Canadian Ophthalmological Society Research Articles

Glaucoma Severity Stage at First Visit at a University Eye Clinic in Congo.

Initial presentation of glaucoma at a major eye clinic mostly features advanced disease with a high proportion of blindness. This is likely a microcosm of a nationwide issue requiring concerted strategies to detect glaucoma early. To characterize the severity stage of new glaucoma patients and identify the predictors of late presentation in Congolese attending a university eye clinic. New glaucoma patients (n=118) were labelled as early or late presenters based visual field sensitivity in the worse eye. Predictors of late presentation were determined through logistic regression analytical models. Mean age was 58.9±15.7 years, 51.7% were males. Overall, the worse eye had advanced whereas the better eye had moderate glaucoma, with an asymmetry of -7.4dB (P<0.001). Blindness was present in 30.5% of worse and 5.1% of better eyes. Seventy-two patients (61.0%) were late presenters. Visual acuity was lower (P<0.001), intraocular pressure (IOP) higher (P=0.02), cup-to-disc ratio larger (P=0.011), and retinal nerve fiber layer thinner (P=0.001) in late presenters' worse than better eye. The worse and better eyes of late presenters had advanced glaucoma, with a -9.6dB interocular asymmetry (P<0.001); 40.3% and 8.3% were blind, respectively. In early presenters, the worse and better eye had moderate and early disease, respectively; the asymmetry was -3.2dB (P<0.001), and 15.2% were blind. Overall, 58.5% and 65.3% presented with advanced disease in the worse eye based on visual field and cup-to-disc ratio criteria of the Canadian Ophthalmological Society staging scale, respectively. Most new glaucoma patients had bilateral advanced but asymmetric disease. These findings call for the establishment of community-based measures for early detection of glaucoma and a referral network system connecting community healthcare to tertiary eye clinics.

Effects of low-vision rehabilitation on reading speed and depression in age-related macular degeneration: A systematic review and meta-analysis

Age-related macular degeneration (AMD) is a prevalent eye disease, which can lead to vision loss, impacting daily functioning. This study aimed to evaluate the effect of low-vision rehabilitation techniques such as magnifiers, telescopes, and microperimeter feedback, on improving reading speed and reducing depression in AMD patients. This study is a systematic review and meta-analysis. A systematic search of databases MEDLINE (OVID), EMBASE (OVID), and CINHAL (EBSCO), gray literature including ClinicalTrials.gov and ProQuest Dissertations and Theses Global (ProQuest), Conferences of The Association for Research in Vision and Ophthalmology, American Academy of Ophthalmology, and Canadian Ophthalmological Society were done from inception to 27 July 2022. Fixed-effect and random-effect models were applied to account for heterogeneity between studies. Publication bias was checked through funnel plots. A total of 33 studies (2611 subjects) were included;14 studies were included in the meta-analysis (1123 subjects) and 19 were included in the qualitative analysis. We found a non-significant increase in reading speed (effect size [ES] = 0.02, 95% confidence interval [CI] = [−0.18, 0.23]) for studies comparing patients who received no low-vision rehabilitation, versus the intervention group of AMD patients who received low-vision rehabilitation. We also found a significant decrease in reading speed (ES = −0.92, 95% CI = [−1.46, −0.39]) between studies evaluating the difference in reading speed at baseline visits compared to the follow-up visits in AMD patients who received low-vision rehabilitation. Low-vision rehabilitation was also found to result in a decrease in depression severity when compared to control groups, as well as from initial assessment to subsequent follow-up visits. Individuals with AMD who engaged in low-vision rehabilitation demonstrated improved reading speeds compared to their own baseline and to those who did not receive any interventions. Furthermore, these interventions also contributed to a reduction in symptoms of depression.

