Felfeli T, Glazier RH, Gozdyra P
… +3 more, Wilson M, Presseau J, Brent MH
Can J Ophthalmol
· 2026 Jun · PMID 41554519
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OBJECTIVE: To evaluate longitudinal trends and determinants of diabetic retinopathy (DR) screening uptake over 10 years among adults with newly diagnosed diabetes in Ontario, Canada. METHODS: A population-based cohort st...OBJECTIVE: To evaluate longitudinal trends and determinants of diabetic retinopathy (DR) screening uptake over 10 years among adults with newly diagnosed diabetes in Ontario, Canada. METHODS: A population-based cohort study using linked ICES (formerly the Institute for Clinical Evaluative Sciences) administrative data, including adults aged ≥19 years with newly diagnosed diabetes between April 1, 2011, and March 31, 2020. The primary outcome was DR screening within 2 years of diagnosis. Predictors included age, sex, socioeconomic status, comorbidities, rurality, immigration status, and health system factors. Logistic regression evaluated the associations. Five-year rates and ocular complications were assessed. RESULTS: Among 691,557 individuals, 396,073 (57.3%) received DR screening within 2 years of diagnosis. Screening was more common among older adults, females, and individuals with higher comorbidity or rural residence, and less common among younger patients (OR [odds ratio]: 0.22 for age 20-39 vs ≥65; p < 0.0001), males (OR: 1.10 for females vs males; p < 0.0001), immigrants (OR: 0.98; p < 0.0001), and those in the lowest income quintile. One-year rates declined from 44.9% (2011/12) to 35.2% (2019/20), and 5-year rates from 76.8% (2011/12) to 72.4% (2017/18). DR and other ocular conditions were more often diagnosed among screened individuals. Screening dropped sharply during COVID-19, especially among younger adults. CONCLUSIONS: Despite universal health care, substantial disparities in DR screening persist across age, sex, immigration status, and socioeconomic strata. Screening rates declined over time and were further exacerbated by COVID-19. These findings underscore the urgent need for targeted, equity-oriented strategies, such as teleophthalmology and primary care integration, to improve uptake and prevent vision loss in the growing diabetic population.
Sachdeva K, Butt FR, Mihalache A
… +3 more, Nassrallah G, Muni RH, Popovic MM
Can J Ophthalmol
· 2026 Jun · PMID 41548879
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INTRODUCTION: Ocular tumours are detrimental to quality of life and survival. The diagnostic capabilities of artificial intelligence (AI) have increased in the past decade. This systematic review aims to evaluate the dia...INTRODUCTION: Ocular tumours are detrimental to quality of life and survival. The diagnostic capabilities of artificial intelligence (AI) have increased in the past decade. This systematic review aims to evaluate the diagnostic performance of AI models across external, anterior segment, and posterior segment ocular tumours. METHODS: A systematic literature search of Ovid Embase, MEDLINE, and the Cochrane Library was performed for studies on AI in ocular tumour diagnosis published from January 2000 to January 2025. Quantitative outcomes were diagnostic accuracy, sensitivity, specificity, and the area under the receiver operating characteristic curve. Findings were synthesized using descriptive statistics. The QUADAS-2 tool assessed the risk of bias and applicability. RESULTS: Of the 1 947 studies screened, 23 studies were included and categorized as external ocular tumour diagnosis (n = 12), anterior segment tumour diagnosis (n = 2), posterior ocular tumour diagnosis (n = 8), or general ocular tumour diagnosis (n = 1). The main AI models used were DenseNet (n = 4) and ResNet models (n = 3). Weighted mean AI accuracy was 91.4% (81.8% to 98.3%) for external ocular tumour diagnosis, 89.8% (78.1% to 99.0%) for posterior segment ocular tumour diagnosis, and 98.5% for anterior segment tumour diagnosis in the only reporting study. Of the 10 studies comparing AI diagnostic accuracy with physicians, 2 reported significantly higher diagnostic accuracy among ophthalmologists (p < 0.05). Quality assessment demonstrated low or unclear risk of bias and applicability concerns in 69.5% of studies. CONCLUSIONS: AI tools are a potential avenue for efficient and accurate ocular tumour diagnosis. Further studies comparing ophthalmologists' diagnostic performance to AI diagnostic performance are needed.
