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

Objective: To develop a surgical assessment tool to evaluate the breadth of surgical procedures in which ophthalmology residents are required to gain competence and to validate this tool for cataract surgery.

Design: A questionnaire development study.

Participants: Ophthalmology residents and faculty at the University of Ottawa.

Methods: The Canadian Ophthalmology Assessment Tool for Surgery (COATS) was developed by a group of experts by modifying a previously validated assessment tool, the Ottawa Surgical Competency Operating Room Evaluation, and consists of 6 Likert scale items, 1 yes or no question assessing independence and 2 open-ended questions for narrative feedback. During a 2-year period, residents were evaluated on the performance of cataract surgery using the COATS. The primary outcome was the total COATS score, defined as the sum of the Likert scale items.

Results: A total of 165 COATS assessments were collected across 5 residents. Mean total COATS scores were lower for the first 2 months of training compared with the last 3 months of training (4.33 ± 0.25 vs 4.81 ± 0.03; p = 0.01; Cohen's d = 0.25) and for procedures where the resident was rated as "not independent" versus "independent" (4.26 ± 0.13 vs 4.74 ± 0.06; p = 0.006; Cohen's d = 0.13). There was a significant correlation between the number of cataract surgeries performed and the mean total COATS score (Pearson r = 0.20; p = 0.02). Forty-five COATS assessments per resident were required to obtain an overall reliability of 0.70, the accepted threshold for low-stakes assessments.

Conclusions: The COATS is a valid tool for the assessment of surgical competence in cataract surgery. There is also evidence that it is a reliable tool when completed multiple times per resident over the course of training.

Objective: To synthesize and critically appraise the available evidence on choroidal vitiligo, integrating clinical presentation, multimodal imaging characteristics, and diagnostic differentiation from mimics, while proposing a set of diagnostic criteria based on literature synthesis and authors' expert consensus.

Methods: A systematic search of PubMed, Embase, and Cochrane Reviews through July 2025 identified English-language studies reporting on choroidal vitiligo. Two reviewers independently screened, extracted data, and assessed methodological quality for case reports and case series. Narrative synthesis and descriptive statistics were used to summarize the findings.

Results: Eight studies met inclusion criteria, comprising 16 patients (28 eyes) from 5 countries. The majority of patients (75%) were asymptomatic, middle-aged females, with bilateral involvement in 88% of cases and preserved visual acuity (≥20/25 in 81% of eyes). Multimodal imaging consistently revealed well-demarcated choroidal hypopigmentation with intact retinal architecture and no intraocular inflammation. OCT demonstrated preserved retinal layers with occasional mild choroidal thinning. Fundus autofluorescence often showed scleral hyper-autofluorescence; FA/indocyanine green angiography showed mild window defects without leakage. Cutaneous vitiligo was present in 63% of patients, with no systemic autoimmune disease reported.

Conclusions: Choroidal vitiligo is a rare, benign, and often incidental finding, best recognized through multimodal imaging. This review proposes clinical diagnostic criteria for primary choroidal vitiligo and highlights its key imaging signature to aid differentiation from neoplastic and inflammatory mimics. We recommend baseline multimodal imaging and follow-up at 6-12 months to confirm stability. Standardized imaging criteria and prospective studies are needed to better define prevalence, natural history, and systemic associations. Given that most included studies were single-case reports, the overall level of evidence is low.

Objective: To evaluate the intraocular pressure (IOP)-lowering effect, adverse event profile, and risk factors for failure of an ab externo microshunt combined with phacoemulsification after 1 year of follow-up.

Design: A retrospective, single-center, interventional cohort study.

Participants: One hundred nineteen consecutive glaucomatous eyes of 97 patients with an IOP above target or progressing on maximal medical therapy.

Methods: All eyes underwent ab externo microshunt surgery with mitomycin C in combination with phacoemulsification from July 2015 to June 2019.

Main outcome measures: Primary outcome was complete success, defined as (1) no 2 consecutive IOP readings >17 mm Hg or IOP <6 mm Hg with >2 lines of vision loss, (2) at least 20% IOP reduction from baseline, and (3) on no medications. Secondary outcomes included upper IOP thresholds of 14 mm Hg and 21 mm Hg, qualified success (with medications), change in IOP, medications, visual outcomes, complications, interventions, and reoperations.

