Watt H, Salimi A, Karam M
… +5 more, Alik M, Osba AA, Ahmad S, Gupta R, Saheb H
Can J Ophthalmol
· 2026 Jun · PMID 42320535
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OBJECTIVE: To estimate the pooled prevalence, anatomical distribution, and occupational impact of work-related musculoskeletal (MSK) pain among ophthalmologists, and to identify modifiable ergonomic risk factors. DESIGN:...OBJECTIVE: To estimate the pooled prevalence, anatomical distribution, and occupational impact of work-related musculoskeletal (MSK) pain among ophthalmologists, and to identify modifiable ergonomic risk factors. DESIGN: A systematic review and meta-analysis of published data. The protocol was preregistered (PROSPERO CRD42023422368) and reported in accordance with PRISMA. PARTICIPANTS: The participants were 6691 ophthalmologists from 21 studies. METHODS: Electronic databases (MEDLINE, Embase, Cochrane, and PubMed) were searched for peer-reviewed quantitative studies reporting MSK pain prevalence in ophthalmologists. Pooled estimates with 95% CI were calculated using random-effects models; heterogeneity was quantified using I². MAIN OUTCOME MEASURES: Prevalence of overall and site-specific MSK pain; effects on workload and productivity; prevalence of treatment or mitigation strategies. RESULTS: The pooled prevalence of any MSK pain was 70% (95% CI: 65%-75%; I² = 92%); neck (41%; 95% CI: 35%-47%; I² = 95%), lower back (36%; 95% CI: 32%-39%; I² = 87%), and shoulder pain (28%; 95% CI: 22%-35%; I² = 91%) were most common. Pain led to workload modification in up to 44% and contributed to reduced clinical volume, sick leave, or contemplation of early retirement. Forty-six percent (95% CI: 22%-71%) pursued no treatment; 39% (95% CI: 30%-49%) used medical therapy; and 29% (95% CI: 20%-41%) sought physiotherapy. Heterogeneity was high across studies, reflecting differing case definitions and self-reported measures. CONCLUSIONS: MSK pain affects most ophthalmologists, particularly in the cervical and lumbar regions and frequently alters practice patterns. These findings underscore the need for early ergonomic training, structured micro-breaks, and workspace redesign. Prospective intervention trials are required to establish causality and quantify benefit.
Can J Ophthalmol
· 2026 Jun · PMID 42320534
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OBJECTIVE: A major challenge in teaching slit-lamp biomicroscopy is providing adequate depth perception and anatomical detail; the Deep Reality Viewer (DRV) addresses this by enabling stereopsis. This study evaluated the...OBJECTIVE: A major challenge in teaching slit-lamp biomicroscopy is providing adequate depth perception and anatomical detail; the Deep Reality Viewer (DRV) addresses this by enabling stereopsis. This study evaluated the utility of DRV for slit-lamp examination (SLE) teaching and compared it with 2-dimensional monitors. METHODS: In this single-centre prospective comparative study, 33 medical learners completed a qualitative assessment comparing DRV versus 2-dimensional (2D) monitors for SLE of the anterior segment and optic nerve head (ONH). Perceived educational value and task-specific utility were compared across 16 Likert-scale (1-5) parameters in 4 domains: image quality, anatomical visualization, user experience, and teaching utility. The primary outcome was the comparison of teaching utility ratings between modalities. Secondary outcomes included composite domain scores, trainee-level differences, and intermodality agreement for ONH assessments. RESULTS: Median [IQR] DRV was rated significantly higher than 2D monitors for image quality (4.3 [4.0-4.6] vs 3.5 [3.3-4.2]; p < .001), anatomical visualization (4.4 [4.0-4.8] vs 3.6 [3.2-4.3]; p < .001), and teaching utility (5.0 [4.5-5.0] vs 4.0 [3.8-4.8]; p < .001). Cup-to-disc ratio estimates showed minimal systematic bias (mean differences -0.01 to 0.03) with no significant difference in variability between DRV and 2D monitors (all p > .05). Subjective ratings of ONH visual quality did not significantly differ between modalities (all p > .05). CONCLUSIONS: DRV may be a useful tool to improve SLE teaching, as its perceived image quality and depth perception appear superior to 2D monitors.