Can J Ophthalmol
· 2026 Jun · PMID 41547546
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OBJECTIVE: Eye care providers have a responsibility to accommodate patients with visual impairment; however, few studies have explored the accessibility of eye clinics. It is critical to involve stakeholders in these dis...OBJECTIVE: Eye care providers have a responsibility to accommodate patients with visual impairment; however, few studies have explored the accessibility of eye clinics. It is critical to involve stakeholders in these discussions to design spaces with thoughtfulness and intentionality. This study aimed to identify challenges and practical solutions for the accessibility of eye clinic design. DESIGN: An observational, qualitative study. PARTICIPANTS: Participants with visual impairment and blindness were recruited for interviews through "Get Together with Technology", an initiative through the Canadian Council of the Blind that brings together people with vision impairment to use adaptive technology. METHODS: Participants completed 45-minute semi-structured interviews using video conferencing. Audio recordings were transcribed, de-identified, coded, and analyzed for themes. RESULTS: Twenty adult participants were interviewed from across Canada. Eleven participants had a self-reported visual acuity of counting fingers or less. The most common self-reported primary diagnoses were retinitis pigmentosa (5/20) and glaucoma (3/20). Three major themes were intentionality of accommodations, confidence, and design features. Most participants with early-onset vision loss reported greater confidence in navigating eye care clinics. Participants with late-onset vision loss endorsed barriers to adapting to new skills and technologies. Participants identified challenges and practical solutions for specific clinic features, including paperwork, staff interactions, signage, obstructions, lighting, and transportation. CONCLUSIONS: This study highlighted the diverse needs and lived experiences of patients with visual impairment and blindness who access eye care services with respect to accessibility in clinic design. Through a solutions-focused worldview, this study identifies practical suggestions and modifications for health services to meaningfully accommodate patients with visual impairment.
Gregory-Evans CY, Shunmugam M, Li B
… +1 more, Gregory-Evans K
Can J Ophthalmol
· 2026 Jun · PMID 41539649
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OBJECTIVE: To evaluate the breadth of RPGR gene variants in a cohort of Canadian inherited retinal dystrophy patients. DESIGN: A retrospective cohort analysis. PARTICIPANTS: We evaluated 54 subjects in Western Canada wit...OBJECTIVE: To evaluate the breadth of RPGR gene variants in a cohort of Canadian inherited retinal dystrophy patients. DESIGN: A retrospective cohort analysis. PARTICIPANTS: We evaluated 54 subjects in Western Canada with an inherited retinal dystrophy diagnosis and confirmed variants in the RPGR gene. METHODS: Clinical information collected included family history, age, sex, and ethnicity. All participants underwent a full ophthalmic examination, wide-field colour fundus photography, fundus autofluorescence imaging, and visual field testing. Pathogenicity of variants was assessed by comparison to genetic databases of disease-causing variants and in silico modelling. RESULTS: Correlation of genotype with clinical phenotype established a conclusive molecular diagnosis in 34/54 cases (62.9%), with either retinitis pigmentosa (31 cases), cone-rod dystrophy (1 case) or macular dystrophy (2 cases). In the remaining cases, 18 novel RPGR variants were identified comprising 3 nonsense, 5 frameshift, 6 duplications/deletions, 3 missense and 1 splicing variant. Using in silico modelling, 3 novel variants were classified as pathogenic, and 6 were classified as likely pathogenic, increasing the diagnostic rate to 79.6%. Only 3.8% of the cohort were South Asian compared to the local population statistic of 13.5%. Ten of 13 female RPGR carriers were symptomatic and displayed moderate-to-severe phenotypic characteristics. CONCLUSIONS: Through genetic testing, we identified 18 novel RPGR variants, of which 9 were determined to be pathogenic or likely pathogenic. RPGR variants were not a significant cause of retinal dystrophy in South Asians. Female RPGR carriers with visual deficits are likely to be a significant cohort for future RPGR gene therapy trials or treatment modalities.
