OBJECTIVE: To examine the incidence, distribution, emerging trends, and resistance patterns of bacterial keratitis isolates in Toronto over the past 21 years. DESIGN: A retrospective observational study conducted at a te...OBJECTIVE: To examine the incidence, distribution, emerging trends, and resistance patterns of bacterial keratitis isolates in Toronto over the past 21 years. DESIGN: A retrospective observational study conducted at a tertiary care centre in Toronto. METHODS: A retrospective review was conducted on the microbiology records of suspected bacterial keratitis cases that underwent diagnostic corneal scraping and cultures between January 1, 2000, and December 31, 2021. The distribution of primary isolated pathogens and the results of in vitro susceptibility were assessed. RESULTS: A total of 3 554 corneal scrapings were collected over 21 years. A pathogen was identified in 1 842 samples (51.8%), with bacterial keratitis comprising 84.9% of all isolates. Of these, 75.4% were Gram-positive, and 24.0% were Gram-negative. Coagulase-negative Staphylococcus (CoNS) and Pseudomonas aeruginosa were the most frequently isolated Gram-positive and Gram-negative bacteria, respectively. A decreasing trend in the detection of Staphylococcus aureus (E = -0.004; p = 0.015) and Streptococcus pneumoniae (E = -0.002; p = 0.03) was observed over the 21-year study period. Methicillin/oxacillin-resistant CoNS (MRCoNS) was found in 37.5% of the CoNS isolates. The susceptibility of Gram-positive organisms, including methicillin/oxacillin-resistant species, to vancomycin was highest at 100%. Gram-negative organisms showed 99.5% susceptibility to ciprofloxacin and 99.4% susceptibility to tobramycin. CONCLUSIONS: This study represents the largest and longest case series of bacterial keratitis in Canada. CoNS was the most common pathogen, while Pseudomonas aeruginosa was the leading Gram-negative isolate. The findings support the empirical use of fortified tobramycin and vancomycin for the initial management of severe bacterial keratitis.
OBJECTIVE: To investigate associations between self-reported vision difficulties and mental health diagnoses in adults from a nationally representative sample. DESIGN: A retrospective, cross-sectional population-based an...OBJECTIVE: To investigate associations between self-reported vision difficulties and mental health diagnoses in adults from a nationally representative sample. DESIGN: A retrospective, cross-sectional population-based analysis. METHODS: Using data from the 2022 National Health Interview Survey, we included adult participants who provided self-reported vision data. The primary outcome was the association between vision difficulty and anxiety or depression diagnoses. Secondary outcomes pertained to symptom severity and receiving medications or therapy. Additional analyses explored the relationships between mental health variables and eyewear use. Multivariable regression models were conducted, adjusting for sociodemographic confounders. RESULTS: A total of 27,640 adults were included, of which 5 210 (19%) reported vision difficulties. Adults self-reporting vision difficulty had higher odds of an anxiety disorder (OR = 2.00, 95% CI = [1.82, 2.19]; p < 0.001) and more severe anxiety symptoms per the GAD-7 (OR = 2.67, 95% CI = [2.44, 2.92]; p < 0.001). Likewise, adults self-reporting vision difficulty had higher odds of depression (OR = 2.31, 95% CI = [2.12, 2.52]; p < 0.001) and more severe depressive symptoms per the PHQ-8 (OR = 2.90, 95% CI = [2.67, 3.15]; p < 0.001). Moreover, self-reported vision difficulty was associated with higher odds of taking medication for a mental health condition (OR = 1.71, 95% CI = [1.35, 2.16]; p < 0.001) and receiving therapy (OR = 1.71, 95% CI = [1.53, 1.91]; p < 0.001). Wearing glasses or contact lenses was largely associated with higher odds of the mental health variables studied. CONCLUSION: There are robust associations between self-reported vision difficulty and psychosocial well-being, with individuals reporting vision difficulty more likely to report greater severity of anxiety or depressive symptoms. Similar associations were observed among individuals who wore glasses or contact lenses. Increased collaboration between eye care and mental health professionals is needed.
