Canadian journal of ophthalmology. Journal canadien d'ophtalmologie最新文献

Objective: To compare the accuracy of keratoconus-specific formulae for nontoric and toric intraocular lenses in eyes with keratoconus undergoing cataract surgery.

Design: Consecutive retrospective case series.

Participants: Patients with keratoconus who underwent cataract surgery.

Methods: A retrospective chart review was conducted on cataract surgeries performed by the Cornea Service in the Department of Ophthalmology and Visual Sciences of the University of British Columbia from 2000 to 2023. The Kane keratoconus, Kane, Barrett Universal 2, Barrett True K, SRK II, SRK/T, Hoffer Q, Holladay I, EVO, Hill RBF and Hoffer QST, and Pearl DGS formulae were calculated. The postoperative mean absolute error (MAE) and mean prediction error (MPE) were calculated for each formula.

Results: A total of 133 eyes from 88 patients were eligible for inclusion in the study, 113 from 74 patients received nontoric IOLs, and 20 from 14 patients received toric IOLs. Pearl DGS had the most myopic MPE of -0.51 ± 1.04, which was statistically significant (p < 0.001) compared to all other formulae. There were no statistically significant differences in the MPE and MAE of the Kane keratoconus, Kane, Barrett Universal 2, Barrett True K keratoconus-specific formula, SRK II, SRK/T, Hoffer Q, Holladay I, EVO, Hill RBF and Hoffer QST formulae (p > 0.05).

Conclusion: There was no difference in IOL power estimation accuracy with keratoconus-specific formulae compared to conventional formulae for cataract surgery in KC patients. The IOL power estimation in KC remains significantly less accurate compared with non-KC patients.

Objective: eConsult allows specialists to diagnose and recommend treatment plans for nonurgent conditions without the need for patient travel. Our purpose is to evaluate the effectiveness of eConsult in reducing unnecessary in-person retinal consultations in Manitoba.

Design: Retrospective eConsult chart review.

Participants: Any person for whom an eConsult was submitted for a retina problem in Manitoba between November 2020 and October 2023 (n = 196).

Methods: The primary objective was to quantify eConsults requiring no in-person referral, routine in-person referral, or urgent (within 4 weeks) in-person referral. Secondary objectives included describing characteristics of eConsults and quantifying the amount of time spent on the platform by both the referring provider and the specialist. On the basis of these variables, patient travel, consultation time, and specialist billings savings were calculated.

Results: 66.8% of eConsults did not require in-person assessment (n = 131), 24.5% required to be seen on a routine basis (n = 48), and 8.7% required to be seen within 4 weeks (n = 17). This translated to a net cost of $2,660.43 for the provincial government in billings over 3 years, but 81 990 km saved in patient travel. 99% of eConsults came from optometrists (n = 194). Referring providers spent an average of 10.6 ± 9.4 minutes on the platform per referral, and the specialist consultant spent 9.1 ± 6.6 minutes.

Conclusion: eConsult is a potentially cost-effective way to address increasing demand for retinal services, reduce wait times by reducing unnecessary referrals, and facilitate data sharing between optometrists and ophthalmologists.

Objective: The Artisan is an iris-claw intraocular lens (IOL) that can be used to correct aphakia in eyes with insufficient capsular support. This study aims to evaluate long-term visual outcomes and complications following retropupillary implantation of the Artisan IOL at a Canadian centre.

Design: Retrospective chart review.

Participants: Patients who underwent implantation of an Artisan IOL at a tertiary Canadian center between January 2013 and December 2021.

Methods: Retrospective chart review was performed, and clinical outcomes at postoperative follow-up visits were summarized. Outcomes included postoperative best corrected and uncorrected distance visual acuity (BCDVA and UCDVA), intraocular pressure (IOP), as well as intraoperative and postoperative complications.

Results: Seventy-three eyes of 67 patients were evaluated. Mean follow-up duration was 11 months (range: 1-63 months). Common indications for Artisan implantation were IOL dislocation (n = 50; 68.5%) and aphakia (n = 23; 31.5%). Causes for IOL dislocation included idiopathic zonular weakness (n = 25; 34.2%), pseudo-exfoliation (n = 14; 19.2%), surgical complications (n = 6; 8.2%), trauma (n = 3; 4.1%), and Marfan syndrome (n = 2; 2.7%). Causes for aphakia included complicated cataract surgery (n = 20; 27.4%), ocular trauma (n = 2; 2.7%), and post-vitrectomy and lensectomy (n = 1; 1.4%). Average BCDVA (logMAR) was 0.62 ± 0.56 at preop, 0.46 ± 0.55 at 3 months postop, and 0.43 ± 0.55 at 9-12 months (p < 0.0001). Average UCDVA (logMAR) was 1.19 ± 0.68 at preop, 0.65 ± 0.60 at 3 months postop, and 0.42 ± 0.46 at 9-12 months (p < 0.0001). IOP did not differ significantly in follow-up. Pupil ovalization (n = 11, 15.1%) was the most common complication.

