Al-Burak SA, Suleiman A, Voznyy V
… +5 more, Elganga M, Zajner C, Juncal V, Sheidow TG, Malvankar-Mehta MS
Can J Ophthalmol
· 2026 Jun · PMID 42242290
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BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for diabetes, obesity, and cardiovascular risk reduction. However, their ocular safety profile, particularly regarding age-rel...BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for diabetes, obesity, and cardiovascular risk reduction. However, their ocular safety profile, particularly regarding age-related macular degeneration (AMD), remains uncertain. This systematic review evaluates the association between GLP-1 RA use and the incidence or progression of AMD including both nonexudative and neovascular subtypes. METHODS: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and registered with PROSPERO (CRD420251183938). MEDLINE, Embase, CENTRAL, Web of Science, and PubMed were searched from inception through 2025 for observational studies and randomized trials evaluating AMD outcomes among adults exposed to GLP-1 RAs. Comparators included nonuse, placebo, or alternative metabolic therapies. Risk of bias was assessed using Risk of Bias in Non-Randomized Studies of Interventions and certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation framework. Due to heterogeneity of outcome definitions, results were synthesized qualitatively. RESULTS: Eight observational studies encompassing 91 408 to 600 816 participants were included. GLP-1 RA use was associated with a reduced incidence of nonexudative AMD across diabetic and nondiabetic populations, with relative risk reductions varying substantially by population, comparator, and follow-up duration. Findings for neovascular AMD were heterogeneous: most studies reported neutral or protective associations, whereas one population-based cohort of older adults with diabetes observed an increased risk (adjusted hazard ratio 2.21, 95% CI 1.65-2.96), with low absolute event rates. Overall risk of bias was moderate to high, and certainty of evidence for all outcomes was very low. CONCLUSIONS: Current evidence does not demonstrate a consistent increase in AMD risk associated with GLP-1 RA therapy and may be associated with a lower incidence of nonexudative AMD, although the certainty of evidence is very low and noncausal explanations cannot be excluded. Prospective studies with standardized endpoints are needed to clarify causal relationships.
Can J Ophthalmol
· 2026 Jun · PMID 42208601
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OBJECTIVE: To determine whether nonglaucomatous retinal nerve fibre layer (RNFL) defects independently predict incident cerebral infarction or coronary heart disease. DESIGN: Retrospective, observational cohort study. PA...OBJECTIVE: To determine whether nonglaucomatous retinal nerve fibre layer (RNFL) defects independently predict incident cerebral infarction or coronary heart disease. DESIGN: Retrospective, observational cohort study. PARTICIPANTS: A total of 80,996 adults from a health screening cohort (2011-2022) with gradable serial fundus photographs. Individuals with pre-existing ocular or vascular disease were excluded. METHODS: RNFL defects were classified as glaucomatous or nonglaucomatous based on predefined imaging criteria. Multivariable logistic regression identified independent predictors. To ensure temporal validity, participants with prior stroke or coronary heart disease were excluded. A 1:3 propensity score-matched analysis compared outcomes between individuals with nonglaucomatous RNFL defects and matched controls. Vascular events were tracked through 2024. RESULTS: Of 80,996 individuals, 787 had nonglaucomatous RNFL defects, 1,328 had glaucomatous defects, and 78,881 served as controls. Male sex (odds ratio [OR] 1.33), hypertension (OR 2.77), diabetes (OR 1.68), reduced eGFR, and younger age were independently associated with nonglaucomatous RNFL defects (all p < .05). In the matched cohort (747 vs 2,241), incident vascular events occurred in 7.5% of those with nonglaucomatous RNFL defects versus 0.6% in controls (OR 9.11; 95% CI: 5.37-15.48; p < .001). CONCLUSIONS: Nonglaucomatous RNFL defects are strong independent predictors of future cerebral infarction or coronary heart disease. Routine fundus photography may provide systemic vascular risk insight beyond ophthalmic evaluation.