OBJECTIVE: Socioeconomic status (SES) is a known social determinant of general health. The purpose of this review was to explore the association between SES and visual impairment and ocular disease in Canada. METHODS: Me...OBJECTIVE: Socioeconomic status (SES) is a known social determinant of general health. The purpose of this review was to explore the association between SES and visual impairment and ocular disease in Canada. METHODS: Medline, Embase, CINAHL, and Cochrane were searched from inception to October 2024 for studies that explored the association between SES and visual impairment or ocular disease in Canadian patients. Descriptive statistics were used to summarize the findings. The review was registered in PROSPERO (registration number, CRD42024502490). RESULTS: Twenty-eight studies were included in the review. The included studies covered all provinces and territories and included patients of all ages. Fourteen of the included studies explored the relationship between SES and visual impairment. Eleven of the 14 studies found that patients of lower SES were more likely to have visual impairment, while 3 studies found no significant differences. Fourteen studies have explored the association between SES and various ocular diseases. Glaucoma, macular diseases, diabetic retinopathy, and idiopathic intracranial hypertension were all noted to be of higher prevalence in patients with lower income levels. Patients of lower SES were at the greatest risk of having more severe cataracts (p = 0.001). Among patients with diabetes, those in the lowest SES quintile were at an increased risk of ophthalmological complications compared to higher earners. CONCLUSIONS: SES is a determinant of ocular health in Canada. Higher rates of visual impairment and ocular diseases are associated with lower patient socioeconomic status. Efforts are required to mitigate this disparity and improve health equity.
OBJECTIVE: This study examines 10-year trends in enucleation and evisceration surgeries at a tertiary care hospital, focusing on changing indications, procedural volume, and demographic associations. METHODS: A retrospec...OBJECTIVE: This study examines 10-year trends in enucleation and evisceration surgeries at a tertiary care hospital, focusing on changing indications, procedural volume, and demographic associations. METHODS: A retrospective chart review was conducted at Tampa General Hospital from 2015 to 2024, including 261 enucleations and eviscerations. Patient demographics, clinical indications, surgical details, and histopathological findings were analyzed. Exenteration cases (n = 30) were assessed separately. RESULTS: A total of 261 eye removal surgeries were performed between 2015 and 2024. During the 10-year period, 129 (49.4%) enucleations and 132 (50.6%) eviscerations were performed. The cohort consisted of 139 (53.3%) males and 122 (46.7%) females. Infection (37.9%) and trauma (26.4%) were the leading indications. Enucleation was strongly associated with malignancy, particularly melanoma (p < 0.001), while evisceration was preferred for infections (p < 0.001). The total number of surgeries increased over the study period (p < 0.05). CONCLUSIONS: There was a similar incidence of enucleations and eviscerations, although both increased throughout the study period. There was no association between gender and diagnosis for these surgeries.
OBJECTIVE: To assess transient intraocular pressure (IOP) and visual acuity (VA) changes following anti-vascular endothelial growth factor (anti-VEGF) injections and explore factors influencing recovery. DESIGN: A prospe...OBJECTIVE: To assess transient intraocular pressure (IOP) and visual acuity (VA) changes following anti-vascular endothelial growth factor (anti-VEGF) injections and explore factors influencing recovery. DESIGN: A prospective observational study. PARTICIPANTS: Eighty-six patients (100 eyes) receiving anti-VEGF injections with either aflibercept, bevacizumab, or ranibizumab at a retina clinic were included. METHODS: Age, biological sex, diagnosis (neovascular age-related macular degeneration, retinal vein occlusion, diabetic macular edema), antiseptic used, anti-VEGF agent, glaucoma status, and IOP-lowering pretreatment were collected. IOP and VA using Snellen charts were measured at baseline, 1, 10, 20, and 30 minutes after injection. Spearman's correlation coefficients were used to assess the relationships between IOP and VA. Ordinal logistic regression was used to evaluate predictors of delayed VA recovery. RESULTS: At 1 minute after intravitreal injection (IVI), VA worsened significantly from a baseline of 0.29 ± 0.21 to 0.76 ± 0.65 logMAR (p < 0.001), while IOP rose from 14.34 ± 4.39 mm Hg to 54.53 ± 20.21 mm Hg (p < 0.001). VA progressively improved over time, with 43% of eyes returning to baseline at 1 minute, 67% at 10 minutes, 83% at 20 minutes, and 89% at 30 minutes. The Spearman correlation coefficient for VA and IOP was statistically significant at 1-minute follow-up after IVI at 0.244 (p = 0.014) but not at later follow-ups. Eyes returning to baseline VA at 1 minute exhibited lower IOP than those not at baseline (p = 0.0004). Logistic regression revealed no significant predictors of delayed VA recovery. CONCLUSIONS: Worsened VA and elevated IOP are common in the immediate postinjection period with later improvement. Patients' awareness of VA fluctuations within the first 30 minutes postinjection may aid in the early detection and management of complications associated with IOP elevation.
