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

Objective: To obtain prescription eyewear in Ontario, eye exams must be performed by optometrists or ophthalmologists (eye care providers [ECPs]). In 2004, government-insured routine eye exams were delisted for Ontarians aged 20-64 leaving eye exam coverage only for those aged ≤19 and 65+. We assessed whether having eyewear insurance impacts Ontarians' utilization of ECPs.

Design: Cross-sectional survey.

Participants: Ontarians aged 12+ without diabetes responding to the Canadian Community Health Survey in 2003, 2005, and 2013/2014.

Methods: We compared the utilization of ECPs by eyewear insurance status and eligibility for government-funded eye exams. Individuals with eyewear insurance funded by employers, government or privately were considered to have insurance.

Results: ECP utilization was significantly higher in Ontarians with eyewear insurance versus those without, in all survey years and all age groups, including those eligible for government-funded eye exams (e.g., 66.4% vs 59.1% [p < 0.05] for the 65+). This higher level of utilization was particularly evident among Ontarians aged 20-64 in 2013/2014, when this group no longer had government-funded eye exams (34.9% vs 19.9% among 20-39-year-olds, 43.4% vs 32.9% among 40-64-year-olds, p < 0.05 for both). Adjusting for confounding effects, the likelihood of visiting an ECP was greater among Ontarians with eyewear insurance than those without (adjusted prevalence ratio 1.26 for Ontarians aged 12+ and 1.41 for those aged 20-64; p < 0.05 for both).

Conclusions: Lack of eyewear insurance negatively impacts the utilization of ECPs, even among Ontarians eligible for government-funded eye exams, where the cost barrier for eye exams has been removed by the Ontario government.

Objective: To compare the efficiency of venturi and peristaltic pump phacoemulsification systems in patients undergoing routine laser cataract surgery.

Design: Single center, nonrandomized clinical study.

Participants: The study compared consecutive eyes with moderate nuclear sclerosis undergoing routine laser cataract surgery at the Outpatient Eye Center, Mercy Health System, Springfield, MO, USA.

Methods: Each surgery used the same femtosecond laser settings. Surgeries were performed with either a venturi or peristaltic vacuum system by a single surgeon (WJS). The EFX, percent power, ultrasound time (UST), the total time that the phaco tip was in the eye (phaco tip in/out time, PIOT), and the surgery time (speculum in/out time) were recorded. Exclusions and intraoperative complications were also analyzed.

Results: 995 eyes were included in the study. The EFX in the venturi eyes (1.7 ± 1.3; n = 521) compared to peristaltic eyes (2.1 ± 1.4; n = 474) was lower (p < 0.0001). Similarly, the UST in the eyes performed with the venturi system versus the peristaltic system was reduced (32.4 ± 22.3 s vs 40.7± 25.7 s; p < 0.0001). The PIOT in the venturi group compared to the peristaltic group was less (71.1 ± 31.1 sec vs 79.1 ± 36.1 s; p = 0.0002). The case time (speculum in/out time) was lower for the venturi eyes (307.2 ± 68.8 s vs. 311.6 ± 53.6 s; p = 0.268).

Conclusion: In eyes undergoing routine laser cataract surgery, the use of the venturi pump system was more efficient compared to the peristaltic pump system based on energy use and time, and there was no significant difference in complications.

Objective: Outline geographic disparities in access to language-and gender-concordant ophthalmologic care in Canada.

Design: Cross-sectional.

Participants: Practicing ophthalmologists in Canada (September 2023).

Methods: Data on ophthalmologists, including demographics, languages spoken, and practice locations, were collected from provincial regulatory body websites. Population data were extracted from the 2021 Statistics Canada Census. Ratio of ophthalmologists-to-potential patients and mean distances (absolute, population-weighted) to gender- and language-concordant care were calculated. The five most common languages spoken in the included provinces were analyzed.

Results: There were 986 and 1338 ophthalmologists in the language and gender analysis, respectively. Few ophthalmologists spoke non-official languages in Saskatchewan, Manitoba, and Nova Scotia. In a population-weighted analysis, the distance to a language-concordant ophthalmologist were 4.55 times greater for Spanish speakers compared to their English counterparts. Cantonese speakers had the shortest distances to language-concordant care but were still had 40% greater distance than English speakers in the same regions. Despite French-speaking ophthalmologists being the most prevalent per 100 000 speakers, francophones outside Quebec endured distances over double that of anglophones to access language-concordant care. Females in Newfoundland and Saskatchewan faced the longest distances to access gender-concordant care. In Ontario, females may face 3 times the distance to gender-concordant ophthalmologists compared to males. Quebec approaches gender parity with a male-to-female ratio of 55:45.

