 2019 (COVID-19) pandemic has disrupted medical education across the globe due to unique logistical challenges and physical-distancing protocols.1 For this reason, medical educators have had to adapt to these unprecedented times at a rapid rate. Concerns with ophthalmology's representation in medical school curricula were identified before the 2020 pandemic.2–4 An increasingly crowded medical curriculum has led to the erosion of ophthalmology education for undergraduate medical students.
Appointment trends in new and established patients in ophthalmology and optometry during a pandemicIn response to COVID-19 being formally declared a pandemic, US health care systems implemented protocols aimed at mitigating risk for both patients and providers.1 The American Academy of Ophthalmology and American Optometric Association recommended delaying all elective ambulatory provider visits and rescheduling routine ophthalmic visits.2,3 Although these measures reduced the potential for transmission, little is known about how outpatient ophthalmic care has been affected. The current study evaluated the effect of the COVID-19 lockdown on both new and established patients of different disease acuity scheduled to be seen in optometry, general, and subspecialty clinics.
Accuracy of self-reported risk factors for hydroxychloroquine retinopathyHydroxychloroquine (HCQ) is an effective and typically well-tolerated anti-inflammatory medication, but retinal toxicity is a potential side effect.1 Current screening guidelines recommend baseline ophthalmic examination to rule out maculopathy and then yearly examination with visual field and optical coherence tomography after 5 years of HCQ use.1 The presence of HCQ retinopathy risk factors,2 such as HCQ duration ≥5 years, HCQ daily dose >5 mg/kg real body weight, tamoxifen use, or renal disease, should increase suspicion for retinopathy and may modify the retinopathy screening timeline.
Profile of glaucoma surgical and laser procedures in Alberta from 2003 to 2018Glaucoma is the leading cause of irreversible blindness worldwide and increases in prevalence with age across all ethnic groups.1 The volume of various glaucoma procedures may fluctuate with disease prevalence, introduction of new therapies, changes in practice patterns, and number of surgeons. Evaluating trends in different glaucoma procedure utilization rates is critical for health policy planning. Given the recent introduction of micro-invasive glaucoma surgery (MIGS), prior studies have not assessed its influence on the volume of different glaucoma procedures.
Low prevalence of fibrate use in adults with type 1 and type 2 diabetes and established diabetic retinopathyDiabetic retinopathy (DR) is common, with estimated prevalences of 25% (type 2 diabetes [T2D]) and 77% (type 1 diabetes [T1D]).1 The estimated 10-year cumulative incidence of DR is 67% (T2D not on insulin), 79% (T2D on insulin), and 89% (T1D)2 and at 25 years is 97% (T1D).3 DR comprises 3 processes: (i) nonproliferative DR (microaneurysms, intraretinal hemorrhages, intraretinal microvascular anomalies) and proliferative DR (neovascularization, vitreous hemorrhage, tractional retinal detachment); (ii) diabetic macular edema (ME), from vessel leakage within the macula; and (iii) macular ischemia.
Enhancing medical professionals’ and students’ empathy for visually impaired patients using virtual realityPhysician empathy—a cognitive attribute that involves understanding the patients’ experience, concerns, and needs to effectively communicate with the intention to help1—has been associated with improved patient outcomes.2 Yet, there remains a deficit in the available tools and interventions for increasing empathy for the visually impaired.
Ocular injury in pediatric patients admitted with major traumaAn estimated 2.4 million eye injuries occur in the United States annually, 35% of which occur in children under the age of 17years.1 Ocular trauma is a leading cause of childhood visual impairment and blindness and concurrence with other trauma can result in complicated rehabilitation and can negatively affect development. However, few reports detail the effects of polytrauma in pediatric patients admitted with ocular injuries.2–4 We sought to evaluate the epidemiology of these patients using the National Trauma Data Bank (2008–2014).