OBJECTIVE: To evaluate the efficacy and safety of a triamcinolone acetonide (TA) injection for upper eyelid retraction and excursion in patients with active thyroid eye disease (TED). DESIGN: A retrospective observationa...OBJECTIVE: To evaluate the efficacy and safety of a triamcinolone acetonide (TA) injection for upper eyelid retraction and excursion in patients with active thyroid eye disease (TED). DESIGN: A retrospective observational study. PARTICIPANTS: Fifty-six eyelids of 42 patients with TED who had magnetic resonance imaging-confirmed inflammation of the levator palpebrae superioris (LPS), with or without lacrimal gland (LG) involvement. METHODS: Each patient received a transcutaneous injection of 1 mL of TA (40 mg/mL). Clinical outcomes included margin reflex distance-1 (MRD-1), upper eyelid excursion, Hertel exophthalmometry, and clinical activity score (CAS), recorded at baseline, 2 months, and 6 months postinjection. Intraocular pressure (IOP) and adverse events were monitored. Outcomes were compared between patients with inflammation localized in the LPS muscle (LPS group) and those with LPS inflammation, extending to the lacrimal gland (LPS-LG group). RESULTS: All variables improved by 2 months postinjection, and MRD-1 significantly decreased from 5.8 mm at baseline to 4.5 mm at 6 months (p < 0.001). Upper eyelid excursion improved from 12.8 mm to 14.5 mm (p < 0.001). Hertel exophthalmometric values were reduced (16.8 mm to 16.4 mm; p = 0.007). CAS decreased significantly from 1.7 to 0.1 (p < 0.001). No significant differences in treatment outcomes were observed between the LPS and LPS-LG groups. No cases of IOP elevation or post-procedural complications were observed. CONCLUSIONS: A transcutaneous TA injection effectively improves upper eyelid retraction and excursion in active TED without significant adverse events.
OBJECTIVE: This study aims to evaluate the relationship between sodium-glucose cotransporter 2 inhibitors (SGLT2i) and diabetic retinopathy (DR) in diabetes mellitus. METHODS: We conducted a systematic search in PubMed,...OBJECTIVE: This study aims to evaluate the relationship between sodium-glucose cotransporter 2 inhibitors (SGLT2i) and diabetic retinopathy (DR) in diabetes mellitus. METHODS: We conducted a systematic search in PubMed, Embase, Cochrane Library, and ClinicalTrials.gov from their inception to November 9, 2024, for randomized controlled trials (RCTs) and real-world studies of SGLT2i in the treatment of diabetes mellitus. Outcome measures included DR incidence, DR progression, and sight-threatening diabetic retinopathy (STDR). The relative risk (RR) with its 95% confidence interval (CI) was used for the meta-analysis. RESULTS: A total of 16 RCTs and 19 real-world studies were included, involving 2,319,193 patients. The meta-analysis of RCTs indicated that, compared with the control group, SGLT2i was not significantly associated with DR incidence [RR = 0.92, 95% CI 0.60-1.44, I = 0%]. The meta-analysis of real-world studies demonstrated that SGLT2i significantly reduced DR incidence [RR = 0.81, 95% CI 0.73-0.90, I = 93%], DR progression [RR = 0.86, 95% CI 0.76-0.97, I = 70%], and STDR [RR = 0.69, 95% CI 0.61-0.79, I = 84%] compared with the control group. Subgroup analyses revealed that the type of control group might be a source of heterogeneity for DR incidence (p < 0.00001) and STDR (p = 0.01). Sensitivity analysis and assessment of publication bias indicated that the results were robust. CONCLUSIONS: SGLT2i may have a role in reducing the risk of DR, but more multicenter, prospective, and high-quality RCTs are needed to validate our findings in the future.