Williams AM, Liang HW, Usmani B
… +2 more, Cassidy J, Lin HS
Can J Ophthalmol
· 2026 Jun · PMID 41529821
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OBJECTIVE: To assess the association between loss to follow-up (LTFU) and risk of increase in cup-to-disc ratio (CDR) among a national registry cohort of patients with primary open-angle glaucoma (POAG). DESIGN: A retros...OBJECTIVE: To assess the association between loss to follow-up (LTFU) and risk of increase in cup-to-disc ratio (CDR) among a national registry cohort of patients with primary open-angle glaucoma (POAG). DESIGN: A retrospective longitudinal cohort study. PARTICIPANTS: Patients who had a POAG diagnosis in 2014 and had CDR documented in the IRIS Registry (Intelligent Research in Sight) both in 2014 and 2019. METHODS: LTFU was defined as a calendar year or more without an encounter. Log-Poisson regression models were used to estimate the relative risk (RR) and 95% confidence intervals (CIs) for the increase in CDR. A sensitivity analysis was also conducted to address ceiling effects for patients with baseline CDR ≥0.8. MAIN OUTCOME MEASURES: An increase by ≥0.2 in CDR from 2014 to 2019. RESULTS: Among 208,517 patients, 6.9% had an increase by ≥0.2 in CDR from 2014 to 2019. While most patients (81.6%) maintained follow-up every year, 16.1% were LTFU for 1-2 years, and 2.3% were LTFU for 3-4 years. A lapse of 3-4 years was associated with a 15% higher risk of increase in CDR (adjusted RR [aRR] = 1.15, 95% CI: 1.00-1.32) compared to no lapse in care after accounting for age, sex, race, insurance, smoking status, glaucoma severity, baseline intraocular pressure (IOP), and baseline CDR. For patients with CDR ≥ 0.8 at baseline, risk of increase in CDR by ≥0.05 was also associated with LTFU (aRR = 1.34, 95% CI: 1.11-1.60; lapse of 3-4 years compared to no lapse). CONCLUSIONS: LTFU is an independent risk factor for an increase in CDR among patients with POAG.
Tran E, De Francesco T, Ma J
… +2 more, Schlenker MB, Ahmed IIK
Can J Ophthalmol
· 2026 Jun · PMID 41529820
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OBJECTIVE: To evaluate the intraocular pressure (IOP)-lowering effect, adverse event profile, and risk factors for failure of an ab externo microshunt combined with phacoemulsification after 1 year of follow-up. DESIGN:...OBJECTIVE: To evaluate the intraocular pressure (IOP)-lowering effect, adverse event profile, and risk factors for failure of an ab externo microshunt combined with phacoemulsification after 1 year of follow-up. DESIGN: A retrospective, single-center, interventional cohort study. PARTICIPANTS: One hundred nineteen consecutive glaucomatous eyes of 97 patients with an IOP above target or progressing on maximal medical therapy. METHODS: All eyes underwent ab externo microshunt surgery with mitomycin C in combination with phacoemulsification from July 2015 to June 2019. MAIN OUTCOME MEASURES: Primary outcome was complete success, defined as (1) no 2 consecutive IOP readings >17 mm Hg or IOP <6 mm Hg with >2 lines of vision loss, (2) at least 20% IOP reduction from baseline, and (3) on no medications. Secondary outcomes included upper IOP thresholds of 14 mm Hg and 21 mm Hg, qualified success (with medications), change in IOP, medications, visual outcomes, complications, interventions, and reoperations. RESULTS: At 1-year, complete success was achieved in 67.5% of eyes and qualified success in 79.8%. The median best-corrected vision acuity improved from 0.4 (interquartile range [IQR] 0.2-0.7) at baseline to 0.14 (IQR 0.1-0.3) at 1 year (p < 0.0001), with 93.2% having the same or improved vision. The most common complications were shallow anterior chamber (10.1%), iritis (9.2%), and choroidal detachment (8.4%). Needling was required in 24.4% of the eyes. Reoperation was required in 5.9% of the eyes. CONCLUSIONS: The ab externo SIBS microshunt demonstrates reasonable rates of complete and qualified success at 1 year, decreased IOP and medication use, good visual outcomes, and few reoperations when performed in combination with phacoemulsification.
