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

Objective: To evaluate the use of fixed-combination, dorzolamide-timolol prophylaxis in controlling intraocular pressure (IOP) following phacoemulsification surgery, while controlling for glaucomatous status.

Design: A retrospective chart review.

Participants: A total of 558 patients undergoing phacoemulsification between September 5, 2023, and April 15, 2024, performed by a single surgeon. Only the first operated eye was included for bilateral surgeries, with 519 eyes analyzed in the study.

Methods: Patients were divided on the basis of a change in practice that occurred on December 31, 2023; all control eyes were obtained between January 1 and April 15, 2024, whereas all intervention eyes were obtained prior to this period. The control group received no prophylaxis (n = 233), and the intervention group received Cosopt immediately postoperatively (n = 286). Preoperative and postoperative day 1 (POD1) IOPs were measured using the iCare IC-100 tonometer. IOP readings ≥28 mm Hg were considered elevation spikes. Mean IOPs and spike incidences were statistically compared.

Results: Mean preoperative IOPs were identical (14.4 ± 3.1 mm Hg; p = 0.511). Mean POD1 IOP was significantly lower in the Cosopt group (13.7 ± 5.0 vs 18.4 ± 6.4 mm Hg; p < 0.0001). POD1 IOP spikes were less frequent in the Cosopt group (1.7% vs 9.9%; p < 0.0001). Cosopt was effective independent of glaucoma comorbidities (OR: 0.15; 95% CI: 0.06-0.42; p < 0.0002). Open-angle glaucoma and ocular hypertension (analyzed as a group: OR: 6.08; 95% CI: 1.72-21.54; p = 0.005) and narrow angles (OR: 6.54; 95% CI: 1.16-36.79; p = 0.03) were independent risk factors for IOP spikes.

Conclusions: Prophylactic dorzolamide-timolol reduces mean postoperative IOP and POD1 pressure spikes, independent of glaucoma comorbidities.

Access to eye care remains a global health priority, particularly for underserved populations in rural, Indigenous, and low-income communities. Despite advancements in ophthalmic care and technology, substantial inequities persist, exacerbating preventable vision loss and its associated social and economic consequences. International and national eye care frameworks have emerged as critical tools to address these disparities by guiding policy, resource allocation, and service delivery. This narrative review synthesizes strategies, outcomes, and gaps from 14 international and national frameworks globally. Measurable outcomes also are reported to illustrate the implementation impact. Key strategies identified across these frameworks include the integration of eye care into primary health care and universal health coverage, attention to workforce adequacy and distribution including workforce development through training primary care providers and community health workers, early detection programs, use of technology such as tele-ophthalmology and artificial intelligence, and community engagement through culturally sensitive outreach. However, notable gaps remain, including limited implementation tools, inconsistent success metrics, uneven workforce distribution, inadequate funding, and barriers to technological adoption, particularly in low-resource settings. By highlighting both effective strategies and persistent challenges, this study provides actionable insights for policymakers and stakeholders seeking to develop or enhance national eye care frameworks. A coordinated, equity-focused approach is essential to reduce preventable vision loss and improve health outcomes worldwide.

Objective: To investigate the barriers to eyecare reported by new immigrants to Northern Ontario and evaluate their baseline eye health.

Design: Cross-sectional study.

Participants: Immigrants who came to Northern Ontario on or after January 1, 2021, aged 18 or older.

Methods: The Thunder Bay Multicultural Association referred participants between August 2023 and June 2024. A survey and eye exam were conducted to collect sociodemographic data, barriers to eye care, and baseline eye health.

Results: There were 62 participants screened. The median age was 29 years (IQR: 25.25 to 37.75). The ratio of male to female participants was 34 to 28 (54.8% to 45.16%). The most reported countries of origin were India (40.3%) and Ukraine (25.8%). Most participants expressed concerns about their eye health (76.4%), and 90.9% endorsed free eye exams upon entry into Canada. Barriers to eyecare were reported by 56% of participants in the following categories: finances, time issues, difficulties navigating the health care system, and cultural differences between health care in Canada versus their native countries. New diagnoses were made in 41.8% of the participants. The most common diagnoses included glaucoma or glaucoma suspicion (17.7%), retinal tear (9.6%), and new uncorrected refractive error (4.84%). Follow-up was arranged for 41.8%. Treatment or prescription eyewear was recommended for 29.1% of participants. The following significant correlations were found: European origin and diagnosis of posterior segment condition (p = 0.001), Ukrainian origin and diagnosis of retinal tear (p = 0.002), no eye exam in the participant's lifetime and new refractive error diagnosis (p = 0.041).