Conjunctival carriage of SARS-CoV-2 using serial sampling: risk factors and protective factorsTo date, there remain many unknowns regarding ocular involvement in COVID-19. Various studies have reported conflicting rates of conjunctival carriage of SARS-CoV-2 (Table 1). A cross-sectional study on 1099 patients in China found only 0.8% of COVID-19 patients developed conjunctival congestion,1 whereas a recent meta-analysis found the pooled prevalence of ocular manifestations among COVID-19 patients was 5.5% and the sensitivity of detecting SARS-CoV-2 in ocular fluids was merely 0.6%.2 The low detection rate may suggest a low incidence of viral infiltration into ocular surface or may be due to variations in sampling technique, sampling time window, and underrepresentation from critical cases.
New virtual CaRMS: perspectives from residency programsThe coronavirus disease 2019 (COVID-19) pandemic will have long-lasting effects on health care, ranging from clinical practice to medical education. Since March 2020, the Association of Faculties of Medicine of Canada and medical schools across the country have been responding to the outbreak by taking numerous precautionary measures. These measures have resulted in a compressed and delayed timeline for all medical trainees, especially the class of 2021. Canadian program directors and residency selection committees are facing unprecedented challenges for the recruitment and assessment of applicants in the upcoming cycle, in particular with the cancellation of visiting electives.
Risk factors for central retinal artery occlusion in young patientsThe acute irreversible loss of vision associated with central retinal artery occlusion (CRAO) can be devastating, especially in young patients. The literature has revealed potential risk factors, including hypercoagulability, trauma, sickle cell disorders, cardiac valvular disease, carotid stenosis, use of oral contraceptives, pregnancy, collagen vascular disease, increased intraocular pressure, optic nerve drusen, congenital prepapillary arterial loop, intravenous drug abuse, migraine, vasculitis, and perioperative factors in young patients with CRAO.
First-dose effects with intravitreal aflibercept in wet age-related macular degeneration: a post-hoc analysis of VIEW-1 and VIEW-2 phase 3 studiesA post-hoc analysis of data from the VEGF Trap-Eye: Investigation of Efficacy and Safety in Wet AMD (VIEW) studies1 was conducted after publication of best-corrected visual acuity (BCVA) data from the Development of Macular Atrophy in Patients with Neovascular Age-Related Macular Degeneration: A Comparison of Ranibizumab and Aflibercept (RIVAL) study. BCVA results from RIVAL suggested (although not a predefined endpoint) a delayed improvement with intravitreal aflibercept (IVT-AFL) versus ranibizumab (RBZ) in treatment-naïve patients with neovascular age-related macular degeneration (nAMD).
Transition from retrobulbar to subtenon anaesthesia in ocular surgery: a surgeon's perspectiveAnaesthesia and akinesia are desirable in ocular surgery. Although effective, retrobulbar anaesthesia (RBA) carries the risk of serious complications.1 Subtenon anaesthesia (STA) is an alternative anaesthetic technique with a better safety profile.2,3
A national survey of Canadian women in ophthalmology: on role models, mentorship, and communities of practiceThe proportion of women in ophthalmology has been increasing, from 3.1% in 1970 to 20.5% in 2011.1 In 2019, there was no sex difference in the match rate to Canadian ophthalmology residency, yet female matriculants accounted for only 35% due to fewer applicants.2 The leaky pipeline of academic medicine persists, with fewer women attaining leadership positions.3 This perpetuates a cycle whereby fewer women serve as role models and mentors, with a downstream impact on female medical trainees.
Perspectives on virtual ophthalmology education among Canadian medical studentsOcular complaints are common in primary and emergency care settings, yet the quantity and quality of ophthalmology education vary significantly across Canada, and medical students report not receiving sufficient ophthalmic knowledge from their medical school curricula.1–3 Time constraints, an explosion of medical knowledge in other specialties, and the coronavirus disease 2019 (COVID-19) pandemic have led to a reduction in undergraduate ophthalmology teaching.4,5 Reduced in-person clinical teaching to accommodate safety protocols in the post-COVID-19 era may result in many medical trainees graduating with inadequate ophthalmic knowledge and skills.
Absence of severe acute respiratory syndrome coronavirus 2 in ocular postmortem studiesThe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes the coronavirus disease 2019 (COVID-19), has infected over 15 million people and caused over 600 000 deaths globally, as of July 26, 2020.1 Interestingly, the pooled prevalence of ocular manifestations among COVID-19 patients is thought to be as low as 5.5%,2 with conjunctivitis accounting for the majority. Alongside this there has been considerable interest as to whether ophthalmic surgery can generate aerosols and ultimately whether such surgery can result in possible transmission.
