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

Objective: To determine the characteristics associated with higher online ratings of academic ophthalmologists in Canada.

Design: Retrospective cross-sectional study.

Methods: All ophthalmologists affiliated with Canadian ophthalmology departments were queried in March 2023 using WebMDs. Online ratings and physician profile details were extracted and descriptively analyzed using nonparametric tests with significance at p < 0.05. Subgroup analysis was conducted using ≥ 4-star rated profiles.

Results: Eight hundred and ninety-nine department faculty from 15 institutions were considered, and 660 ophthalmologists with active, rated profiles were included. A total of 27,823 online ratings with a median of 4.14 stars (out of 5) were observed. Most profiles were of men (74.1%). Women received lower overall ratings compared to men (median = 4.08 vs. 4.20; p = 0.021), and lower number of reviews (median = 23 vs. 34; p < 0.001). Most profiles included office addresses (87.9%), private practice affiliation (79.8%), and contact information (51.1%). There was a positive correlations between higher ratings and profiles that included biographies (rho = 0.13; p = 0.001), languages spoken (rho = 0.15; p < 0.001), educational background (rho = 0.13; p < 0.001), areas of expertise (rho = 0.10; p = 0.010), awards (rho = 0.12; p = 0.002), and among physicians indicating they accept new patients (rho = 0.15; p < 0.001) and accommodate virtual visits (rho = 0.09; p = 0.020).

Conclusions: Canadian ophthalmologists having certain personal information on their online profiles tended to have higher ratings, despite weak associations, possibly due to wider public outreach. Women had fewer and lower overall ratings compared to men. Further research about online ratings' influence on physician selection and physician career satisfaction is needed.

Objective: Conjunctival melanoma (CJM) is a rare subtype of mucosal melanomas. Despite an increasing understanding of CJM genetics, predicting patient prognosis remains challenging. Here we sought to see if a 31-gene expression profile (31-GEP) test (i.e., DecisionDx-Melanoma) originally developed and validated for cutaneous melanoma (CM) could be useful in the prognostication of patients with CJM.

Design/participants: We performed a single-center retrospective review and gene expression profiling of 10 patients with CJM.

Methods: Deidentified archived samples of each primary tumor were sent to Castle Biosciences, where 31-GEP testing was performed. Patients were followed until death or a minimum of 5 years postexcision and monitored for tumor recurrence or metastatic spread. Mean fold change in individual gene expression was compared between nonmetastatic and metastatic groups via independent t-tests.

Results: Fifty percent of patients developed metastatic disease and had reduced overall survival (3.6 vs 9.3 months; p = 0.018). In 4 of 10 patients, two nonmetastatic and two metastatic, tumor samples passed Castle Biosciences quality control allowing for class designation. All metastatic patients and one nonmetastatic patient were designated as class 2B. The final nonmetastatic patient was designated as class 1B. In individual gene analysis, BAP1 expression was significantly reduced in the metastatic group (p = 0.03).

Conclusions: In assessing if a CM gene expression panel could aid in the risk stratification of patients with CJM, we found that the uveal melanoma-relevant gene, BAP1, may be important. Additional studies with larger sample sizes are needed to determine the relevance of this and other differentially expressed genes in CJM prognostication.

Objective: To analyze factors predictive of tumor recurrence, orbital exenteration, lymph node metastasis, systemic metastasis, and metastasis-related death in patients with eyelid and periocular sebaceous gland carcinoma (eSGC) undergoing protocol-based management.

Methods: Retrospective interventional study RESULTS: Of the 355 patients with eSGC, 248 (70%) were referred to us without any prior intervention, and 107 (30%) had a history of prior intervention. The treatment modalities after presentation to our center included excisional biopsy (n = 303, 85%), orbital exenteration (n = 36, 85%), neoadjuvant chemotherapy (n = 12, 3%), and topical mitomycin C (n = 4, 1%). The 15-year Kaplan Meier estimates of tumor recurrence, need for orbital exenteration, lymph node metastasis, systemic metastasis, and metastasis-related death were 23%, 26%, 12%, 8%, and 9%, respectively. Multivariate Cox regression model identified positive histopathological margins (p < 0.001) and perivascular invasion (p < 0.001) as predictors of tumor recurrence; diffuse tumor morphology (p = 0.009), tumor diameter >20 mm (p = 0.027), orbital extension of the tumor (p < 0.001), perivascular invasion (p = 0.013), and pagetoid tumor spread (p < 0.001) on histopathology as predictors of orbital exenteration; diffuse tumor morphology (p = 0.005), tumor diameter >10 mm (p = 0.015), and perivascular invasion (p = 0.008) as predictors of lymph node metastasis; diffuse tumor morphology (p = 0.024) as a predictor of systemic metastasis; and multicentric tumor origin (p = 0.035) as a predictor of metastasis-related death.