Conclusions: The results highlight the disparities in accessibility to non-English ophthalmologic care and the underrepresentation of female ophthalmologists across Canada. These disparities underscore the need for targeted strategies to ensure that the ophthalmologic workforce mirrors the demographic of the population it serves.

Objective: To assess the feasibility of using artificial intelligence (AI) to improve readability of online cataract surgery patient education materials (PEMs) in English and Spanish.

Participants: Websites with information dedicated to educating patients about cataract surgery.

Design: Comparative cross-sectional study.

Methods: The first 50 patient-oriented websites containing PEMs related to cataract surgery were identified through online search. Website authorship was categorized as an institution, private practice, or medical organization. Websites were assessed qualitatively for information accuracy, the presence of narrative video content, and multilingual availability. Readability of PEMs was assessed using five validated reading formulas. A natural language processing platform was used to simplify PEMs in English and Spanish. Converted PEMs were reassessed for readability and accuracy.

Results: A total of 32 institution, 7 private practice, and 11 medical organization sites were included. The overall average original reading grade level was 11.68 ± 1.59. After conversion, overall reading grade level improved to 7.94 ± 0.82 (p < 0.01). The first 10 results had better readability (10.40 ± 1.59) and reading ease (57.51 ± 9.24) compared to the subsequent 40 results (11.99 ± 1.43; p = 0.01; 47.64 ± 8.59; p < 0.01). Converted simplified Spanish text had an average reading ease score of 61.17 ± 5.39 (8-9th grade level). Native Spanish text reading ease improved from 57.41 ± 5.24 to 71.78 ± 5.24 (p < 0.01) following conversion (7th-grade level).

Conclusion: AI conversion can enhance the readability of online PEMs on cataract surgery, while maintaining accuracy and content integrity, thereby improving accessibility and comprehensibility for a wider audience.

Objective: To evaluate and improve the quality of periocular biopsy follow-up by determining the absolute compliance rate, examining delays between stages, identifying obstacles to high-quality follow-up, and offering recommendations for improvement.

Methods: Phase 1: A retrospective, observational, and descriptive study was conducted using chart reviews of adult patients who underwent periocular biopsies at the Centre Hospitalier Universitaire de Sherbrooke (CHUS) from January 2019 to October 2022. Phase 2: Three simultaneous Plan-Do-Study-Act (PDSA) cycles were implemented, focusing on enhancing communication channels between clinicians and pathologists, introducing a priority system for urgent cases, and establishing an automatic reminder system for pathologists.

Results: Phase 1: Among the 103 patients analyzed, 29 had malignant lesions, while 74 had nonmalignant lesions. The absolute compliance rate was 37.9% for malignant lesions. All of these noncompliances were due to excessive turnaround time (TT) to issue the pathology report. The percentage of cases that had adequate pathology TT (≤ 7 days) were 37.9% for malignant lesions, much lower than the Quebec Ministry of Health's target (80% at ≤7 days). Phase 2: The implemented PDSA cycles led to significant increases in absolute compliance rates and pathology TT compliance rates for malignant lesions. Primary outcomes showed that the absolute compliance rate increased to 93.3%. Secondary outcomes indicated that the pathology TT compliance rate also reached 93.3%.

Conclusions: Delayed pathology reporting was identified as the primary cause of suboptimal follow-up. The successful implementation of targeted PDSA cycles improved communication, prioritization, and reminder systems, resulting in considerable improvements in primary and secondary outcomes.

Objective: To develop surveillance programs for uveal melanoma patients, tailored to metastatic risk.

Methods: Surveillance schedules were developed using the number needed to scan (NNS) concept, based on weighted average metastasis-free survival (MFS) rates from systematic review data of 18 prognostic groups (Disomy 3 (D3), Monosomy 3 (M3), EIF1AX-mutation, SF3B1-mutation, BAP1-mutation, high or low nBAP-1 immunohistochemistry, gene expression profiling classes (1;1A;1B;1^PRAME-;1^PRAME+;2;2^PRAME-;2^PRAME+), and V stages I-III).