Closing the Gender Gap Among Canadian Ophthalmology Societies

ABSTRACT Objective To evaluate gender distribution in Canadian ophthalmology societies’ leadership and to determine associations between gender, academic productivity, and institutional rank. Methods We identified members and assessed their gender composition using publicly available updated webpages. SCOPUS database was used to gather research metrics. Results In this study, data was collected from 12 Canadian ophthalmology societies, which included 277 executive committee members. Of these, 70.5% (196) were male and 29.1% (81) were female (p < .0001). Males were significantly more prevalent in presidential leadership roles (39 males vs. 23 females, p = .02), while females were more represented in other leadership categories (77 females vs. 61 males, p = .03). The Canadian Ophthalmological Society (COS) showed an upward trend in female representation from 19.2% in 2016 to 42.3% in 2021. Research productivity showed a positive correlation with society leadership rank, with a correlation coefficient of 0.732 for the m-index (p < .001) and 0.356 for the h-index (p < .05). Academic rank was also positively correlated with society leadership rank, with a correlation coefficient of 0.536 (p < .001). There was no significant difference in h-index (12.7 ± 1.0 for males vs. 13.8 ± 1.5 for females, p = .85) or number of publications (48.6 ± 5.1 for males vs. 60.0 ± 11.3 for females, p = .83) between male and female executive members, but females had a higher m-index (0.67 ± 0.05) compared to males (0.58 ± 0.03, p < .05). In academic rank, males were more likely to be associate professors (25% vs. 5% for females, p = .0001) or instructors (14.8% vs. 6.3% for females, p = .05), while a higher proportion of females held assistant professor positions (47.5% for females vs. 30.1% for males, p = .006). Conclusion In this study, we found that males were more prevalent in executive positions, particularly in presidential roles among Canadian ophthalmology societies. The gender distribution in leadership reflected the gender composition of practicing ophthalmologists in Canada. There was a positive correlation between research productivity and society rank, as well as academic position and society rank. Male and female executive members had similar h-index and number of publications, but females had a higher m-index. These findings highlight the need for continued efforts to address gender disparities in ophthalmology leadership.

Comparison of 3D heads-up display system with conventional surgical microscopy for minimally invasive glaucoma surgery on an artificial eye model

ObjectifComparer un nouveau dispositif de visualisation tête haute en 3 dimensions (3D) au microscope chirurgical classique dans la chirurgie du glaucome à effraction minimale (MIGS, pour minimally invasive glaucoma surgery) sur un modèle d’œil artificiel et évaluer l'opinion des chirurgiens ophtalmologistes à cet égard. Matériel et MéthodesAinsi, 21 ophtalmologistes qui participaient au congrès annuel de la Société canadienne d'ophtalmologie de 2021 à Halifax (Nouvelle-Écosse) ont pris part à une activité de transfert des compétences de 90 minutes sur la MIGS. À l'aide d'un modèle d’œil artificiel (SimulEYE iTrack; InsEYE LLC, Westlake Village, Californie), les participants ont réalisé des MIGS à l'aide d'un dispositif de visualisation tête haute en 3D (Zeiss Artevo 800; Carl Zeiss Meditec, Iéna, Allemagne) et d'un microscope chirurgical classique. Par la suite, les participants et les formateurs ont rempli un formulaire de 16 questions en vue de comparer les 2 systèmes (dispositif de visualisation tête haute en 3D vs microscope chirurgical classique). Les réponses ont été enregistrées sur une échelle Likert double en 9 points s’échelonnant comme suit : de fortement en faveur du dispositif de visualisation tête haute en 3D (1) à fortement en faveur du microscope chirurgical classique (9). Le test U de Mann–Whitney pour analyse non paramétrique a servi à comparer les réponses des formateurs à celles des participants, de même que les réponses des experts à celles des novices. RésultatsLes réponses favorisaient le dispositif de visualisation tête haute en 3D par rapport au microscope chirurgical classique; pour l'ensemble des questions, elles variaient de 1 (fortement en faveur du dispositif de visualisation tête haute en 3D) à 5 (équivalence des dispositifs). Le test U de Mann–Whitney n'a pas relevé de différence significative entre les réponses des formateurs et celles des participants, ni entre celles les experts et des novices. La plupart des évaluations favorisant le dispositif de visualisation tête haute en 3D portaient sur la configuration ergonomique du modèle chirurgical, la profondeur de champ et/ou le champ d'observation de même que sur son utilité pour entraîner des résidents à réaliser des MIGS. Les évaluations qui indiquaient une équivalence entre le dispositif de visualisation tête haute en 3D et le microscope chirurgical classique portaient sur les défaillances du système et les décalages de l'image pendant la chirurgie. ConclusionsTous les ophtalmologistes, sans égard à leur degré d'expérience, ont préféré le dispositif de visualisation tête haute en 3D au microscope chirurgical classique pour réaliser une MIGS simulée. D'après les résultats du sondage, le recours au dispositif de visualisation tête haute en 3D permet d'enseigner efficacement la MIGS sur un modèle d’œil artificiel, surtout depuis l'avènement de la formation axée sur les compétences en ophtalmologie.