OBJECTIVE: This study aims to investigate the age- and sex-standardized incidence and prevalence of uveitis in Ontario, Canada, from 2000 to 2021. By employing various case definitions, this research seeks to discern tre...OBJECTIVE: This study aims to investigate the age- and sex-standardized incidence and prevalence of uveitis in Ontario, Canada, from 2000 to 2021. By employing various case definitions, this research seeks to discern trends in uveitis occurrence and provide a comprehensive understanding of its epidemiology. METHODS: A retrospective cohort study utilizing health administrative data was conducted. Multiple case definitions were employed to capture the diverse epidemiological trends of uveitis. Annual age/sex standardized incidence and prevalence rates with 95% confidence intervals (CI) were determined using annual population denominators. RESULTS: The age- and sex-standardized incidence rates exhibited variations over the study period showing a general decline from 2000 to 2021, more notably in recent years. The case definition with one diagnosis code estimated an incidence per 100,000 people of 184.4 (95% CI: 181.5-187.2) in 2000 and 109.2 (95% CI: 107.4-110.9) in 2021. The standardized prevalence exhibited a consistent upward trend, with the case definition requiring "at least one diagnosis code ever" recording 1 998.3 (1 989.1-2 007.5) in 2000 and 2 761.2 (2 752.7-2 769.7) in 2021 per 100,000 people. Lower incidence and prevalence rates were observed when employing case definitions requiring more stringent criteria with additional uveitis-related health encounters. CONCLUSIONS: The estimated trends showed declining standardized incidence, but a persistent increase in prevalence rates over time. These insights contribute valuable knowledge for health care professionals, policymakers, and researchers on the rising prevalence of uveitis and implications for planning for appropriate health care provisions to meet growing demands for uveitis care.
OBJECTIVE: To compare the efficacy of different settings in continuous-wave transscleral cyclophotocoagulation (CW-TSCPC). DESIGN: Prospective, randomized, triple-blind clinical trial in a single tertiary center. PARTICI...OBJECTIVE: To compare the efficacy of different settings in continuous-wave transscleral cyclophotocoagulation (CW-TSCPC). DESIGN: Prospective, randomized, triple-blind clinical trial in a single tertiary center. PARTICIPANTS: Adult glaucoma patients who need continuous wave-transscleral cyclophotocoagulation to control intraocular pressure (IOP) or prevent or treat ocular pain/discomfort secondary to increased IOP. METHODS: Group A uses 1 250 mW for 4 seconds. Group B uses 2 000 mW for 2 seconds. MAIN OUTCOME MEASURES: IOP, best-corrected visual acuity, glaucoma medication, complications, and the need to retreat. RESULTS: Eighteen and 19 eyes in group A and group B, respectively, were included. Groups were comparable at baseline (p > 0.1) for mean age (76.9, 73.5 years), mean IOP (29.1, 29.8 mm Hg), mean logMAR visual acuity (1.6, 1.7), and mean number of glaucoma agents (3.4, 3.4). IOP was comparable between groups at 1 (15.6, 13.7 mm Hg), 4-6 (14.6, 14.8 mm Hg) and 12 months (10.3, 17.3 mm Hg; p = 0.07). There was a trend toward more medication reduction earlier in group B at 1 and 4-6 months (p = 0.11). Complication rates were similar between groups (group A: n = 6; group B: n = 9), with more serious complications in group B. Reintervention was required in 5 patients in group A, and 3 patients in group B after a mean of 4.7 and 6.7 months, respectively. CONCLUSIONS: Both techniques are efficient and comparable in reducing IOP. Our study favours the 1 250 mW for 4 seconds group, with its possibly better safety profile.