Bhui SB, Gardiner J, Lam WC
… +2 more, Berkowitz J, Ma PE
Can J Ophthalmol
· 2026 Jun · PMID 42161340
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OBJECTIVE: To evaluate access to pediatric retina services, including examinations under anesthesia (EUA) and surgical interventions, at a provincial children's hospital before and during the coronal virus disease-19 (CO...OBJECTIVE: To evaluate access to pediatric retina services, including examinations under anesthesia (EUA) and surgical interventions, at a provincial children's hospital before and during the coronal virus disease-19 (COVID-19) pandemic. METHODS: A retrospective review of pediatric retina service utilization at British Columbia Children's Hospital from January 1, 2012, to December 31, 2023, was conducted. The prepandemic period (2012-2019) was compared to the postpandemic period (2020-2023). Data collected included the number of procedures, procedure type (EUA vs surgical intervention), urgency classification, and number of unique patients. Annualized means were used to account for unequal study durations. Statistical comparisons are presented descriptively. RESULTS: A total of 257 procedures were performed in the prepandemic period and 204 during the pandemic period. The mean number of procedures per year increased from 32.1 (SD 8.03) prepandemic to 51 (SD 6.98) during the pandemic. EUA comprised 60% of the procedures prepandemic and 50% during the pandemic. Surgical intervention proportions remained relatively stable, including pars plana vitrectomy (36% vs 35%). The proportion of elective procedures increased during the pandemic period. The mean number of unique patients per year has also increased. CONCLUSIONS: Access to pediatric retina services at a provincial children's hospital was maintained during the COVID-19 pandemic, with stable procedural distribution despite broader health care system disruptions. Further investigation is required to understand the long-term outcomes and postpandemic trends.
Shin JH, Yoon CK, Park UC
… +2 more, Park KH, Lee EK
Can J Ophthalmol
· 2026 Jun · PMID 42150619
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OBJECTIVE: To investigate macular vascular abnormalities in patients with unilateral pigmentary retinopathy (UPR) using swept-source optical coherence tomography angiography (OCTA). METHODS: Patients with UPR who had pig...OBJECTIVE: To investigate macular vascular abnormalities in patients with unilateral pigmentary retinopathy (UPR) using swept-source optical coherence tomography angiography (OCTA). METHODS: Patients with UPR who had pigmentary retinopathy in 1 eye and no functional or structural abnormalities suggestive of pigmentary retinopathy in the fellow eye were included. Age- and sex-matched healthy controls were also recruited. Quantitative microvascular parameters were compared between the affected and unaffected eyes of UPR, and between the unaffected eyes of UPR patients and those of healthy controls. RESULTS: Eleven patients with UPR and 11 healthy individuals were included. Affected eyes demonstrated significantly lower perfusion density (PD) in the superficial capillary plexus (SCP; 35.64% ± 6.18%) and deep capillary plexus (DCP; 14.35% ± 6.34%) than in unaffected eyes (SCP; 43.47% ± 1.72%; p = 0.004; DCP; 25.95% ± 5.22%; p = 0.003). There were no significant differences in OCTA variables between the unaffected eyes of patients and control eyes except for the length and size of the DCP foveal avascular zone (FAZ). The preserved width of the inner segment ellipsoid (ISE) was negatively correlated with interocular differences in PD, vessel length density (VLD), FAZ size, and perimeter. Univariable analyses identified preserved ISE width, PD and VLD in both the SCP and DCP, and SCP FAZ size as factors associated with best-corrected visual acuity. CONCLUSIONS: OCTA revealed reduced macular microvasculature in the affected eyes with UPR. Greater structural loss in the affected eye was associated with more pronounced interocular differences in retinal microvasculature. Microvascular alterations and structural deterioration of the photoreceptors show considerable correlation with functional outcomes in these patients.