Perception of Canadian ophthalmologists on immediately sequential bilateral cataract surgery: insights and implications

ObjectifÉvaluer la perception des ophtalmologistes canadiens en ce qui a trait à la chirurgie de la cataracte bilatérale immédiatement séquentielle (CCBIS). NatureSondage anonyme envoyé à tous les membres actifs de la Société canadienne d'ophtalmologie. MéthodesOn a ainsi obtenu de l'information sur les aspects suivants : données démographiques de base, types de pratique professionnelle en lien avec la chirurgie de la cataracte, avantages, inconvénients et préoccupations en lien avec la CCBIS. RésultatsAu total, 352 ophtalmologistes ont répondu au sondage. De ce nombre, 94 répondants (27 %) réalisent régulièrement des CCBIS, 123 (35 %) réalisent des CCBIS à titre exceptionnel et 131 (37 %) ne réalisent jamais de CCBIS. Les ophtalmologistes qui réalisent des CCBIS sont significativement plus jeunes que ceux qui n'en réalisent jamais (p < 0,001) et sont actifs depuis moins longtemps (p < 0,001). La prévalence des ophtalmologistes qui réalisent des CCBIS varie significativement en fonction de la province (p < 0,001) : la plupart des ophtalmologistes qui réalisent couramment des CCBIS proviennent du Québec (n = 44; 48 %), endroit où les mesures de dissuasion financière sont les moins corsées au pays. Les CCBIS sont le plus souvent réalisées dans des centres universitaires (n = 39; 42 %), plutôt que dans des cliniques privées ou communautaires (p < 0,001). Le principal motif justifiant le recours à la CCBIS tient à une utilisation plus efficace des blocs opératoires (n = 142; 65 %). Le risque de complications bilatérales (n = 193; 57 %) et l'absence de résultats réfractifs dans le premier œil au moment de réaliser l'intervention dans le deuxième œil (n = 184; 52 %) constituent les préoccupations principales en lien avec la CCBIS. La pandémie de COVID-19 a eu un effet positif sur la perception de 152 répondants (43 %) à cet égard; il s'agit surtout des ophtalmologistes qui réalisaient déjà régulièrement des CCBIS (n = 77; 84 %). ConclusionsLes ophtalmologistes qui réalisent des CCBIS sont susceptibles d’être plus jeunes et de travailler dans des centres universitaires. Le Québec a la prévalence la plus élevée d'ophtalmologistes qui réalisent des CCBIS. En raison de la pandémie de COVID-19, les ophtalmologistes qui réalisaient déjà des CCBIS se sont mis à en réaliser encore plus, comparativement à ceux qui n'en réalisaient jamais.

The Mental Health State of Canadian Ophthalmologists during the COVID-19 Pandemic: A Survey-Based Study and Review.

The coronavirus disease 2019 (COVID-19) pandemic disrupted the practice of medicine, causing stress and uncertainty among ophthalmologists. This cross-sectional, survey-based study of Canadian Ophthalmological Society members (n = 1152) aims to report on Canadian ophthalmologists' mental health during the COVID-19 pandemic. Four questionnaires were administered between December 2020 and May 2021: the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), the 7-item Insomnia Severity Index (ISI), and the Impact of Event Scale-Revised (IES-R). From all of the responses, 60/85 answers were deemed complete and were included. The median age was 50-59 years and 53% were women. On PHQ-9, most respondents had no or minimal depressive symptoms (n = 38, 63%), while 12% (n = 7) had moderately severe depressive symptoms and 12% (n = 7) reported impaired daily functioning and/or thoughts of suicide or self-harm. On the GAD-7 scale, 65% (n = 39) had no significant anxiety, while 13% (n = 8) had moderate to severe anxiety. Most respondents did not have clinically significant insomnia (n = 41, 68%). Finally, 16 respondents (27%) had an IES-R score ≥24 suggesting possible post-traumatic stress disorder. No significant differences were found based on demographics. During the COVID-19 pandemic, up to 40% of respondents experienced varying degrees of depression, anxiety, insomnia, and distress from the event. In 12%, there were concerns for impaired daily functioning and/or suicidal thoughts.

