Can J Ophthalmol
· 2026 Jun · PMID 41429184
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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 r...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.
Gupta A, Francis C, Dhurjon L
… +5 more, Gupta S, Tong L, Tam E, Nazemi F, Somani S
Can J Ophthalmol
· 2026 Jun · PMID 41422834
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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 Ontari...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.
Can J Ophthalmol
· 2026 Jun · PMID 41418819
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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 inequiti...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.
Choi HS, Yoon CK, Park UC
… +2 more, Park KH, Lee EK
Can J Ophthalmol
· 2026 Jun · PMID 41386279
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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 retrospectivel...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.
Tolba R, Lin G, Callejo S
… +9 more, Sainani K, Jabbour S, Segal L, Racine L, Harissi-Dagher M, Nguyen Q, Massicotte E, Daigle P, Robert MC
Can J Ophthalmol
· 2026 Jun · PMID 41354097
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OBJECTIVE: To evaluate the demographics, clinical characteristics, treatments, and outcomes of patients with ocular surface squamous neoplasia (OSSN). DESIGN: A retrospective cohort study. PARTICIPANTS: Patients followed...OBJECTIVE: To evaluate the demographics, clinical characteristics, treatments, and outcomes of patients with ocular surface squamous neoplasia (OSSN). DESIGN: A retrospective cohort study. PARTICIPANTS: Patients followed for OSSN at the Centre Hospitalier de l'Université de Montréal in Quebec between 2013 and 2024. METHODS: Baseline characteristics were extracted alongside pathologic grades, treatment modalities, and recurrences. RESULTS: In total, 67 eyes from 66 patients with a median age at diagnosis of 71 years (range 43-92) were identified. Of the patients, 67.2% (n = 45) were male, and 25.5% (n = 13/51) had a history of skin cancer. Lesions most frequently presented on the bulbar conjunctiva (41%, n = 57), the limbus (25.9%, n = 36), and/or the cornea (13.7%, n = 18). Lesions were papillomatous (31.6%, n = 30), gelatinous (29.5%, n = 28), and leukoplakic (23.2%, n = 22). Of the 80.6% (n = 54) of patients who underwent surgery, 36 received combination therapy with topical drops preoperatively (n = 5), postoperatively (n = 24), or both (n = 7). A total of 19.4% (13) had topical chemotherapy alone: 5-fluorouracil 1% (n = 3), and interferon α2b (n = 10). In cases in which histopathology was available (n = 52), conjunctival intraepithelial neoplasia (CIN) was seen in 87% (n = 45) (CIN1: 4% [n = 2], CIN2: 13% [n = 7], and CIN3: 69% [n = 36]) whereas 13% (n = 7) were squamous cell carcinoma. Recurrence occurred in 23.9% (n = 16). On Cox regression, recurrences were not associated with specific treatment approaches (all hazard ratio CIs crossing 1; P > 0.639) but were associated with positive margins (hazard ratio 3.892; P = 0.04). CONCLUSIONS: OSSN in Quebec predominantly presents as papillomatous bulbar conjunctival lesions in the older White men. In total, 83% of biopsied lesions are of a higher grade (CIN3 and SCC), warranting efforts for earlier detection and referral.
Bondok M, Bondok MS, Knafo M
… +4 more, Law C, Nathoo N, Grimm LJ, Mishra A
Can J Ophthalmol
· 2026 Jun · PMID 41330434
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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 m...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.
Felfeli T, Fang H, Gauthier-Loiselle M
… +2 more, Jiang F, Mandelcorn ED
Can J Ophthalmol
· 2026 Jun · PMID 41320166
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OBJECTIVE: To assess the real-world disease burden among a sample of patients with X-linked retinitis pigmentosa (XLRP) in Canada. DESIGN: A retrospective, noninterventional chart review. PARTICIPANTS: Canadian ophthalmo...OBJECTIVE: To assess the real-world disease burden among a sample of patients with X-linked retinitis pigmentosa (XLRP) in Canada. DESIGN: A retrospective, noninterventional chart review. PARTICIPANTS: Canadian ophthalmologists provided information regarding eligible patients aged ≥5 years who had been diagnosed with XLRP for ≥12 months and had ≥1 clinical encounter with the participating ophthalmologist in the last 12 months. METHODS: Information on participating ophthalmologists' practice setting and experience managing XLRP and patient information, including demographics, comorbidities, disease characteristics and management, productivity loss, and caregiver burden, were descriptively reported prior to or on patients' latest clinical encounter. RESULTS: In total, 12 ophthalmologists abstracted information for 36 patients with XLRP (median age: 34 years; 83% male). Among patients aged ≥46 years (n = 11), all patients had severely impaired visual acuity in ≥1 eye and 91% of patients were nearly unable to see in dim light. Most adult patients (n = 30) required assistance with ≥1 activity of daily living (70%), including transportation and shopping (60%) and house cleaning and maintenance (43%). A total of 60% of adults received informal care (mean: 24.0 ± 16.4 hours per week), and 40% were not working due to disability. CONCLUSIONS: These results highlight the substantial real-world burden of XLRP on patients and their caregivers and its progressive nature and increasing impact over time. The study reveals significant unmet needs, including high levels of caregiver support, loss of productivity, and assistance with basic daily activities, emphasizing the need for effective treatments.
