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

Objective: This study presents an independent clinical evaluation of Dr.Noon CVD, a commercially developed artificial intelligence (AI)-based retinal imaging model that estimates cardiovascular disease (CVD) risk. We assessed whether the model can effectively evaluate CVD risk in patients with hypertensive retinopathy (HR), a population in which the applicability of conventional CVD risk models remains uncertain.

Methods: We retrospectively analyzed 102 age-matched patients from Hanyang University Guri Hospital and classified them into normal (Group 1), low-grade HR (Group 2), and high-grade HR (Group 3) groups using Keith-Wagener-Barker grading. CVD risks were assessed via Dr.Noon CVD score and conventional risk scores (PREVENT, PCE, SCORE2, SCORE2-Diabetes). Associations and predictive performance were evaluated using logistic regression, area under the ROC curve (AUC), and net reclassification improvement (NRI).

Results: Low-density lipoprotein cholesterol, estimated glomerular filtration rate, and blood pressure were significantly higher in the HR groups versus Group 1 (p < 0.05). Dr.Noon CVD scores differed significantly across HR grades (p = 0.002), particularly between Groups 3 and 1 (p = 0.002), while conventional scores showed no significant separation (p > 0.1). Higher Dr.Noon CVD scores were associated with Group 3 in both unadjusted (OR = 1.11; p = 0.001) and adjusted models (OR = 1.33; p < 0.001). Scores remained stable between acute and chronic HR (p = 0.966). Combining Dr.Noon CVD score with conventional models improved CVD risk classification (higher AUC and NRI).

Conclusions: Dr.Noon CVD identified elevated CVD risk in HR patients and enhanced stratification when combined with existing models. These results support the use of retinal biomarkers in CVD risk assessment and the need for multidisciplinary management.

Objective: To assess the real-world disease burden among a sample of patients with X-linked retinitis pigmentosa (XLRP) in Canada.

Design: A retrospective, noninterventional chart review.

Participants: Canadian ophthalmologists provided information regarding eligible patients aged ≥5 years who had been diagnosed with XLRP for ≥12 months and had ≥1 clinical encounter with the participating ophthalmologist in the last 12 months.

Methods: Information on participating ophthalmologists' practice setting and experience managing XLRP and patient information, including demographics, comorbidities, disease characteristics and management, productivity loss, and caregiver burden, were descriptively reported prior to or on patients' latest clinical encounter.

Results: In total, 12 ophthalmologists abstracted information for 36 patients with XLRP (median age: 34 years; 83% male). Among patients aged ≥46 years (n = 11), all patients had severely impaired visual acuity in ≥1 eye and 91% of patients were nearly unable to see in dim light. Most adult patients (n = 30) required assistance with ≥1 activity of daily living (70%), including transportation and shopping (60%) and house cleaning and maintenance (43%). A total of 60% of adults received informal care (mean: 24.0 ± 16.4 hours per week), and 40% were not working due to disability.

Conclusions: These results highlight the substantial real-world burden of XLRP on patients and their caregivers and its progressive nature and increasing impact over time. The study reveals significant unmet needs, including high levels of caregiver support, loss of productivity, and assistance with basic daily activities, emphasizing the need for effective treatments.

Objective: School-based vision screening programs identify children with ocular abnormalities and refer them to eye care professionals, allowing access to better vision and improved learning potential. While non-health care professionals often conduct these screenings, effective training methods are not well defined. This study describes a standardized, competency-based training program to prepare non-health care personnel to perform reliable vision screenings for children.

Design: Competency-based and experiential learning.

Participants: 170 students from McMaster University.

Methods: Training included 4 phases: (1) online modules with assessments; (2) hands-on screening skill development at practical stations; (3) competency evaluation via Objective Structured Clinical Examination; and (4) remediation for underperforming trainees.

Results: From 2022 to 2025, 170 trainees enrolled in the program, 128 completed the program successfully, and only 9 required Phase 4 support. Over 19,000 senior kindergarten students were screened through the new competency-based screening program.

Conclusions: Further validation will support the standardization of this training model. A universally adopted training method to teach non-eye care professionals to accurately perform vision screening is essential to ensure that all children receive the highest standard of care.

Objective: To report the etiologies, clinical course, and management outcomes of pediatric full-thickness macular holes (MH).

Design: A retrospective observational case series.

Participants: Patients under the age of 18 years with confirmed full-thickness MH and a minimum of 3 months of follow-up, examined between January 1, 2025, and December 31, 2023, at a tertiary eye care center.

Methods: Data from all subjects were obtained from initial and follow-up visits, including demographic data, best-corrected visual acuity (BCVA), key examination and imaging findings, MH etiology, MH aperture, and base diameters based on optical coherence tomography (OCT) imaging (Spectralis; Heidelberg Engineering, Heidelberg, Germany), spontaneous closure rate, time to closure, surgical technique, surgical success rate for hole closure, postoperative complications, additional surgical procedures performed, and duration of follow-up.

Main outcome measures: Spontaneous closure rate versus surgical closure rate and BCVA at final follow-up.

Results: Forty-seven eyes from 47 patients were included, the majority of which were Caucasian males. The mean age was 13 ± 3.17 years, and blunt trauma was the most common etiology (n = 41, 87%). The median MH aperture diameter was 222 μm (IQR 156, range: 110-565; n=25). Of those opting for watchful waiting, spontaneous closure was observed in 26 eyes (63%), and median closure time was 45 days from the date of initial diagnosis (IQR: 66.5, range: 8-302). Eighteen eyes (38%) underwent surgical intervention, on average 134 days (range: 4-553 days) from initial diagnosis. Of those undergoing surgery, MH closure was noted postoperatively in 13 eyes (72%). Two surgical complications (11%) were reported: a postoperative cataract that required subsequent extraction, and a reopening of MH within 1 year in a patient with X-linked retinoschisis (XLRS). For patients who underwent surgery, the mean BCVA improved from 20/315 (logMAR 1.20) at presentation to 20/70 (logMAR 0.54) at final follow-up (p < 0.05). For patients who underwent watchful waiting, the mean BCVA improved from 20/230 (logMAR 1.06) to 20/50 (logMAR 0.40) (p < 0.05). There was no statistically significant difference in BCVA at presentation or final follow-up between the surgical intervention group and the spontaneous closure group.

Conclusions: Macular holes in the pediatric population are most often the result of blunt trauma. Watchful waiting for spontaneous closure and surgical intervention both appear to have comparable outcomes on closure and vision recovery.