Success of the Canadian Ophthalmological Society’s first virtual meeting amid COVID-19 pandemic

ObjectiveTo assess participant attendance and engagement for an in-person Canadian Ophthalmological Society (COS) annual meeting (2019) compared with a virtual COS annual meeting (2020). DesignRetrospective case-control study of key event metrics of the 2019 and 2020 COS meetings as well as Twitter activity. MethodsKey annual meeting metrics were collected retrospectively for 2020 virtual meeting and compared with the most recent in-person annual meeting cohort from 2019. Metrics collected included attendance by ophthalmology specialist, geographic distribution of attendees, postevent survey rate, and social media engagement (Twitter). ResultsOverall, there was a 7% (n = 60) increase in the number of registrants between 2019 and 2020. The largest change noted was the increase in registrants from British Columbia (n = 78). More ophthalmologists registered for the 2020 meeting than for 2019 meeting (627 versus 592). Of those who registered for the meeting, meeting participation (defined as checking in for the 2019 and logging in for the 2020 meetings) increased from 70% in 2019 to 79% in 2020. There was a 158% (n = 15 000) increase in tweet impressions in 2020 compared with 2019. ConclusionThe first COS virtual meeting attracted more participants and was available to a geographically wider audience. Indeed, more professionals from provinces that are geographically further from the traditional COS meeting locations were able to participate in the event. Meeting engagement on a social media platform increased in the virtual meeting in 2020 relative to the in-person meeting in 2019, and possible enablers for increased engagement should be sought and incorporated into future meetings.

Surgeon Preferences for Endothelial Keratoplasty in Canada

To quantify practice patterns and assess attitudes and barriers to performing Descemet membrane endothelial keratoplasty (DMEK) in Canada. An anonymous online survey was distributed to all corneal surgeons included in the Canadian Ophthalmological Society's database. Of 70 listed surgeons, 41 responses were collected (58.6% response rate). Most respondents were practicing in university hospitals (43.9%) or private practice (43.9%) and were involved in residency teaching (77.5%). Most respondents performed DMEK surgery (78%), and most surgeons prepared their own DMEK grafts (62%). Surgeons who were in practice for more than 25 years were less likely to perform DMEK (75% vs. 13%, P = 0.009) and performed fewer corneal transplantation in the previous year (mean 28 vs. 44, P = 0.022). Those who were not performing DMEK reported access to preprepared tissue (77.8%), access to wet laboratory courses (50%), and assistance or mentorship (50%) as common facilitators to start performing DMEK surgery. DMEK is the preferred surgery for endothelial disease among Canadian corneal surgeons. Eye banks play a key role in increased adoption by ensuring an adequate supply of tissue and prestripping tissue for surgeons new to DMEK to be confident in performing it. Ensuring adequate supply of donor tissue and supplementary surgeon training can ensure that DMEK surgery is widely available in Canada.

Brazilian guidelines on the frequency of ophthalmic assessment and recommended examinations in healthy children younger than 5 years