Can J Ophthalmol
· 2026 Jun · PMID 41314619
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OBJECTIVE: School-based vision screening programs identify children with ocular abnormalities and refer them to eye care professionals, allowing access to better vision and improved learning potential. While non-health c...OBJECTIVE: School-based vision screening programs identify children with ocular abnormalities and refer them to eye care professionals, allowing access to better vision and improved learning potential. While non-health care professionals often conduct these screenings, effective training methods are not well defined. This study describes a standardized, competency-based training program to prepare non-health care personnel to perform reliable vision screenings for children. DESIGN: Competency-based and experiential learning. PARTICIPANTS: 170 students from McMaster University. METHODS: Training included 4 phases: (1) online modules with assessments; (2) hands-on screening skill development at practical stations; (3) competency evaluation via Objective Structured Clinical Examination; and (4) remediation for underperforming trainees. RESULTS: From 2022 to 2025, 170 trainees enrolled in the program, 128 completed the program successfully, and only 9 required Phase 4 support. Over 19,000 senior kindergarten students were screened through the new competency-based screening program. CONCLUSIONS: Further validation will support the standardization of this training model. A universally adopted training method to teach non-eye care professionals to accurately perform vision screening is essential to ensure that all children receive the highest standard of care.
Nam D, Jang YH, Lee Y
… +7 more, Seo J, Thakur S, Nusinovici S, Kim M, Shin YU, Park HC, Hwang S
Can J Ophthalmol
· 2026 Jun · PMID 41290195
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OBJECTIVE: This study presents an independent clinical evaluation of Dr.Noon CVD, a commercially developed artificial intelligence (AI)-based retinal imaging model that estimates cardiovascular disease (CVD) risk. We ass...OBJECTIVE: This study presents an independent clinical evaluation of Dr.Noon CVD, a commercially developed artificial intelligence (AI)-based retinal imaging model that estimates cardiovascular disease (CVD) risk. We assessed whether the model can effectively evaluate CVD risk in patients with hypertensive retinopathy (HR), a population in which the applicability of conventional CVD risk models remains uncertain. METHODS: We retrospectively analyzed 102 age-matched patients from Hanyang University Guri Hospital and classified them into normal (Group 1), low-grade HR (Group 2), and high-grade HR (Group 3) groups using Keith-Wagener-Barker grading. CVD risks were assessed via Dr.Noon CVD score and conventional risk scores (PREVENT, PCE, SCORE2, SCORE2-Diabetes). Associations and predictive performance were evaluated using logistic regression, area under the ROC curve (AUC), and net reclassification improvement (NRI). RESULTS: Low-density lipoprotein cholesterol, estimated glomerular filtration rate, and blood pressure were significantly higher in the HR groups versus Group 1 (p < 0.05). Dr.Noon CVD scores differed significantly across HR grades (p = 0.002), particularly between Groups 3 and 1 (p = 0.002), while conventional scores showed no significant separation (p > 0.1). Higher Dr.Noon CVD scores were associated with Group 3 in both unadjusted (OR = 1.11; p = 0.001) and adjusted models (OR = 1.33; p < 0.001). Scores remained stable between acute and chronic HR (p = 0.966). Combining Dr.Noon CVD score with conventional models improved CVD risk classification (higher AUC and NRI). CONCLUSIONS: Dr.Noon CVD identified elevated CVD risk in HR patients and enhanced stratification when combined with existing models. These results support the use of retinal biomarkers in CVD risk assessment and the need for multidisciplinary management.