Undergraduate ophthalmology education in Canadian medical schools: a cross-sectional surveyIn recent years, concerns have been raised about the adequacy of ophthalmology education in Canadian medical schools. A 2009 survey of recent Canadian medical school graduates reported that the majority of graduates believed that they did not obtain sufficient ophthalmology knowledge or skills during medical school.1 To improve undergraduate ophthalmology training, it is necessary to have an understanding of the current curricula in Canadian medical schools. The last study to describe the ophthalmology training provided in preclerkship and clerkship in Canada was conducted in 1998, and therefore an updated evaluation was warranted.
Treatment of corticosteroid-resistant thyroid eye disease with subcutaneous tocilizumabWithin the last decade, novel biologics have emerged as a promising treatment for thyroid eye disease (TED), both as primary therapy and as an alternative to methotrexate or radiation in patients with steroid-refractory disease. Upregulation of several cytokines, including interleukin-6 (IL-6), have been implicated in the pathogenesis of TED.1 Tocilizumab (RoActemra, Hoffman-La Roche, Basel, Switzerland) is a recombinant humanized monoclonal antibody inhibitor of the IL-6 receptor. Its off-label intravenous use has been previously described in 2 case reports and a randomized trial to demonstrate clinical improvement in corticosteroid-resistant TED.
Distribution of recurrence time intervals after anti-vascular endothelial growth factor therapy for myopic choroidal neovascularizationMyopic choroidal neovascularization (mCNV) is one of the most sight-threatening complications of pathological myopia. Currently, anti–vascular endothelial growth factor (VEGF) therapy is a standard treatment strategy for mCNV.1 Once the CNV activity was ceased after initiating the therapy, patients were followed up every month and were generally treated as soon as recurrence was observed (pro re nata; PRN protocol). The continuous visits for examination pose a burden for patients and health care providers.
Incidences of microorganisms isolated from neonates’ eye swabs in Eastern OntarioWe read with interest the debate on whether the Canadian Paediatric Society should advocate rescinding neonatal ocular prophylaxis regulations.1,2 Effective 2019, Ontarian parents may opt out mandatory prophylactic eye treatment to almost all newborns.3 Nevertheless, not all clinicians and parents are well informed of the interpretation of Neisseria gonorrhoeae susceptibility result and incidences of microorganisms isolated from neonates’ eyes.
FLACS ophthalmic viscosurgical device press to prevent radial anterior capsular tearsThe quality of the capsulotomy created by femtosecond lasers has been an issue.1 An American Society of Cataract and Refractive Surgery (ASCRS) committee 2013 review quoted the incidence of incomplete femtosecond laser assisted cataract surgery (FLACS) capsulotomies as having been reduced from over 10% initially, to about 1%.2 However, in 2015, a large series (>4000 eyes) revealed 1.84% anterior capsular tears with FLACS compared with 0.22% with phaco (p < 0.0001).3
Extraocular muscle fenestration: a novel weakening procedureIn 1922, Jameson introduced the scleral suturing technique as a graded method for extraocular muscle weakening, and since that time it has become the nidus for modern-day conventional recessions.1 Recently, sutureless ocular surgeries have rapidly evolved and become more popular. In this report we describe a new sutureless strabismus surgical technique for weakening of the extraocular muscles that was conceived by the senior author (M.R.).
Spectral-domain optical coherence tomography features in cases of pre-eclampsia and the relationship with systemic parametersPre-eclampsia is a multisystem progressive disorder characterized by the new onset of hypertension and proteinuria or end-organ dysfunction in the last half of pregnancy.1 The prevalence of retinal involvement may vary according to the severity of pre-eclampsia.2 The correlation between systemic features and retinal morbidity in pre-eclamptic women is still controversial.2–5 To the best of our knowledge, there is lack of data regarding the correlation between other systemic features and retinal morbidity.