Hoyek S, Gilbert JB, Chaaya C
… +10 more, Kearney W, Ross C, Lin MM, Vu DM, Rothman AL, Elze T, Lorch A, Miller JW, Patel NA, IRIS® Registry Analytic Center Consortium
OBJECTIVE: To describe observed intraocular pressure (IOP) changes following vitrectomy (PPV) surgery and PPV combined with phacoemulsification in eyes with and without glaucoma. METHODS: A total of 20,894 patients from...OBJECTIVE: To describe observed intraocular pressure (IOP) changes following vitrectomy (PPV) surgery and PPV combined with phacoemulsification in eyes with and without glaucoma. METHODS: A total of 20,894 patients from the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) who underwent vitrectomy surgery for epiretinal membrane or vitreous opacities from January 2016 to March 2023 were included. Mean IOPs from postoperative day 1, days 2-10, days 11-30, and then monthly through 6 months were compared to baseline. The IOP spike was defined as having an IOP >30 mm Hg and an increase >10 mm Hg from baseline. RESULTS: While IOP spikes were uncommon (<1%), a higher proportion of subjects demonstrated an IOP spike (0.8% vs 0.1%; p < 0.001) in the group with pre-existing glaucoma compared to the group without glaucoma, respectively. At 3 months post-surgery, the probability of an IOP spike was higher in this group (OR = 5.38, 95% CI [3.25 - 9.16]; p < 0.001). Eyes that underwent PPV only showed an increase in postoperative IOP, whereas those that underwent PPV combined with phacoemulsification showed a decrease in postoperative IOP. Longitudinal analysis of IOP showed an initial sharp decline in IOP on day 1, followed by an increase in IOP from week 1 through month 1 and a gradual decrease to postoperative month 3. Overall, eyes that underwent PPV combined with phacoemulsification showed a decrease in postoperative IOP relative to those with PPV alone. CONCLUSIONS: For the entire post-vitrectomy cohort, there was an initial decrease in IOP at postoperative day 1, followed by a transient rise near postoperative month 1, and subsequently a decline to near-baseline level by month 3. Overall, IOP spikes were more frequent and more severe (>40) in the glaucoma/suspect group compared to the group without glaucoma. Ninety-day IOP decreases slightly following vitrectomy surgery in eyes without pre-existing glaucoma, while it increases in eyes with glaucoma, with differences not clinically significant.
OBJECTIVE: To assess the effect of belzutifan, a first-in-class oral hypoxia-inducible factor 2α inhibitor, on retinal hemangioblastoma (RH) outcomes. SUBJECTS/METHODS: This is a single-centre retrospective cohort study...OBJECTIVE: To assess the effect of belzutifan, a first-in-class oral hypoxia-inducible factor 2α inhibitor, on retinal hemangioblastoma (RH) outcomes. SUBJECTS/METHODS: This is a single-centre retrospective cohort study of patients with confirmed von Hippel-Lindau syndrome (VHLS) and RH. Subjects were taking oral belzutifan for renal cell carcinoma, central nervous system hemangioblastoma, or pancreatic neuroendocrine tumours. Patients were assessed for ophthalmic structural, functional, and therapeutic outcomes for >11 months. Patient demographics, VHL genotype, visual function, behaviour of pre-existing RH, number of new lesions, systemic features, and drug-related adverse events were recorded. RESULTS: Sixteen patients (30 eyes) taking oral belzutifan were identified. The mean age was 37 ± 9 years. The proportion of type 1 VHLS was 87.5%, with large (≥1 exon) VHL deletions (81.3%) being the most common. No new RHs developed during the treatment period. The mean final visual acuity was 0.4 ± 1.0 logMAR, with 80% retaining a visual acuity of 0.3 logMAR or better in at least 1 eye (81.3% bilateral). CONCLUSIONS: In patients with VHLS, oral belzutifan resulted in stability of pre-existing RH and no new RH developed during the treatment period. Early use of belzutifan may be a therapeutic avenue to prevent RH development and blindness in patients with VHLS when compared with destructive/ablative alternatives, particularly for posterior or juxtapapillary lesions.