To provide guidance on the frequency and components of eye examinations for healthy children aged 0 to 5 years. These guidelines were developed based on the medical literature and clinical experience of an expert committee. PubMed/Medline searches were performed, with selected publications not restricted to systematic reviews, randomized controlled trials, or observational studies. The Grading of Recommendations Assessment, Development, and Evaluation profile was applied when suitable, and for issues without scientific evidence, recommendations were based on expert consensus. Recommendations by the American Academy of Pediatrics, American Association of Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology, Royal College of Ophthalmologists, and Canadian Ophthalmological Society were also reviewed. The final guideline document was approved by the Brazilian Pediatric Ophthalmology Society and by the Brazilian Pediatric Society. Newborns must undergo the red reflex test and inspection of the eyes and adnexa by a pediatrician within 72 hours of life. The red reflex test should be repeated by the pediatrician during childcare consultations at least three times per year during the first 3 years of life. If feasible, a comprehensive ophthalmologic examination may be performed between 6 and 12 months of age. Until 36 months of age, the pediatrician should assess the infant's visual development milestones, age-appropriate assessment of visual function, ocular fixation, and eye alignment. At least one comprehensive ophthalmologic examination should be performed at 3 to 5 years of age. The examination should minimally include inspection of the eyes and adnexa, age-appropriate visual function assessment, evaluations of ocular motility and alignment (cover tests), cycloplegic refraction, and dilated fundus. Guidelines concerning the frequency of ophthalmic assessment are important tools for directing physicians regarding best practices that avoid treatable vision problems that affect children's development, school, and social performance and cause unnecessary permanent vision loss.

Marijuana and Glaucoma: A Social Media Content Analysis

This study analyzes the content quality and characteristics of the most popular and highly ranked search results on the internet related to glaucoma and medical cannabis (MC). Internet-based, cross-sectional study. Not applicable. Google and 2 social media platforms (Facebook, YouTube) were used to identify online information most accessible to patients. Search criteria included "glaucoma" AND "marijuana" or "cannabinoid" or "CBD." The top 20 Google search and YouTube results for each search term and the posts from the top 9 patient-based glaucoma Facebook groups were aggregated and analyzed using the search criteria. The quality of the content was graded by 2 independent graders using a previously validated Sandvik score and previously reported risk score. The differing values were resolved by a final grader. Additional analysis included whether the source was professional (by physician or medical organization) or shared an opinion on MC (pro, mixed, or against) use in glaucoma. This search resulted in an aggregate of 51 websites on Google, 126 posts from Facebook groups, and 37 videos on YouTube. The mean (± standard deviation) Sandvik score and risk score were 11.0 (±2.23), 10.2 (±1.12), 10.6 (±1.89) and 0.27 (±0.49), 0.46 (±0.62), 0.97 (±0.90) for Google, Facebook, and YouTube, respectively. Analysis of variance showed statistically significant differences in Sandvik (P= 0.01) and risk (P < 0.0001) scores across the 3 platforms. A significant portion of online material was pro-MC use in the setting of glaucoma (24% of Google, 59% of YouTube, and 21% of Facebook results). Professional content had a significantly higher content quality score and a lower risk score, and was less likely to recommend MC use in glaucoma. Despite American Academy of Ophthalmology, Canadian Ophthalmological Society, and American Glaucoma Society statements against MC use in patients with glaucoma, a significant portion of online material recommends its use. With the wide variation in quality and content of online information, it is important for physicians to be aware of the different platforms and opinions that are readily available to patients.

Face and content validity of an artificial eye model for Ab-Interno Goniotomy

To determine the face and content validity of an artificial eye model for ab-interno goniotomy (SimulEYE KDB model, InsEYEt, Westlake Village, CA) by surveying ophthalmologists with varying experience using a Kahook Dual Blade (KDB; New World Medical, Rancho Cucamonga, CA, USA) following a 90-min wet-lab course using the model. Overall 13 ophthalmologists participated following a surgical simulation session on goniotomy using the goniotomy blade at the 2019 Canadian Ophthalmological Society annual meeting. A 17-question survey to assess the face and content validity of the model was given immediately following the surgical simulation session on goniotomy using the goniotomy blade. Responses to each survey question were recorded on a 5-point Likert scale ranging from (1) strongly agree to (5) strongly disagree. Respondents rated statements regarding the model with a median response of 1 (Strongly Agree) to 3 (Neither agree or disagree). Mann-Whitney U nonparametric analysis revealed no significant difference in responses between instructor vs. non-instructor or between prior experience vs. no prior experience for any of the survey statements. The model received highest survey ratings for utility in training residents, acquisition of surgical skills, accessibility, and higher likelihood of success with the procedure than theory and observation alone. Lowest ratings were for realism of the model compared to a human cadaveric eye. Our results suggest the SimulEYE KDB model is a reasonably cost-effective solution for simulating angle-based surgeries. Additionally, our project shows that experienced ophthalmologists found the artificial eye models useful and helpful for angle-based surgery training.