Endothelial dysfunction after scleral lens use in patients with herpetic eye diseaseHerpes simplex virus and varicella zoster virus (VZV) affect approximately 4 billion individuals globally. When the infection involves the ophthalmic division of the trigeminal nerve (V1), they are termed “herpetic keratitis” (HK) and “herpes zoster ophthalmicus” (HZO). The estimated incidence of VZV is 4/1000 people, with approximately 10–20% of cases demonstrating ocular involvement.1 HK has been approximated to affect 1.5 million people with an estimated incidence of 11.8/100,000. Together, these are thought to be the leading cause of infectious ocular blindness in the developed world.
National survey of Canadian Retina Society members on guidelines for ophthalmic care during the COVID-19 crisis: Canadian Retina Research Network (CR2N) COVID-19 Steering Committee analysisAn anonymous survey was designed by the Canadian Retina Research Network coronavirus disease 2019 (COVID-19) Steering Committee to assess awareness of, confidence in, and adherence to recent guidelines released by the Canadian Ophthalmology Society (COS) and Canadian Retina Society (CRS) for ophthalmic care during the COVID-19 pandemic.1,2 The survey was pilot-tested and validated with 9 content experts. It was then distributed via email to physician members of the CRS in May 2020 with one reminder email to maximize response rate.
Face and content validity of the SimulEYE A-Vit model for anterior vitrectomyThe ability to perform a successful anterior vitrectomy is a necessary skill for any cataract surgeon due to the nontrivial rate of posterior capsular rupture (PCR). PCR has been reported to occur in up to 5.2% of recent North American phacoemulsification surgeries, though estimates as high as 8.9% have been reported for inexperienced practitioners.1–3 PCR causing vitreous loss is associated with increased risk of complications, including retinal detachment, cystoid macular edema, and endophthalmitis.
National Ophthalmologist Wellness Survey (NOWS) 2019Recognizing the importance of physician health and wellness, and its impact on patient care and productivity, in 2017 the Canadian Medical Association (CMA) launched the online National Physician Health Survey (NPHS)1 to obtain data on the health and wellness of Canadian doctors. Although ophthalmologists who were members of the CMA were invited to participate, there was no specific category dedicated to ophthalmology. Instead, it was placed under the umbrella of surgical specialties. Due to unique differences in ophthalmology from other surgical specialties (including the fact that a significant number of ophthalmologists do not have a surgical practice),2 the authors believed that there is a need to obtain Canadian data specific to ophthalmology.
Physicians' access to primary care: results from the Canadian Medical Association National Physician Health SurveyHistorically, the medical culture has promoted a climate of self-sacrifice, with a prioritization of patient needs above all else—including physicians’ own self-care.1 The 2017 Canadian Medical Association (CMA) National Physician Health Survey revealed 30% burnout, 34% depression (screening), and 19% lifetime suicidal ideation in Canadian residents and physicians (N = 2947).2 These results are concerning and highlight the need to shift the medical culture to support self-care, and for occupational barriers to access be addressed.
Management of patients with ocular neuropathic painThe cornea, although relatively small, measuring 11.5 mm in diameter and 0.5–0.8 mm in thickness, is one of the most densely innervated structures of the human body.1 The nerves of the cornea are susceptible to damage by noxious stimuli, resulting in perception of pain. If pain is apparent in response to benign stimuli, and/or beyond the phase of normal healing, this condition is aptly named “neuropathic pain.” Other terms used to describe this condition include “pain without stain,” “corneal neuralgia,” “keratoneuralgia,” and “corneal pain syndrome.” It has been demonstrated previously that development of keratoneuralgia can occur after iatrogenic intervention, systemic disease, and chronic dry eye.
Validity and reproducibility of ophthalmologist photo grading of diabetic retinopathy and glaucomaScreening for diabetic retinopathy (DR) is an important component of diabetes management to prevent vision loss, yet many diabetic patients do not receive screening eye examinations.1 Tele-ophthalmology programs administering fundus photographs offer a potential solution, and technological advances have made automated photo-interpretation a real possibility.2 Automated algorithms are typically trained on images whose disease status has been classified by a human, so the validity of human grading is important.
Anterior approach levatorpexy for correction of congenital ptosisWe describe a novel modification of levator advancement for congenital upper eyelid ptosis, in a case series. Written informed consent was obtained from all patients/parents. Local institutional review board approval was granted.