Mah JM, McConnell M, Esmail K
… +5 more, Kherani IN, Baxter SA, Hurley BR, O'Connor MD, Gottlieb CC
Can J Ophthalmol
· 2026 Jun · PMID 41526001
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OBJECTIVE: To develop a surgical assessment tool to evaluate the breadth of surgical procedures in which ophthalmology residents are required to gain competence and to validate this tool for cataract surgery. DESIGN: A q...OBJECTIVE: To develop a surgical assessment tool to evaluate the breadth of surgical procedures in which ophthalmology residents are required to gain competence and to validate this tool for cataract surgery. DESIGN: A questionnaire development study. PARTICIPANTS: Ophthalmology residents and faculty at the University of Ottawa. METHODS: The Canadian Ophthalmology Assessment Tool for Surgery (COATS) was developed by a group of experts by modifying a previously validated assessment tool, the Ottawa Surgical Competency Operating Room Evaluation, and consists of 6 Likert scale items, 1 yes or no question assessing independence and 2 open-ended questions for narrative feedback. During a 2-year period, residents were evaluated on the performance of cataract surgery using the COATS. The primary outcome was the total COATS score, defined as the sum of the Likert scale items. RESULTS: A total of 165 COATS assessments were collected across 5 residents. Mean total COATS scores were lower for the first 2 months of training compared with the last 3 months of training (4.33 ± 0.25 vs 4.81 ± 0.03; p = 0.01; Cohen's d = 0.25) and for procedures where the resident was rated as "not independent" versus "independent" (4.26 ± 0.13 vs 4.74 ± 0.06; p = 0.006; Cohen's d = 0.13). There was a significant correlation between the number of cataract surgeries performed and the mean total COATS score (Pearson r = 0.20; p = 0.02). Forty-five COATS assessments per resident were required to obtain an overall reliability of 0.70, the accepted threshold for low-stakes assessments. CONCLUSIONS: The COATS is a valid tool for the assessment of surgical competence in cataract surgery. There is also evidence that it is a reliable tool when completed multiple times per resident over the course of training.
Radi TO, Larche CL, Pereira A
… +5 more, Tang T, Derzko-Dzulynsky L, Bakshi N, Kaplan AJ, Yan P
Can J Ophthalmol
· 2026 Jun · PMID 41513219
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OBJECTIVE: To synthesize and critically appraise the available evidence on choroidal vitiligo, integrating clinical presentation, multimodal imaging characteristics, and diagnostic differentiation from mimics, while prop...OBJECTIVE: To synthesize and critically appraise the available evidence on choroidal vitiligo, integrating clinical presentation, multimodal imaging characteristics, and diagnostic differentiation from mimics, while proposing a set of diagnostic criteria based on literature synthesis and authors' expert consensus. METHODS: A systematic search of PubMed, Embase, and Cochrane Reviews through July 2025 identified English-language studies reporting on choroidal vitiligo. Two reviewers independently screened, extracted data, and assessed methodological quality for case reports and case series. Narrative synthesis and descriptive statistics were used to summarize the findings. RESULTS: Eight studies met inclusion criteria, comprising 16 patients (28 eyes) from 5 countries. The majority of patients (75%) were asymptomatic, middle-aged females, with bilateral involvement in 88% of cases and preserved visual acuity (≥20/25 in 81% of eyes). Multimodal imaging consistently revealed well-demarcated choroidal hypopigmentation with intact retinal architecture and no intraocular inflammation. OCT demonstrated preserved retinal layers with occasional mild choroidal thinning. Fundus autofluorescence often showed scleral hyper-autofluorescence; FA/indocyanine green angiography showed mild window defects without leakage. Cutaneous vitiligo was present in 63% of patients, with no systemic autoimmune disease reported. CONCLUSIONS: Choroidal vitiligo is a rare, benign, and often incidental finding, best recognized through multimodal imaging. This review proposes clinical diagnostic criteria for primary choroidal vitiligo and highlights its key imaging signature to aid differentiation from neoplastic and inflammatory mimics. We recommend baseline multimodal imaging and follow-up at 6-12 months to confirm stability. Standardized imaging criteria and prospective studies are needed to better define prevalence, natural history, and systemic associations. Given that most included studies were single-case reports, the overall level of evidence is low.