OBJECTIVE: To assess the effectiveness of intracameral lidocaine during routine cataract surgery. DESIGN: Prospective, single-blinded, randomized, controlled trial. PARTICIPANTS: Adult patients undergoing routine phacoem...OBJECTIVE: To assess the effectiveness of intracameral lidocaine during routine cataract surgery. DESIGN: Prospective, single-blinded, randomized, controlled trial. PARTICIPANTS: Adult patients undergoing routine phacoemulsification cataract extraction in a chartered surgical facility in Edmonton, Alberta, Canada, were enrolled in the study. METHODS: Patients were randomized to receive intracameral lidocaine or control (intracameral balanced salt solution). Patients rated their pain at the time of intracameral injection and at the conclusion of the surgery, on a scale from 0 to 10. RESULTS: The study included 106 eyes from 82 patients. The overall pain score was lower (p = 0.004) in the lidocaine group (0.43 ± 0.94/10) than in the control group (0.72 ± 2.79/10). Pain was higher (p = 0.002) in more myopic (1.80 ± 4.04/10) than less myopic patients (0.50 ± 1.67/10). There was no difference in pain experienced at the time of injection (p = 0.270). There was no difference in same-day postoperative logMAR visual acuity (p = 0.837). CONCLUSIONS: Intracameral lidocaine reduces pain during cataract surgery, but the effect is small; it is most effective in myopic patients.
OBJECTIVE: To determine the prevalence of structural causes in pharmacologically confirmed Horner syndrome (HS) and assess the clinical significance of incidental neuroimaging findings. DESIGN: A retrospective cohort stu...OBJECTIVE: To determine the prevalence of structural causes in pharmacologically confirmed Horner syndrome (HS) and assess the clinical significance of incidental neuroimaging findings. DESIGN: A retrospective cohort study. PARTICIPANTS: A total of 134 patients with pharmacologically confirmed HS who underwent neuroimaging at a tertiary neuro-ophthalmology clinic between July 2018 and June 2024. METHODS: Neuroimaging findings were reviewed and categorized as either structural causes of HS or incidental. Incidental findings were further classified on the basis of their clinical relevance and need for follow-up. Cases were stratified by symptom duration into acute (<21 days), subacute (21 days to 3 months), and chronic (>3 months). RESULTS: A structural cause for HS was identified in 14.9% (n = 20) of patients, with higher detection rates in acute (26.0%) and subacute (21.4%) presentations compared to chronic cases (6.5%). The most common causes were internal carotid artery (ICA) dissection (3.0%) and ICA aneurysm (2.2%). Incidental findings were observed in 35.6% (n = 47) of patients, most commonly microangiopathic changes (10%), sinus/mucosal changes (3%), and thyroid nodules (3%). While 18.2% (n = 24) of patients required routine follow-up, only 1.5% (n = 2) needed urgent follow-up, and none required emergency intervention. CONCLUSIONS: Structural causes of HS are more frequently identified in acute and subacute presentations, supporting early imaging, especially to rule out ICA dissection. In chronic HS, selective imaging may be appropriate due to lower diagnostic yield. The high rate of incidental findings underscores the need for careful interpretation to optimize resource use and avoid unnecessary investigations.
OBJECTIVE: To estimate the prevalence of diabetic retinopathy (DR) in Canada and to explore possible differences between Indigenous and non-Indigenous Canadians with diabetes. DESIGN: Systematic review and meta-analysis....OBJECTIVE: To estimate the prevalence of diabetic retinopathy (DR) in Canada and to explore possible differences between Indigenous and non-Indigenous Canadians with diabetes. DESIGN: Systematic review and meta-analysis. METHODS: The Ovid MEDLINE, EMBASE, and Web of Science Databases were searched. The prevalence of (i) DR, (ii) diabetic macular edema (DME), (iii) proliferative diabetic retinopathy (PDR), (iv) vision-threatening diabetic retinopathy (VTDR), and (v) PDR complications was estimated. Meta-analyses were performed using Freeman Tukey double arcsine transformations and random-effects modelling. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) guidelines informed the certainty of evidence. RESULTS: Sixteen studies (17,989 individuals) were included. In the Indigenous and non-Indigenous groups respectively, the pooled prevalence of DR is estimated to be 30.5% (95% CI: 16.7%, 46.4%; GRADE: low), and 32.8% (95% CI: 20.7%, 46.3%; GRADE: low), respectively. The prevalence of PDR is estimated to be 2.8% (95% CI: 0.9%, 5.7%; GRADE: moderate), and 1.9% (95% CI: 0.7%, 3.7%; GRADE: moderate), respectively. The prevalence of DME is estimated to be 3.8% (95% CI: 0.0%, 16.0%; GRADE: moderate) and 4.5% (95% CI: 2.5%, 7.0%; GRADE: moderate), respectively; and the prevalence of VTDR is estimated to be 13.6% (95% CI: 5.2%, 25.1%; GRADE: low) and 5.8% (95% CI: 2.5%, 10.4%; GRADE: low), respectively. High-quality evidence is lacking. CONCLUSIONS: There may be no difference in the prevalence of DR between Indigenous and non-Indigenous Canadians; however, Indigenous Canadians likely have a higher prevalence of VTDR. The uniformly high prevalence across both populations underscores the importance of delivering culturally appropriate diabetes care targeted at reducing risk factors and increasing DR screening in the Canadian community.