Conclusions: Outcomes demonstrated favourable efficacy and safety of retropupillary Artisan IOL as an option for providing adequate visual rehabilitation for patients without sufficient capsular support.

Objective: To compare the sensitivity of 3 groups of masked graders with varying levels of ophthalmic training to identify peripheral retinal breaks utilizing ultra-widefield orthogonal, directed peripheral steering, and auto-montaged images.

Design: Retrospective observational cohort study.

Participants: 155 patients from a single vitreoretinal specialist's practice.

Methods: 221 eyes with pretreatment orthogonal, directed-peripheral steering, and auto-montage that underwent laser retinopexy for retinal tears between 2015 and 2021 were divided into 2 groups: treatment-naïve and control. Combined sensitivity and specificity of identifying all retinal breaks on orthogonal, directed-peripheral steering, and auto-montaged imaging were calculated compared with the gold standard of mydriatic, scleral depression examination. Linear probability modeling was performed to calculate the required surface area from auto-montage images to identify breaks that were missed initially on orthogonal images.

Results: For orthogonal images, combined sensitivity was highest for ophthalmologists (67.53%), residents (62.34%), and then optometrists (55.84%). The sensitivity increased for orthogonal/steering (ophthalmologists [85.71%], residents [77.92%], and optometrists [67.53%]) and auto-montage (ophthalmologists [85.51%], residents (80.28%), and optometrists [75.00%]). To ensure identification of all tears with auto-montage that was initially missed on grading the orthogonal image, for every 10% increase in montage surface area, there was a 4.8 percentage point (%p) increase in the likelihood of detecting a retinal tear on montage image grading (p = 0.023).

Conclusions: Masked graders had moderate sensitivity in identifying retinal breaks with ultra-widefield images. Even with directed-peripheral steering and auto-montage, optometrists had the lowest sensitivity compared to ophthalmology residents and general ophthalmologists and required increased surface area to identify all retinal breaks.

Objective: Despite a universal health care system, access to vision care in Canada is not necessarily equally accessible to all patients. The purpose of this review was to explore the association between socioeconomic status (SES) and vision care utilization in Canada.

Methods: Medline, Embase, CINAHL, and Cochrane were searched from inception to January 2024 for relevant articles containing original data. Studies that explored the association between SES and vision care utilization in Canadian patients were included. Risk of bias was assessed using the Newcastle-Ottawa and AXIS assessment tools. Descriptive statistics were used to summarize findings. The review was registered in PROSPERO (registration number: CRD42024502482) and followed PRISMA guidelines.

Results: The search yielded 2,670 records with 23 studies included in this review. The included studies covered all provinces and ranged in date between 1985 and 2022. The included studies explored the relationship between SES and utilization of ophthalmic care, optometric care, or both. Overall, 17 of the 23 studies found that patients of lower SES were significantly more likely to have decreased usage of vision care. Decreased vision care utilization was found for all optometry, ophthalmology care, and diabetic retinopathy screening, as well as for patients of all ages, and in all provinces.

Discussion/conclusion: Low socioeconomic status was consistently associated with decreased vision care utilization for patients of all ages. Efforts are required to increase accessibility to vision care for low-income individuals and to improve health equity.

Objective: The aim of the study was to assess the educational background, professional experience, and research productivity of Canada's academic ophthalmology leadership.

Methods: This cross-sectional study focused on leaders from ophthalmology departments at 15 Canadian universities, as well as the Canadian Journal of Ophthalmology (CJO) editorial board and the Canadian Ophthalmological Society (COS) board of directors.

Results: Ninety-one academic leaders were identified, which included 15 chairs, 9 vice chairs, 17 hospital chiefs, and 15 program directors. Additionally, the 10 members of the COS board of directors and the 31 members of the editorial board of the CJO were included. The duration of professional experience was the longest for hospital chiefs (26.63 ± 7.08 years) followed by chairs (23.86 ± 6.11 years) (p < 0.001). Chairs had the largest mean number of publications (87.13 ± 73.17), followed by vice chairs (70.89 ± 78.29) (p = 0.012). The most common residency programs attended by position holders were offered by the University of Toronto, followed by McGill University. Forty-three academic ophthalmology leaders graduated from U.S. fellowship training programs (48.3%). CJO editors were most likely to have a professor appointment (p = 0.002), fellowship training (p = 0.042), U.S. fellowship training (p = 0.007), a larger number of publications (p = 0.006), and a greater h-index (p = 0.001).

Conclusion: Chairs followed by vice chairs demonstrated the highest mean number of publications and h-index. More than half of the academic leaders had fellowship training either in the U.S. or Toronto. Prospective ophthalmologists interested in academic leadership may leverage these data to strategically guide their professional careers.