Results: In a typical surveillance schedule, involving biannual examinations years 1-5 and annual examinations years 6-10, the NNS varies dramatically from 1 to nearly infinity, underscoring the necessity for personalized surveillance approaches. On the basis of MFS data from 12 articles (n = 8046) and the targeted NNS level, the first surveillance examination under our model is recommended from 3 months to 5 years postdiagnosis. Specifically, the NNS 20 strategy requires an average of 10 examinations (SD 7), with D3 patients needing only two examinations (at 2- and 5-years' postdiagnosis), while those in GEP class 2^PRAME+ require up to 17 examinations, scheduled between year 1 and 8. Under an NNS 20 protocol, we anticipate that 1-2% of examinations will lead to the use of effective treatments for metastatic disease, such as tebentafusp. The study presents customized surveillance schedules for all prognostic groups across various NNS levels, accompanied by a methodology for adapting surveillance to any desired NNS target.

Conclusion: Customizing uveal melanoma surveillance to match metastatic risks could transform current practices, ensuring more precise protocols, reducing unnecessary examinations, and directing health care resources to those in greatest need.

Objective: The purpose of this study is to summarize the results from 3 experimental studies into the use of artificial intelligence to classify and segment colour fundus images with choroidal nevi.

Study design: This study is based on a secondary analysis of colour fundus images taken of patients receiving usual clinical care from the Alberta Ocular Brachytherapy Program.

Methods: High-resolution colour fundus images were labeled by experienced ocular oncologists. In experimental study 1, four pre-trained models (ResNet 50, VGG-19, VGG-16, and AlexNet) were evaluated for their ability to classify images based on the presence of choroidal nevi. In experimental study 2, the performance of 3 patch-based models to classify images based on the presence of choroidal nevi were compared. In experimental study 3, four convolutional neural network models were developed to segment the images. In experimental studies 1 and 2, performance was measured using accuracy, precision, recall, F1 score, and AUC. In experimental study 3, IoU and Dice measures were used to evaluate performance.

Results: A total of 591 labelled colour fundus images were used for analysis. In experimental study 1, VGG-16 showed the best accuracy, AUC, and recall, but lower precision in classifying images. In experimental study 2, the patched approached enhanced with artifact and contrast outperformed the others in classifying images. In experimental study 3, a voting-based Ensemble model excelled in segmenting the part of images with nevi.

Conclusions: It is feasible to train AI models to identify choroidal nevi in colour fundus images.

Objective: To present a series of conjunctival keratoacanthomas and provide clinical, histopathological, immunohistochemical, and imaging results that characterize this rare entity.

Methods: A retrospective chart review of records from 2005 to 2023 from the Florida Lions Ocular Pathology Laboratory was conducted. Nine patients with histologically proven conjunctival keratoacanthoma were identified. Data extracted includes demographics, clinical history, diagnostic testing, histopathological and immunohistochemical testing, treatment modalities, and recurrences.

Results: Patients' mean age was 55.2 ± 21.1 years (range: 22-83). 77.8% (7/9) of patients were male. 55.6% (5/9) were Hispanic. 55.6% of lesions (5/9) were in right eyes. 55.6% of lesions (5/9) were on the temporal, bulbar conjunctiva. The lesions were rapidly growing, with mean onset time of 4.71 ± 3.30 weeks (range: 2-12). High-resolution anterior segment optical coherence tomography of three lesions revealed hyper-reflective, thickened epithelium with abrupt transition between normal and abnormal epithelium. Underlying disorganized subepithelial tissue was noted. However, the overlying abnormal epithelium caused considerable shadowing, which obscured subepithelial structures. Prominent, keratin-filled, cup-shaped lesions with faulty maturational sequencing that extend full thickness, variably pale cytoplasm, and foci of dyskeratosis and hyperkeratosis were present on all lesions' histopathology. All lesions were surgically excised, but two demonstrated partial spontaneous resolution before surgery. Two patients were lost to follow-up; the remaining seven had no signs of recurrence at a of mean of 36.9 ± 45.4 months (range: 3 to 141 months) of follow-up.

Conclusions: Conjunctival keratoacanthomas are rare lesions of the ocular surface with distinct clinical, histopathologic, and diagnostic features.