Can J Ophthalmol
· 2026 Jun · PMID 41290194
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OBJECTIVE: To determine the impact of virtual interviews on the geographic distribution of matched ophthalmology residency applicants. DESIGN: A retrospective database review. PARTICIPANTS: A total of 334 residents comme...OBJECTIVE: To determine the impact of virtual interviews on the geographic distribution of matched ophthalmology residency applicants. DESIGN: A retrospective database review. PARTICIPANTS: A total of 334 residents commencing ophthalmology training from 2016 to 2024 in 15 Canadian ophthalmology residency programs. METHODS: We gathered publicly available information to compare match outcomes pre-virtual (2016-2019) to virtual interviews (2020-2024). Variables collected included resident names, medical school, and residency program location. Chi-squared tests were conducted to determine whether there was a significant difference in the proportion of applicants matching in the same region, province, and institution as their medical schools in pre-virtual versus virtual interview cycles. RESULTS: A total of 292 residents (88% completion rate) were identified. Home program matches were similar between the pre-virtual (51.18%) and virtual cohorts (49.70%). Same-province but different-school matches decreased slightly (18.90% pre-virtual vs 16.36% virtual), while same-region but different-province matches (6.30% vs 6.06%) were similar. Conversely, inter-regional matches increased from 23.62% pre-virtual to 27.88% virtual. Chi-squared analysis showed no statistically significant difference in geographic placement between the two groups (χ² = 0.80; p = 0.85). CONCLUSIONS: The transition to virtual interviews in Canadian ophthalmology residency programs did not significantly alter the geographic distribution of matched applicants. While concerns exist that virtual interviews might limit applicants' ability to explore programs outside their home institutions, our findings suggest that other virtual engagement methods, such as online networking, mentorship programs, and social media, may have helped maintain geographic mobility. Future studies could assess whether these trends persist over time and whether similar strategies could enhance applicant program exposure in other specialties.
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 retinop...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.
Parikh AA, Hoyek S, Cakir B
… +3 more, Chaaya C, Mukai S, Patel NA
Can J Ophthalmol
· 2026 Jun · PMID 41265842
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OBJECTIVE: To report the etiologies, clinical course, and management outcomes of pediatric full-thickness macular holes (MH). DESIGN: A retrospective observational case series. PARTICIPANTS: Patients under the age of 18...OBJECTIVE: To report the etiologies, clinical course, and management outcomes of pediatric full-thickness macular holes (MH). DESIGN: A retrospective observational case series. PARTICIPANTS: Patients under the age of 18 years with confirmed full-thickness MH and a minimum of 3 months of follow-up, examined between January 1, 2025, and December 31, 2023, at a tertiary eye care center. METHODS: Data from all subjects were obtained from initial and follow-up visits, including demographic data, best-corrected visual acuity (BCVA), key examination and imaging findings, MH etiology, MH aperture, and base diameters based on optical coherence tomography (OCT) imaging (Spectralis; Heidelberg Engineering, Heidelberg, Germany), spontaneous closure rate, time to closure, surgical technique, surgical success rate for hole closure, postoperative complications, additional surgical procedures performed, and duration of follow-up. MAIN OUTCOME MEASURES: Spontaneous closure rate versus surgical closure rate and BCVA at final follow-up. RESULTS: Forty-seven eyes from 47 patients were included, the majority of which were Caucasian males. The mean age was 13 ± 3.17 years, and blunt trauma was the most common etiology (n = 41, 87%). The median MH aperture diameter was 222 μm (IQR 156, range: 110-565; n=25). Of those opting for watchful waiting, spontaneous closure was observed in 26 eyes (63%), and median closure time was 45 days from the date of initial diagnosis (IQR: 66.5, range: 8-302). Eighteen eyes (38%) underwent surgical intervention, on average 134 days (range: 4-553 days) from initial diagnosis. Of those undergoing surgery, MH closure was noted postoperatively in 13 eyes (72%). Two surgical complications (11%) were reported: a postoperative cataract that required subsequent extraction, and a reopening of MH within 1 year in a patient with X-linked retinoschisis (XLRS). For patients who underwent surgery, the mean BCVA improved from 20/315 (logMAR 1.20) at presentation to 20/70 (logMAR 0.54) at final follow-up (p < 0.05). For patients who underwent watchful waiting, the mean BCVA improved from 20/230 (logMAR 1.06) to 20/50 (logMAR 0.40) (p < 0.05). There was no statistically significant difference in BCVA at presentation or final follow-up between the surgical intervention group and the spontaneous closure group. CONCLUSIONS: Macular holes in the pediatric population are most often the result of blunt trauma. Watchful waiting for spontaneous closure and surgical intervention both appear to have comparable outcomes on closure and vision recovery.