Zhou TE, Kertes PJ, Najm-Tehrani N
… +1 more, Mireskandari K
Can J Ophthalmol
· 2026 Jun · PMID 41494635
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PURPOSE: Retinopathy of prematurity (ROP) is the leading cause of childhood blindness worldwide. While choroidal involution has been described in animal models, choroidal perfusion in premature infants remains poorly cha...PURPOSE: Retinopathy of prematurity (ROP) is the leading cause of childhood blindness worldwide. While choroidal involution has been described in animal models, choroidal perfusion in premature infants remains poorly characterized because of limited use of intravenous fluorescein angiography (IVFA). METHODS: This retrospective study systematically analyzed IVFAs performed post-treatment in patients with ROP at the Hospital for Sick Children between 2011 and 2020. Eligible patients had received intravitreal bevacizumab or laser photocoagulation, and only transiting eyes were included to allow complete IVFA phase analysis. Three independent experts graded each IVFA for image quality, presence of delayed choroidal perfusion during the arteriovenous phase, and its location (central, peripheral, or multifocal). Inter-rater reliability was assessed using Fleiss's κ. RESULTS: Of 79 IVFAs reviewed, 74 met quality criteria. The cohort had an average birth weight of 602.6 g and a gestational age of 24.0 weeks. Most (63.5%) had zone I, stage 3+ ROP. IVFAs were conducted at a corrected age of 7.5 months. Delayed choroidal perfusion was found in 64 eyes (86.5%), predominantly multifocal. Only 2 eyes had normal perfusion. Inter-rater agreement was high (κ = 0.85). CONCLUSIONS: Delayed choroidal perfusion is common and persistent in treated ROP patients. To our knowledge, this is the largest IVFA series that systematically describes this underrecognized feature with implications for long-term vision.
Rahat Qureshi A, Ahmad A, Slomovic JL
… +5 more, Meghdadi Y, Sharma A, Kutty MLH, Wan MJ, Nguyen MTB
Can J Ophthalmol
· 2026 Jun · PMID 41483857
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OBJECTIVE: To quantify the pediatric ophthalmology workforce density, travel burden, and socioeconomic inequities across all 293 Canadian census divisions (CDs). DESIGN: Cross-sectional geospatial study. PARTICIPANTS: A...OBJECTIVE: To quantify the pediatric ophthalmology workforce density, travel burden, and socioeconomic inequities across all 293 Canadian census divisions (CDs). DESIGN: Cross-sectional geospatial study. PARTICIPANTS: A national database of practicing pediatric ophthalmologists in Canada (95 clinicians, 102 sites) and the 2021 Census counts of residents <18 years and median after-tax household income for all CDs. METHODS: For each CD, we calculated providers per 100,000 children, the straight-line distance to the nearest pediatric ophthalmology practice, and the 30- and 60-minute travel-time access. We defined 2 measures of underservice: (1) provider-absence desert, which is a CD with 0 resident pediatric ophthalmologists; and (2) travel-access desert, which is a CD lying outside a 30-minute drive-time catchment. RESULTS: The unweighted mean provider rate was 0.47 ± 3.82 per 100,000 children. 269 CDs (91.8%) had no resident pediatric ophthalmologist (provider-absence deserts). Separately, drive-time modeling showed that 215/293 CDs (73.4%) and 4,178,025 (41.4%) children lay entirely outside a 30-minute road network catchment (travel-access deserts). The median straight-line distance to the nearest clinic was 124.1 km (interquartile range: 57-251). Seventy-four CDs (25.3%) were ≥250 km away. Access worsened with lower income and greater rurality: the lowest-income quintile had 86.9% of children living beyond 30 minutes, versus 16.2% in the highest-income quintile. CONCLUSIONS: Timely treatment of childhood eye diseases hinges on geographic access to pediatric eye-care clinicians, yet 2 in 5 Canadian children live over 30 minutes from pediatric ophthalmologists, and 90% of CDs have no resident pediatric ophthalmologist at all. These provider-absence and travel-access deserts cluster in the lowest-income and most rural regions, signalling an urgent equity gap.