Ocular manifestations in SARS-CoV-2 positive patients: a systematic review

ABSTRACT Objective: Investigate the importance of optical symptoms within SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) patients.Design: Systematic reviewMethods: Databases searched included Medline, EMBASE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Clinicaltrials.gov, ProQuest. As well, meeting abstracts from American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology and Canadian Ophthalmological Society were also considered. Articles underwent two rounds of screening before risk of bias assessment and data extraction.Results: In total, 582 studies were identified. A total of 2064 unique SARS-CoV-2 positive patients are included in this review from 13 different studies that met the inclusion criteria. We observed that the most common ocular symptoms in patients with SARS-CoV-2 were dry eyes, chemosis, epiphora, and blurred vision. The least common symptoms included hyperemia, conjunctivitis and photophobia. Additionally, we observed a unique relationship between patients with ocular manifestations and the severity of the systemic symptoms.Conclusion: Ocular symptoms do not occur commonly among SARS-CoV-2 positive patients; however, this study displays that there is an occurrence of common ocular manifestations such as dry eyes, chemosis, epiphora, and blurred vision. Therefore, increased ocular examinations may aid in diagnosis of SARS-CoV-2 infections.ABBREVIATIONS: COVID-19 (coronavirus disease 2019), SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2)

Laser Trabeculoplasty Perceptions and Practice Patterns of Canadian Ophthalmologists

AimTo describe the current practice patterns and perceptions of Canadian ophthalmologists using laser trabeculoplasty (LTP).Materials and methodsA cross-sectional survey of 124 members of the Canadian Ophthalmological Society (COS) who perform LTP was conducted. Descriptive statistics and Chi-square comparative analyses were performed on anonymous self-reported survey data.ResultsOf the 124 respondents, 34 (27.4%) completed a glaucoma fellowship. Use of selective laser trabeculoplasty (SLT) (94.4%) was preferred over argon laser trabeculoplasty (ALT) (5.6%). The most frequently cited reasons for SLT preference was less damage to trabecular meshwork (30.7%), availability (16.2%), and repeatability (16.2%). In all, 47.6% of the respondents performed LTP concurrently with medical treatment, 33.9% used it after medical treatment, and 17.7% used it as first-line treatment. Majority (87.1%) of the respondents believed that SLT is effective when repeated. In suitable patients, 41.9% of the respondents stated on average they repeat SLT once, 26.6% twice, and 19.4% greater than 2 times, respectively. Of those who repeat SLT on patients, 80.7% found repeat SLT treatments have good outcomes for patients. In all, 105 (84.7%) ophthalmologists responded they would benefit from an LTP practice guideline. Significantly more ophthalmologists without glaucoma fellowships perceived they would benefit from a practice guideline (p value <0.001).ConclusionThis survey provides valuable practical information on how LTP is used in the treatment of glaucoma in Canada.Clinical significanceThe findings may serve as a baseline survey to trend future practices.How to cite this articleLee EY, Farrokhyar F, Sogbesan E. Laser Trabeculoplasty Perceptions and Practice Patterns of Canadian Ophthalmologists. J Curr Glaucoma Pract 2020;14(3):81–86.

Canadian Opinions on Refractive Surgery and Approaches to Presbyopia Correction.

Purpose:To explore the opinions of Canadian ophthalmologists on refractive and presbyopia-correcting surgeries.Methods:We distributed an online survey to the Canadian Ophthalmological Society members, covering laser refractive surgery (LRS), femtosecond laser-assisted cataract surgery (FLACS), lenticular refractive surgery (lenRS) that includes cataract refractive surgery (CRS) with premium intraocular lens (IOL) implantation, and presbyopia correction.Results:There were 68 (7.6%) total respondents. Most respondents would not consider LRS (62.5%) nor FLACS (73.9%) for themselves. Male sex and performance of LRS or FLACS was significantly associated with consideration of these procedures for self. Most respondents (59.3%) would consider lenRS for themselves. The top method of personal presbyopia correction was spectacles, chosen by 52.5%.Conclusions:When surveying the wide body of Canadian ophthalmologists, most respondents preferred spectacle correction of presbyopia and would consider lenRS, but not LRS or FLACS for themselves. Surgeons performing these procedures were more likely to consider them for self.