Welten A, Algodi HS, Abraha L
… +1 more, Malvankar-Mehta MS
Can J Ophthalmol
· 2026 May · PMID 42150617
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BACKGROUND: Inherited optic neuropathies (IONs) cause progressive visual loss and substantially affect quality of life. This updated systematic review aims to synthesize and evaluate evidence on the patient experience of...BACKGROUND: Inherited optic neuropathies (IONs) cause progressive visual loss and substantially affect quality of life. This updated systematic review aims to synthesize and evaluate evidence on the patient experience of living with IONs, identify currently used assessment tools, and highlight areas for improvement in research and clinical care. METHODS: We systematically searched MEDLINE, EMBASE, PsycINFO, CINAHL, and Scopus for studies on (i) inherited optic neuropathies; (ii) quality of life or health status; (iii) patient-reported outcome measures; and/or (iv) qualitative research. Inclusion was restricted to peer-reviewed studies. Screening, data extraction, and risk of bias assessment were conducted using Covidence. RESULTS: From 1775 unique records, 5 studies met the inclusion criteria. They evaluated quality-of-life outcomes in patients with Leber hereditary optic neuropathy or autosomal-dominant optic neuropathy across 6 countries. Patient-reported outcome measures used included National Eye Institute Visual Functioning Questionnaire-39, National Eye Institute Visual Functioning Questionnaire-25, Short-Form 12 Health Survey, Beck Depression Inventory, and Pittsburgh Sleep Quality Index. Only one study used qualitative interviews to explore the emotional, social, and financial impacts on patients and families. DISCUSSION: This updated systematic review builds upon previous work to further characterize the impact of ION on patients living with these conditions and the tools currently used to assess them. We highlight the need for a multifaceted approach to ION management, combining medical treatment with comprehensive psychosocial support to work toward more patient-centred care and improved quality of life for those living with these challenging conditions.
Butt AB, Ahmad A, Pandya B
… +4 more, Tien CW, Tao BK, Rastogi A, Sharma RA
Can J Ophthalmol
· 2026 May · PMID 42150616
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OBJECTIVE: To determine the pooled prevalence of obstructive sleep apnea (OSA) among adults with idiopathic intracranial hypertension (IIH) using polysomnography (PSG) and the Berlin Questionnaire screening. NATURE: IIH...OBJECTIVE: To determine the pooled prevalence of obstructive sleep apnea (OSA) among adults with idiopathic intracranial hypertension (IIH) using polysomnography (PSG) and the Berlin Questionnaire screening. NATURE: IIH is a vision-threatening disorder characterized by elevated intracranial pressure. OSA shares overlapping risk factors and pathophysiological mechanisms with IIH, including nocturnal hypoxia and hypercapnia. Clarifying OSA prevalence in IIH is clinically important for diagnosis and management. METHODS: For this prospectively registered systematic review and meta-analysis (PROSPERO: CRD420251132794), we searched MEDLINE, Embase, and CENTRAL from inception to August 23, 2025, for studies reporting PSG-confirmed OSA or Berlin Questionnaire positivity in adults with IIH. Risk of bias was assessed using ROBINS-I and RoB-2, and certainty of evidence was checked using the Grading of Recommendations, Assessment, Development and Evaluation tool. Random-effects meta-analyses of proportions generated pooled prevalence estimates. Subgroup analyses excluded high-risk studies, leave-one-out analyses assessed robustness, and funnel plots evaluated publication bias. RESULTS: Eleven studies met the inclusion criteria. Across 9 PSG-based studies (n = 299), the pooled prevalence of OSA in IIH was 0.44 (95% CI: 0.26-0.63; I² = 90.5%). Leave-one-out analyses showed stable results (39%-50%). Excluding high-risk studies (4 studies; n = 132) yielded a pooled prevalence of 0.53 (95% CI: 0.32-0.74). Four Berlin Questionnaire studies (n = 154) showed a pooled prevalence of 0.65 (95% CI: 0.54-0.74; I² = 0%). Funnel plot asymmetry suggested publication bias, and certainty of evidence was very low. CONCLUSIONS: OSA is common among patients with IIH, supporting routine objective sleep evaluation. Prospective studies are needed to clarify this association.