Results: At 1-year, complete success was achieved in 67.5% of eyes and qualified success in 79.8%. The median best-corrected vision acuity improved from 0.4 (interquartile range [IQR] 0.2-0.7) at baseline to 0.14 (IQR 0.1-0.3) at 1 year (p < 0.0001), with 93.2% having the same or improved vision. The most common complications were shallow anterior chamber (10.1%), iritis (9.2%), and choroidal detachment (8.4%). Needling was required in 24.4% of the eyes. Reoperation was required in 5.9% of the eyes.

Conclusions: The ab externo SIBS microshunt demonstrates reasonable rates of complete and qualified success at 1 year, decreased IOP and medication use, good visual outcomes, and few reoperations when performed in combination with phacoemulsification.

Objective: To evaluate the breadth of RPGR gene variants in a cohort of Canadian inherited retinal dystrophy patients.

Design: A retrospective cohort analysis.

Participants: We evaluated 54 subjects in Western Canada with an inherited retinal dystrophy diagnosis and confirmed variants in the RPGR gene.

Methods: Clinical information collected included family history, age, sex, and ethnicity. All participants underwent a full ophthalmic examination, wide-field colour fundus photography, fundus autofluorescence imaging, and visual field testing. Pathogenicity of variants was assessed by comparison to genetic databases of disease-causing variants and in silico modelling.

Results: Correlation of genotype with clinical phenotype established a conclusive molecular diagnosis in 34/54 cases (62.9%), with either retinitis pigmentosa (31 cases), cone-rod dystrophy (1 case) or macular dystrophy (2 cases). In the remaining cases, 18 novel RPGR variants were identified comprising 3 nonsense, 5 frameshift, 6 duplications/deletions, 3 missense and 1 splicing variant. Using in silico modelling, 3 novel variants were classified as pathogenic, and 6 were classified as likely pathogenic, increasing the diagnostic rate to 79.6%. Only 3.8% of the cohort were South Asian compared to the local population statistic of 13.5%. Ten of 13 female RPGR carriers were symptomatic and displayed moderate-to-severe phenotypic characteristics.

Conclusions: Through genetic testing, we identified 18 novel RPGR variants, of which 9 were determined to be pathogenic or likely pathogenic. RPGR variants were not a significant cause of retinal dystrophy in South Asians. Female RPGR carriers with visual deficits are likely to be a significant cohort for future RPGR gene therapy trials or treatment modalities.

Objective: To quantify the pediatric ophthalmology workforce density, travel burden, and socioeconomic inequities across all 293 Canadian census divisions (CDs).

Design: Cross-sectional geospatial study.

Participants: A national database of practicing pediatric ophthalmologists in Canada (95 clinicians, 102 sites) and the 2021 Census counts of residents <18 years and median after-tax household income for all CDs.

Methods: For each CD, we calculated providers per 100,000 children, the straight-line distance to the nearest pediatric ophthalmology practice, and the 30- and 60-minute travel-time access. We defined 2 measures of underservice: (1) provider-absence desert, which is a CD with 0 resident pediatric ophthalmologists; and (2) travel-access desert, which is a CD lying outside a 30-minute drive-time catchment.

Results: The unweighted mean provider rate was 0.47 ± 3.82 per 100,000 children. 269 CDs (91.8%) had no resident pediatric ophthalmologist (provider-absence deserts). Separately, drive-time modeling showed that 215/293 CDs (73.4%) and 4,178,025 (41.4%) children lay entirely outside a 30-minute road network catchment (travel-access deserts). The median straight-line distance to the nearest clinic was 124.1 km (interquartile range: 57-251). Seventy-four CDs (25.3%) were ≥250 km away. Access worsened with lower income and greater rurality: the lowest-income quintile had 86.9% of children living beyond 30 minutes, versus 16.2% in the highest-income quintile.

Conclusions: Timely treatment of childhood eye diseases hinges on geographic access to pediatric eye-care clinicians, yet 2 in 5 Canadian children live over 30 minutes from pediatric ophthalmologists, and 90% of CDs have no resident pediatric ophthalmologist at all. These provider-absence and travel-access deserts cluster in the lowest-income and most rural regions, signalling an urgent equity gap.