Characteristics and trends in publications of abstracts presented at the Canadian Ophthalmological Society Annual Meetings: 2010–2015

To evaluate the publication rate of abstracts presented at the Canadian Ophthalmological Society (COS) Annual Meetings from 2010 to 2015. A retrospective review and literature search of abstracts presented at the COS Annual Meetings from 2010 to 2015. Abstracts were obtained from the scientific programs for the 2010-2015 COS meetings, excluding 2014 (data unavailable). Title, author number, presentation type, subspecialty, institution, and study design were collected. MEDLINE and PubMed were searched in duplicate using abstract title, key words, and authors. Publication date, journal, impact factor, and citation score were recorded for each publication. Publication rates were determined by year of abstract presentation, presentation type, study type, subspecialty, author number, institution, and time to publication. 876 abstracts were presented, of which 326 (37.3%) were posters and 548 (62.7%) were oral presentations. The publication rate was 42.9% (375 publications) with a 16-month median time to publication. The publication rate did not vary significantly by presentation type or year. Publication rates were highest among vision rehabilitation (75.0%) and glaucoma (52.0%) subspecialties; basic science research (65.0%) and systematic reviews/meta analyses (62.0%) study designs had the highest representation. Most presentations were published in the Canadian Journal of Ophthalmology (117 presentations, 31.2%). The mean impact factor and citation score for published abstracts were 2.39 ± 2.3 and 1.70 ± 1.16, respectively. The publication rate of abstracts presented at the COS Annual Meetings has remained stable across this 5-year analysis. Publication rates are comparable to those of other specialty conferences.

Incidence of nonarteritic ischemic optic neuropathy following topical clear corneal cataract surgery: survey and meta-analysis

We estimate the incidence and characteristics of post-cataract-surgery nonarteritic ischemic optic neuropathy (PCNAION) after topical clear corneal cataract extraction (CCCE) in Canada. Canada-wide internet survey and meta-analysis PARTICIPANTS: All certified Canadian ophthalmologists in the Canadian Ophthalmological Society directory, or belonging to a provincial ophthalmology internet group. Identical surveys were distributed to 5 regions in Canada. CCCE surgeons were asked to estimate the number of CCCE they had performed in their career, and the number of PCNAION events that occurred within 1 year after CCCE. The results were analyzed using a random effects meta-analysis of proportions for rare events. The estimated survey response rate was 18%-32%. The 182 survey respondents performed a total of 1 499 694 CCCE with 107 events of PCNAION. Twenty-six percent of surgeons had at least one patient with PCNAION. Meta-analysis revealed a pooled estimate incidence of 2.8 PCNAION events (95% confidence interval 1.6-4.7) per 100 000 cataract procedures during the year after cataract surgery. Seventy-seven percent (82/107) of the PCNAION cases occurred within 3 weeks of surgery, and 7 patients had bilateral PCNAION. PCNAION is a rare complication after topical CCCE. Its incidence is important to estimate for patient care and epidemiologic reasons.

Survey of reported eye injuries from handheld laser devices in Canada

Unprotected exposure to handheld lasers can cause temporary or permanent vision loss depending on the laser classification. To evaluate the occurrence of, and details associated with, reported eye injuries resulting from handheld lasers. A 14-item questionnaire developed by Health Canada was distributed by the Canadian Ophthalmological Society and the Canadian Association of Optometrists to their respective members. Questionnaire data were available from 909 respondents (263 ophthalmologists; 646 optometrists). Response rates were 23.1% and 12.7%, respectively. Validated data were available from 903 respondents, where 157 (17.4%) reported encountering at least 1 eye injury from a handheld laser. A total of 318 eye injuries were reported with an annual increase of 34.4% (95% CI 21.6%-48.7%, p < 0.0001) between 2013 and 2017. When respondents reported on only their most severe case, 77 (53.5%) reported vision loss that ranged from minor to severe, which persisted for more than 6 months in 42.9% of the cases. Another 59 (41.3%) noted the presence of retinal damage. The prevalence of eye injuries from handheld lasers was higher for males (82.5%) than females (14.0%), more frequent among those under the age of 50 years, and occurred predominately as a result of exposure from another person (67.6%) versus self-induced (26.1%) (p < 0.0001). Although this pilot study permits insight into the potential prevalence of injuries resulting from exposure to handheld laser devices in Canada, the results are not nationally representative. These findings support additional surveillance activities that may inform risk assessment and potential risk management strategies.