BACKGROUND: Neurofibromatosis-type 1 (NF1) is a genetic disorder characterized by developing optic pathway gliomas (OPGs) in 15%-20% of patients with higher estimates where consanguinity is prevalent. Clinically, NF1-OPG...BACKGROUND: Neurofibromatosis-type 1 (NF1) is a genetic disorder characterized by developing optic pathway gliomas (OPGs) in 15%-20% of patients with higher estimates where consanguinity is prevalent. Clinically, NF1-OPG might be unpredictable with the risk of OPG progression and visual impairment. The optimal time for screening is controversial. We aim to identify the mean/median age at diagnosis of NF1-OPG and its clinical spectrum. METHODS: A systematic review of PubMed, Web of Science, and Embase databases was conducted for English-language publications from January 1993 to October 2025, exploring the visual screening of OPGs in NF1 patients, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered in the Prospective Register of Systematic Reviews (PROSPERO ID: CRD420251036244). Inclusion criteria focused on studies reporting the age at OPG diagnosis and visual manifestations in NF1 patients. Data were extracted on demographics, age at NF1 and OPG diagnosis, tumour location (using the Dodge classification), and presenting symptoms. Sixteen studies met the inclusion criteria. RESULTS: Among 4 739 NF1 patients, 818 had OPGs, with prevalence ranging from 4.2% to 46.7%. The age at NF1 diagnosis ranged from 0 to 132 months (mean: 18-38 months), and at OPG diagnosis from 0-240 months (median: 29-58 months). Approximately 58.4% of OPGs were asymptomatic, and 25% were above the age of 5 years. Among symptomatic patients, the most frequent presentations included decreased visual acuity (62%), abnormal optic disc (45%), proptosis (20%), strabismus (12%), and visual field defects (7%). CONCLUSIONS: NF1-related OPGs typically present early within 6 years of age. Early ophthalmologic and/or radiologic screening at the time of NF1 diagnosis enhances the detection of silent OPGs.
Can J Ophthalmol
· 2026 Jun · PMID 42150613
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OBJECTIVE: To evaluate the diagnostic yield of panel-based genetic testing for inherited retinal diseases (IRDs) and identify barriers to molecular resolution. DESIGN: Retrospective cohort. PARTICIPANTS: A total of 404 p...OBJECTIVE: To evaluate the diagnostic yield of panel-based genetic testing for inherited retinal diseases (IRDs) and identify barriers to molecular resolution. DESIGN: Retrospective cohort. PARTICIPANTS: A total of 404 patients with clinically confirmed IRDs who were evaluated at the Adult Inherited Retinal Dystrophy Service, Ontario, Canada (October 2021-September 2024). METHODS: Patients underwent targeted massive parallel sequencing panel testing. Diagnostic yield was calculated, and unresolved cases were reviewed. Associations between yield, phenotype, ethnicity, and sex were assessed using χ² analysis. RESULTS: Of 685 referrals, 570 had confirmed IRDs. After we excluded 140 pending results and 26 patients who declined testing, 404 patients were analyzed. At referral, 94 patients (23.2%) had a previous molecular diagnosis, and 138 (34.0%) were diagnosed through clinic-initiated testing, giving an overall yield of 57.4%. Yield varied significantly by phenotype (χ², P = 1.4 × 10⁻⁶), from 94.4% in vitelliform macular dystrophies to 25.0% in vitreoretinopathies, with no sex association (P = 1.0). Disease-causing variants were identified in 83 IRD-associated genes, most frequently ABCA4, USH2A, and BEST1. Of 172 unresolved cases, 62 (36.0%) had negative panels, and 110 (63.9%) were inconclusive, including 30 with unphased pathogenic variants in recessive genes and 10 with high-suspicion variants of uncertain significance. Key barriers included limited family availability for phasing, restricted access to functional assays, and lack of public coverage for whole-exome or whole-genome sequencing. CONCLUSIONS: Massive parallel sequencing-based panel testing achieved a 57% diagnostic yield in this IRD population. Success was strongly phenotype-dependent with substantial heterogeneity. Whole-exome sequencing, whole-genome sequencing, family segregation, and functional genomics could improve diagnostic outcomes and management.