Conclusion: Clinical features, including diffuse tumor morphology, multicentric tumor origin, larger tumor diameter, and orbital extension of the tumor, and histopathological features, including pagetoid tumor spread, positive histopathological margins, and perivascular invasion, are predictors of poor outcomes in eSGC.

Objective: To estimate the prevalence of glaucoma in Canada based on self-reports and test data, including Frequency Doubling Technology Perimetry (FDT), optic nerve vertical cup-to-disc ratio (CDR), intraocular pressure (IOP), and use of glaucoma medications.

Design: Cross-sectional survey.

Participants: 2,600-4,100 participants aged 40-79 in the Canadian Health Measures Survey 2016-2019 with available information from self-report, CDR, FDT, and IOP.

Methods: Glaucoma was defined by self-reports, CDR ≥ 0.7 only, or failed FDT only. Incorporating results of CDR, FDT, IOP, and use of glaucoma medications, participants were further classified as definite glaucoma (failed FDT and CDR ≥ 0.7) or glaucoma suspects (CDR ≥ 0.7 only, failed FDT only, or IOP > 21 mmHg only, or "normal" values of FDT, CDR, and IOP but used glaucoma medications). Survey weights were used in analyses.

Results: The glaucoma prevalence was 2.5% (95% confidence interval [CI] 1.7%-3.3%) utilizing self-reports, 3.0% (95% CI 2.1%-3.9%) by CDR ≥ 0.7 only and 10.3% (7.8%-12.8%) with failed FDT only. Merging test data, the prevalence of definite glaucoma was 0.7% (95% CI 0.3%-1.1%) and the prevalence of suspected glaucoma was 16.3% (95% CI 13.2%-19.4%). Among the patients suspected of having glaucoma, 44.4% had ocular hypertension (OHT, mean IOP 22.8 mmHg) and 6.8% used glaucoma medications. IOP ≥28 mmHg was found in 2.4% of OHT individuals, and none used glaucoma medications.37.5% of Canadians with definite glaucoma were unaware they had glaucoma.

Conclusions: Glaucoma prevalence in Canadians aged 40-79 varied between 0.7% and 10.3% depending on definition used. 16.3% of Canadians were labeled "glaucoma suspects". Nearly 40% of Canadians with definite glaucoma were unaware of having glaucoma.

Objective: To assess the effect of prompt engineering on the accuracy, comprehensiveness, readability, and empathy of large language model (LLM)-generated responses to patient questions regarding retinal disease.

Design: Prospective qualitative study.

Participants: Retina specialists, ChatGPT3.5, and GPT4.

Methods: Twenty common patient questions regarding 5 retinal conditions were inputted to ChatGPT3.5 and GPT4 as a stand-alone question or preceded by an optimized prompt (prompt A) or preceded by prompt A with specified limits to length and grade reading level (prompt B). Accuracy and comprehensiveness were graded by 3 retina specialists on a Likert scale from 1 to 5 (1: very poor to 5: very good). Readability of responses was assessed using Readable.com, an online readability tool.

Results: There were no significant differences between ChatGPT3.5 and GPT4 across any of the metrics tested. Median accuracy of responses to a stand-alone question, prompt A, and prompt B questions were 5.0, 5.0, and 4.0, respectively. Median comprehensiveness of responses to a stand-alone question, prompt A, and prompt B questions were 5.0, 5.0, and 4.0, respectively. The use of prompt B was associated with a lower accuracy and comprehensiveness than responses to stand-alone question or prompt A questions (p < 0.001). Average-grade reading level of responses across both LLMs were 13.45, 11.5, and 10.3 for a stand-alone question, prompt A, and prompt B questions, respectively (p < 0.001).

Conclusions: Prompt engineering can significantly improve readability of LLM-generated responses, although at the cost of reducing accuracy and comprehensiveness. Further study is needed to understand the utility and bioethical implications of LLMs as a patient educational resource.

Objective: To quantify post-cataract surgery health care utilization caused by dry eye symptoms (DES) and identify preoperative risk factors and mediators of postoperative DES.

Setting: An outpatient surgical centre in Toronto, Canada.

Design: Retrospective cohort study.

Participants: Included patients had cataract surgery between April 2019 and January 2020, completed a preoperative Dry Eye Questionnaire 5 (DEQ5), and were over age 18.

Methods: Data collected included DES risk factors, prophylaxis, and intraoperative and postoperative details. DES health care utilization and prevalence were reported as percentages. Risk of DES follow-up with DES prophylaxis use, and within each DEQ5 severity group, were analyzed with χ²-square test of independence and odds ratios. Binomial logistic regression assessed for significance of multiple preoperative and intraoperative risk factors, controlling for one another.