Survey of occupational musculoskeletal pain and injury in Canadian ophthalmology

ObjectiveSurgeons and other physicians have reported occupational musculoskeletal (MSK) pain, and it has been recently raised as a growing issue by ophthalmologists and optometrists. What is most concerning is that it could be a serious threat to career longevity and performance. MSK pain and injury in Canadian ophthalmologists has not been quantified. Our goal was to estimate the prevalence of MSK issues, to determine the impact of MSK injuries to working hours and health, and to ascertain physician characteristics and practice patterns associated with MSK problems. DesignSurvey. ParticipantsOne hundred sixty-nine ophthalmologists and 121 optometrists. MethodsA voluntary internet-based (Survey Monkey) survey was conducted. All Canadian ophthalmologists and ophthalmology residents were contacted via the Canadian Ophthalmological Society, and all optometrists registered through the Canadian Association of Optometrists were contacted through their respective listserve email. ResultsOne hundred sixty-nine ophthalmologists (response rate 17%) and 121 optometrists (2.4%) responded to a voluntary internet-based survey. Fifty percent of the ophthalmology respondents reported clinic-associated MSK pain in the preceding 12 months, compared to 61% of optometry respondents (p = 0.06). Of the ophthalmologists, 48.3% said they had experienced occupational MSK pain in the preceding 12 months, which they directly attributed to their operating room activities. Neck pain was reported in 46%, lower back in 36% and shoulder pain in 28% of ophthalmology respondents. This was compared to 34% (p = 0.04), 37% (p = 0.90) and 41% of optometrists (p= 0.02). Respondents in our survey listed “performing the same task over and over”, “working in cramped or awkward positions” and “bending or twisting your neck” as the most common causes of MSK pain. ConclusionOur survey identified that a large proportion of respondents reported MSK pain associated with clinical and surgical duties. Physician-led research is needed before industry and administrative partners can develop equipment and work-spaces that are better suited to the needs of physicians.

Serum drops for ocular surface disease: national survey of Canadian cornea specialists

ObjectiveTo review the use and preparation of serum drops for the treatment of ocular surface disease in Canada and to assess the need for an improved access to this therapy. DesignCross-sectional study. ParticipantsCornea specialist members of the Canadian Ophthalmological Society and Canadian laboratories preparing serum tears. MethodsA confidential survey was emailed to participants in April 2016 and continued through September 2016. Descriptive statistics on serum drops accessibility, production, and use are reported. ResultsThirty-four cornea specialists (out of 93) and 8 laboratories completed the survey. Half of respondents (47%) described serum drops as inaccessible in their practice setting, mainly because of financial (75%) and logistic (66%) barriers. The use of allogeneic serum was perceived as a potential solution to poor accessibility by 62% of ophthalmologists. A private laboratory or pharmacy produced serum drops for 52% of respondents, whereas 32% coordinated serum drop procurement through a hospital laboratory. No serological tests were routinely performed, and sterility checks were done by one laboratory. Over the last year, each laboratory prepared serum tears for 49 ± 32 patients, representing a median of 15 patients per ophthalmologist. ConclusionsAlthough most cornea specialists agree that serum drops are indicated in several refractory ocular surface disorders, there is significant discrepancy in accessibility to this treatment across Canada. This study confirms the need for an improved access to serum drops. Use of autologous serum is limited by logistic and financial barriers, which could be reduced by the introduction of an allogeneic serum drop.

Excerpt from the Canadian Ophthalmological Society evidence-based clinical practice guidelines for the management of diabetic retinopathy

Excerpt from the Canadian Ophthalmological Society evidence-based clinical practice guidelines for the management of diabetic retinopathy