Padda E, Hanafimosalman M, Racine L
… +6 more, Jabbour S, Daigle P, Massicotte E, Harissi-Dagher M, Segal L, Robert MC
Can J Ophthalmol
· 2026 Jun · PMID 41453402
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OBJECTIVE: To evaluate the real-world effectiveness and safety of topical insulin (25 IU/mL) in patients with neurotrophic keratopathy (NK) across multiple etiologies. METHODS: We retrospectively reviewed 29 consecutive...OBJECTIVE: To evaluate the real-world effectiveness and safety of topical insulin (25 IU/mL) in patients with neurotrophic keratopathy (NK) across multiple etiologies. METHODS: We retrospectively reviewed 29 consecutive eyes of 28 patients with neurotrophic keratopathy treated with topical insulin at a single center. The primary outcome was complete epithelial healing for stages 2 and 3 NK; for stage 1, success was prespecified as improvement in corneal staining and epithelial integrity. Statistical analysis included survival analysis and multivariable logistic regression with Firth penalization. RESULTS: Twenty-nine eyes with a mean follow-up of 32.7 weeks were included. Most common etiologies were infectious (51.7%), including herpes simplex virus (24.1%) and varicella zoster virus (20.7%). Twenty-three eyes had stages 2 or 3 NK. Among eyes with stages 2 and 3 NK, complete epithelial healing occurred in 18/23 (78.3%, 95%; CI: 58.1-90.3%), with a median healing time of 33.5 days (IQR: 15.8-81.8). The cumulative healing rate at 8 weeks was 43.5%. Healing success was not significantly associated with defect size or etiology. Among 8 patients who discontinued insulin after healing, recurrence occurred in 1 case (12.5%) and resolved upon treatment resumption. One patient developed mild punctate keratopathy that resolved with continued therapy. CONCLUSIONS: Topical insulin demonstrated substantial healing efficacy for neurotrophic keratopathy across diverse etiologies, with a favourable safety profile and low recurrence rate. Although healing may be slower than FDA-approved alternatives, the dramatic cost difference suggests insulin may be a cost-effective first-line therapy for refractory cases. This represents one of the largest multietiological case series of insulin therapy for neurotrophic keratopathy reported to date.
Can J Ophthalmol
· 2026 Jun · PMID 41448246
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OBJECTIVE: Vitreomacular traction is a common presentation that can benefit from surgical intervention. The decision to peel the internal limiting membrane (ILM) is made at the discretion of the operating surgeon. We des...OBJECTIVE: Vitreomacular traction is a common presentation that can benefit from surgical intervention. The decision to peel the internal limiting membrane (ILM) is made at the discretion of the operating surgeon. We describe a large cohort of eyes that had surgery with or without ILM peeling to give more evidence for the decision-making process. DESIGN: A retrospective cohort study. PARTICIPANTS: Eyes with the diagnosis of vitreomacular traction (VMT) that underwent surgery between January 1, 2016, and January 1, 2025, at a group retina practice in Edmonton, Canada. METHODS: Eyes at a single center underwent vitrectomy surgery for the treatment of VMT with or without peeling of the ILM. Baseline visual and anatomic measures were captured and compared to postoperative findings. The main outcome measures were visual acuity and anatomic outcomes postsurgery. Complication rates were also captured. RESULTS: A total of 250 surgeries were performed during the study period. There was a significant improvement in vision in all eyes (0.19 logMAR). There was no difference in visual improvement when comparing ILM peeling versus ILM sparing. There was better anatomical resolution in cases that had sparing of the ILM. Complication rates were low with no difference in secondary macular hole formation when comparing ILM peeling to ILM sparing. CONCLUSIONS: Pars plana vitrectomy with or without peeling of the ILM is an effective treatment for symptomatic VMT. There may be better anatomic preservation with sparing of the ILM secondary to less surgical manipulation. Complication rates are low regardless of surgical technique.