Daud F, Tao BK, Sundaram A
… +4 more, Bursztyn LLCD, Sheldon CA, Ing E, Sharma RA
Can J Ophthalmol
· 2026 Jun · PMID 42142530
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BACKGROUND: There is an undersupply of neuro-ophthalmologists in North America compared to care demand, which may be further compounded by barriers to care access, such as geography, education, and socioeconomic status....BACKGROUND: There is an undersupply of neuro-ophthalmologists in North America compared to care demand, which may be further compounded by barriers to care access, such as geography, education, and socioeconomic status. In this study, we sought to analyze the national distribution of neuro-ophthalmologists in Canada and evaluate factors associated with impeded care access. METHODS: A list of all neuro-ophthalmologists in Canada was compiled using the North American Neuro-Ophthalmology Society directory, Canadian Neuro-ophthalmology Group directory, and additional input from the authors. Canadian Census data from 2021 was collected at the level of aggregated dissemination areas (ADAs). The 3-step floating catchment area (3SFCA) method was used to assess accessibility to neuro-ophthalmologists across ADAs. Logistic regression models were created using the accessibility score to determine factors that impact accessibility. RESULTS: Of the 5 433 ADAs in Canada, 1 817 (33%) are located further than 100 km from the nearest neuro-ophthalmologist. The mean distance to a neuro-ophthalmologist was 155.0 km, while the median was 33.0 km. The overall 3SFCA-adjusted rate of accessibility in Canada was 0.015 neuro-ophthalmologists per 100,000 people. Regression analysis found rural residency (odds ratio [OR] = 0.56; p < 0.001) to be the most significant factor associated with reduced access to neuro-ophthalmological care, while areas with higher Indigenous population percentages were associated with reduced access to care (OR = 0.36; p < 0.001). CONCLUSIONS: There are disparities in access to neuro-ophthalmologists across Canada. Rural residence and an increased Indigenous population were found to be significant factors associated with reduced access to neuro-ophthalmological care. Further research should investigate strategies to mitigate these discrepancies.
García-Bardera J, García-Bermúdez M, Garcia-Feijoo J
… +8 more, Ponce-de-León-Miguel Á, Heredia-Pastor C, Ginés-Gallego C, Méndez-Hernández C, García-Sáenz S, Fernández-Vidal A, Martínez-de-la-Casa Jose M, Morales-Fernández L
Can J Ophthalmol
· 2026 May · PMID 42140610
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OBJECTIVE: To describe the 3-year clinical outcomes of PRESERFLO MicroShunt (PMS) implantation in eyes with uncontrolled glaucoma and previous failed trabeculectomy. DESIGN: A retrospective, single-centre observational c...OBJECTIVE: To describe the 3-year clinical outcomes of PRESERFLO MicroShunt (PMS) implantation in eyes with uncontrolled glaucoma and previous failed trabeculectomy. DESIGN: A retrospective, single-centre observational cohort study. PARTICIPANTS: Seventy-four eyes with glaucoma that had at least 1 failed trabeculectomy and no other previous surgeries for glaucoma. METHODS: All consecutive eyes undergoing PMS implantation after failed trabeculectomy were included. Clinical data were collected at baseline and scheduled postoperative visits. Primary outcome measures were intraocular pressure (IOP), number of glaucoma medications, and surgical success, defined as an IOP reduction ≥20% (criterion 1) or ≥30% (criterion 2) from baseline, with postoperative IOP <18 mm Hg and no need for additional glaucoma filtering surgery. Complete success was defined as achieving target IOP without medications and qualified success as achieving target IOP with medications. RESULTS: The median follow-up was 36 months. Mean baseline IOP was 23.0 ± 5.7 mm Hg on 3.0 ± 0.7 medications. At 3 years, mean IOP decreased to 12.1 ± 3.5 mm Hg (-46.1%; mean reduction -10.6 mm Hg; 95% CI, -12.1 to -8.3; P < 0.001) with 0.8 ± 1.3 medications; 51.4% of eyes were medication-free. Using criterion 1, overall success was 68.6% (51.5% complete); using criterion 2, overall success was 62.9% (51.5% complete). No eye required additional glaucoma-filtering surgery. Complications occurred in 44.6% of eyes, most of which were mild and self-resolving; 5.9% required surgical intervention. CONCLUSIONS: PMS implantation resulted in sustained IOP reduction, reduced medication burden, and an acceptable safety profile over 3 years in eyes with previous failed trabeculectomy. Further prospective studies with longer follow-up are warranted.