OBJECTIVE: Boston keratoprosthesis (KPro) plays an important role in treating complex corneal disease but is associated with many complications. This study addresses correlations and trends found in KPro patients, to und...OBJECTIVE: Boston keratoprosthesis (KPro) plays an important role in treating complex corneal disease but is associated with many complications. This study addresses correlations and trends found in KPro patients, to understand the evolution and optimize postoperative care to minimize complications. DESIGN: A retrospective case series analyzing outcomes and evolution over 15 years. PARTICIPANTS: 157 eyes of 136 patients who underwent KPro surgery between 2008 and 2022 in Montreal, Quebec. METHODS: Mean follow-up of 8.44 ± 4.70 years. Parameters followed included initial graft indication, age, pre-and-post-operative best corrected visual acuity (BCVA), intraocular pressure, cup-to-disc ratio, glaucoma interventions, and postoperative complications. RESULTS: Aniridia was the most common initial graft indication. Fifty-four percent of patients had at least one prior graft failure. The most significant decrease in vision occurred in the first 3 years, followed by a gradual decrease, with 33% of patients retaining BCVA better than 20/200 by 15 years. The best BCVA was significantly better than the initial BCVA. Panocular conditions, such as aniridia, showed quicker visual decline than purely anterior segment pathologies. Retroprosthetic membranes, hypotony, and cystoid macular edema are common complications. Certain complications were seen to be significantly more prevalent in younger populations, although visual acuity and de novo glaucoma development did not differ significantly with age. De novo glaucoma occurred in 63.64%, diagnosed most frequently in the first 2-3 years, with one-third of patients requiring surgical intervention. CONCLUSIONS: KPro offers a prolongation of functional vision, but patients must be monitored closely to detect and treat associated complications, especially in the first 5 years postoperatively.
BACKGROUND: We examined the cataract surgery wait time (WT) disparities across Ontario regions and institution types using a data-driven, population-level, and objective method based on billing codes. METHODS: We identif...BACKGROUND: We examined the cataract surgery wait time (WT) disparities across Ontario regions and institution types using a data-driven, population-level, and objective method based on billing codes. METHODS: We identified 1,138,532 adults who underwent cataract surgery between 2005-2019. WT from referral to initial surgeon visit (WT1) and from surgery decision to first eye surgery (WT2) were compared between rural (population <10,000) and urban settings, LHINs, and institution types (acute care, ambulatory, or other). RESULTS: Median WT1 and WT2 were 70 and 81 days for rural patients and 67 and 76 days for urban patients. Overall, 18.8% and 20.8% of rural patients exceeded WT1 and WT2 provincial guidelines of 182 days, compared to 20.6% and 20.7% of urban patients. Median WT1 and WT2 were 69 and 78 days for surgeries done in acute care (n=517,511), and 73 and 84 for surgeries in ambulatory care (n=270,648) respectively. The percentage exceeding provincial guidelines in both groups ranged from 20.2% to 21.8%. Across LHINs, WT1 ranged from 36 (Erie St. Clair) to 85 days (North Simcoe Muskoka), and WT2 ranged from 44 (Erie St. Clair) to 110 (Champlain). The percentage of patients with WT1 and WT2 exceeding provincial guidelines ranged from 11.4% (Erie St. Clair) to 24.7% (Toronto Central), and from 10.7% (Erie St. Clair) to 30.4% (Champlain) respectively. INTERPRETATION: Though WTs were comparable between institution type, urban, and rural settings, northern LHINs experienced higher WTs than southern LHINs. More data-driven studies are needed to inform health care policies aimed at addressing access to cataract surgery.