Conclusions: Most new immigrants reported concerns about their ocular health and barriers to eye care. Several were found to have new ocular diagnoses. Many required further intervention. Screening eye examinations upon arrival into Canada may improve long-term eye health, particularly among newcomers to the North.

Background: In Canada, nearly 90% of children under 6 have never received a comprehensive eye exam, despite national guidelines recommending at least 1 before age 5. Missed diagnoses of amblyopia, strabismus, and retinopathy of prematurity (ROP) contribute to preventable vision loss and inequities.

Objective: To synthesize evidence on pediatric teleophthalmology screening, evaluating performance, feasibility, and economic considerations, with attention to relevance in the Canadian context.

Methods: A scoping review was conducted in Ovid MEDLINE, EMBASE, CINAHL, and Scopus (2005-2025) for studies assessing teleophthalmology screening in children. Screening was performed in duplicate, with data extracted on modalities, conditions, settings, and costs.

Results: Of 3 752 identified studies, 30 met inclusion criteria, involving >15,000 children. Digital retinal imaging (n = 18), video (n = 7), and smartphone-based tools (n = 5) demonstrated diagnostic performance comparable to gold-standard in-person exams in most reports. Cost-analysis studies consistently found teleophthalmology to be more cost-effective than in-person screening. Barriers included equipment costs, staff training, and poor connectivity in rural areas; facilitators included reduced costs and expanded screening capacity. Evidence gaps remain for non-ROP conditions (e.g., amblyopia, strabismus, retinoblastoma) and for rural, low-resource, and Indigenous populations.

Conclusions: Teleophthalmology shows promise for expanding pediatric vision screening capacity and accessibility in Canada. However, Canadian validation studies are limited. Implementation research focusing on rural and Indigenous communities, non-ROP conditions, and patient-centered outcomes is urgently needed to guide equitable integration into pediatric eye care.

Objective: To examine and compare medical students' perceptions of ophthalmology as a career, with a focus on women and under-represented students.

Study design: Phase 1 of a multi-institutional, explanatory sequential mixed-methods study.

Methods: Medical students from 4 geographically representative Canadian institutions with varying levels of ophthalmology exposure completed a 17-item survey assessing perceptions, barriers, and facilitators to pursuing ophthalmology. Quantitative data were analyzed using nonparametric tests and ordinal logistic regression to assess associations between both demographics and context-specific factors and survey responses. Open-ended qualitative responses were analyzed thematically using Braun and Clarke's framework.

Results: A total of 314 students participated, including 213 (67.8%) women, 125 (39.8%) visible minorities, and 73 (23.3%) Canadian immigrants. Negative perceptions of pursuing ophthalmology increased during medical school, with 29.9% of students expressing a negative view at the start of medical school compared to 45.5% at the time of the survey-a 52.1% relative increase (p = 0.007). Only 30.9% viewed the field as racially diverse, and 26.8% as gender balanced. Analysis of the qualitative responses showed that barriers to pursuing ophthalmology included intense competition, limited early exposure, lack of mentorship, perceived exclusivity based on personal connections, high research expectations, and difficulties with parallel planning.

Conclusions: Increased early exposure, improved mentorship opportunities, and promoting diversity may support greater gender and racial representation in ophthalmology.

Objective: This study aimed to evaluate the association between optical coherence tomography (OCT)-derived biomarkers and disease severity in patients with choroideremia (CHM) and CHM carriers.

Methods: We retrospectively reviewed consecutive CHM patients and female carriers who underwent comprehensive ophthalmic imaging. Evaluated OCT biomarkers included central macular thickness (CMT), cystoid space (CS), outer retinal tubulation (ORT), and hyperreflective foci (HF). Disease severity in CHM patients was assessed using the preserved islet area (PIA) on fundus autofluorescence images, while a pre-existing grading system was applied for carriers. Linear mixed models were used to assess the associations.

Results: Thirty-one affected males (62 eyes) and nine female carriers (18 eyes) were included. In CHM patients, the total number of HF showed a significant negative correlation with PIA (β = -0.449, 95% CI: -0.853 to -0.045; p = 0.043). Subgroup analysis revealed that choroidal HF in the fovea was significantly associated with reduced PIA (β = -0.221, 95% CI: -0.379 to -0.063; p = 0.015). Other OCT biomarkers, including CMT, CS, and ORT, were not significantly correlated with disease severity. In female carriers, none of the OCT biomarkers differed significantly across the stages of fundus severity.

Conclusions: The total number of HF and choroidal HF in the fovea showed significant associations with disease severity measures in CHM, suggesting potential utility as structural biomarkers alongside established OCT parameters. No OCT-derived biomarkers were significantly associated with disease severity among the CHM carriers.