Results: Of 1074 patients (46% male, mean age: 71, mean DEQ5: 5.12), 18.1% had at least one nonroutine postoperative appointment due to DES. Patients with moderate/severe DEQ5 scores were 1.843 times likelier to have postoperative DES concerns than those with no/mild scores (CI = 1.307-2.599). Preoperative DES prophylaxis did not reduce DES risk in any severity group. Higher DEQ5 score, female sex, bilateral sequential surgeries, and femtosecond laser-assisted cataract surgery had higher likelihood of postoperative DES (B = 0.054; p < 0.001; B = -0.351; p = 0.037; B = 0.695; p = 0.003; B = 0.491; p = 0.003, respectively).

Conclusion: Nearly 1 in 5 patients had DES postcataract surgery, with 1 in 12 requiring one or more nonroutine follow-ups for DES, suggesting substantial health care burden. Current standard preoperative DES treatment may not reduce postoperative DES, and further studies are needed to elucidate why.

Objective: To examine the association between quantitative vascular parameters extracted from intravenous fluorescein angiography (IVFA) and baseline clinical characteristics of patients with retinal vein occlusion (RVO).

Methods: Our prospective single-centre study in Toronto, Canada, recruited patients with a diagnosis of macular edema secondary to RVO presenting with a central macular thickness (CMT) ≥310 μm from 2017 to 2023. IVFA images were captured using an ultra-widefield scanning laser ophthalmoscope and processed using the artificial intelligence-based RETICAD system to extract quantitative measurements of blood flow, perfusion, and blood-retinal barrier (BRB) permeability. Univariable and multivariable regression models were used to investigate associations between quantitative IVFA parameters and baseline best-corrected visual acuity (BCVA), CMT, and macular volume.

Results: The study included 41 eyes from 41 RVO patients. In the multivariable analysis, BRB permeability was significantly associated with both CMT (p < 0.001) and macular volume (p = 0.005). Subgroup analyses revealed that in central RVO patients, central BRB permeability remained significantly associated with CMT (p = 0.022) and macular volume (p = 0.010); however, there was no association with BCVA (p = 0.921). In branch RVO patients, central BRB permeability was significantly associated with BCVA (p = 0.006) and CMT (p = 0.009), but not with macular volume (p = 0.723). Additionally, both central and peripheral BRB permeability were significantly higher in patients with RVO compared to healthy controls (p < 0.001).

Conclusions: Our investigation reveals novel associations between baseline clinical characteristics and quantitative IVFA parameters in RVO patients, which may serve as clinically relevant biomarkers. Future studies should explore these associations in diverse RVO patient populations with extended follow-up.

Objective: To investigate the localization, distribution, and type of central microaneurysms (MAs) and their relationship with retinal vascular alterations in patients with retinal vein occlusion (RVO).

Methods: In this cross-sectional study, ultra-widefield color fundus photography (UWF-CF), standard and single-capture 65° widefield (WF) optical coherence tomography angiography (OCTA) were performed in consecutive patients with RVO treated at the Department of Ophthalmology and Optometry, Medical University of Vienna. UWF-CF, en face and B-Scans in 6 mm × 6 mm OCTA were examined for detection of MAs. Nonperfusion areas (NPA) and collateral vessels (CV) were evaluated on WF-OCTA, ghost vessels (GV), and tortuous vessels (TV) on UWF-CF.

Results: One-hundred-and-twelve patients were included in the study, and data from 59 eyes of 59 patients with disease duration longer than 3 months, good image quality, and without relevant ocular comorbidities were eligible for statistical analysis. Fifty-six of 59 (94.9%) patients were previously treated with anti-vascular endothelial growth factor agents for macular edema, 31 of 59 (52.5%) patients presented with MAs in the central 6 mm and 60 MAs were found in total using multimodal imaging. There was no statistically significant difference in the greatest diameter of fluid-associated versus non-fluid-associated MAs (p = 0.53). Eyes with MAs were associated with CV, TV, and GV (χ²-test; p < 0.001, p = 0.0498, and p = 0.001). Median NPA was 27.3 mm² (quartiles 1.3-62.8 mm²) in eyes with MAs and 0 mm² (quartiles 0-36.2 mm²) in eyes without MAs (Mann-Whitney-U-test; p = 0.018).

Conclusion: MAs were associated with extensive NPA, the presence of CV, GV, and TV. There was no correlation between the diameter of the MA and the adjacent intraretinal fluid in our predominantly pretreated RVO study patients.