OBJECTIVE: To evaluate treatment patterns of newly diagnosed glaucoma among patients with uveitis compared with primary open-angle glaucoma (POAG) without uveitis, and to identify predictors of surgical intervention. DES...OBJECTIVE: To evaluate treatment patterns of newly diagnosed glaucoma among patients with uveitis compared with primary open-angle glaucoma (POAG) without uveitis, and to identify predictors of surgical intervention. DESIGN: Retrospective cohort study using a multicentre electronic health record network. METHODS: Adults ≥40 years with glaucoma were identified using ICD-10 codes and stratified by uveitis history within a 2-year lookback. Two phenotypes for uveitis-associated glaucoma were evaluated: (i) specific (uveitic or steroid-induced glaucoma) and (ii) sensitive (including POAG with uveitis). Cohorts were propensity score-matched (1:1) to POAG controls without uveitis. Outcomes included incidence of bleb-forming glaucoma surgeries (trabeculectomy, aqueous shunts, XEN stents), non-bleb-forming procedures (minimally invasive glaucoma surgeries, selective laser trabeculoplasty), and initiation of intraocular pressure (IOP)-lowering drops over 10 years. Cox models estimated hazard ratios (HRs) with 95% CIs. RESULTS: In the specific phenotype (n = 7848 per cohort), uveitis-associated glaucoma was associated with greater risk of bleb-forming surgery (8.9% vs 4.1%; HR: 1.75 [95% CI: 1.56-1.96]), particularly aqueous shunts (HR: 2.95 [95% CI: 2.55-3.42]); trabeculectomy risk was lower (HR: 0.70 [95% CI: 95% 0.54-0.91]). In the sensitive phenotype (n = 13 873 each), uveitis history was associated with greater risk of bleb-forming surgery (HR: 1.76 [95% CI: 1.60-1.93]), including aqueous shunts (HR: 2.67 [95% CI: 2.38-3.00]), but lower risk of noninvasive procedures and IOP-lowering drops. Predictors of bleb-forming surgery included male sex, Hispanic ethnicity, anterior uveitis, nicotine dependence, higher body mass index, and immunomodulatory therapy use. CONCLUSIONS: Uveitis-associated glaucoma is associated with a greater risk of bleb-forming surgery, especially aqueous shunts, highlighting the need for early identification and tailored management in this high-risk population.
OBJECTIVE: The association between body mass index (BMI) and astigmatism among children remains unclear. We conducted a longitudinal study to examine the relationship between BMI and astigmatism in a large pediatric coho...OBJECTIVE: The association between body mass index (BMI) and astigmatism among children remains unclear. We conducted a longitudinal study to examine the relationship between BMI and astigmatism in a large pediatric cohort. DESIGN: A population-based retrospective cohort study. PARTICIPANTS: A total of 22,130 children aged 6 to 10 years from Maccabi Healthcare Services, Israel's second-largest health maintenance organization, who underwent refractive assessment between 2012 and 2022 and had at least 2 years of follow-up. METHODS: BMI was categorized using U.S. Centers for Disease Control and Prevention percentiles. Astigmatism was defined as ≥0.75 D and classified by severity and axis. Multinomial logistic regression assessed the associations between baseline BMI and astigmatism at follow-up, adjusting for sociodemographic factors. The population attributable fraction was calculated. RESULTS: Mean baseline age was 8.1 years, mean follow-up was 62.9 months, and 53.6% of participants were female. Astigmatism at follow-up increased across baseline BMI categories (p < 0.001). In multivariable analysis, overweight and obesity were associated with higher odds ratios (ORs) for low-to-moderate astigmatism (OR: 1.10; 95% CI: 1.01-1.21; p = .026 and OR: 1.24; 95% CI: 1.14-1.34; p < .001, respectively) and high astigmatism (OR: 1.40; 95% CI: 1.00-1.96; p = .048 and OR: 1.76; 95% CI: 1.30-2.38; p < .001, respectively). BMI was also associated with against-the-rule astigmatism, with the strongest association observed in obesity (OR: 1.41; 95% CI: 1.29-1.55; p < .001). Population attributable fractions were 4.3% for low-to-moderate astigmatism and 13.4% for high astigmatism. CONCLUSIONS: Overweight and obesity were associated with increased risk of astigmatism. Early vision screening in children with high BMI may support timely correction and reduce visual impairment.
So S, Qing Wang T, Thind A
… +2 more, Hutnik CML, Malvankar-Mehta MS
Can J Ophthalmol
· 2026 Jun · PMID 42288115
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OBJECTIVE: Selective laser trabeculoplasty (SLT) has increasingly been used as a first-line glaucoma treatment. To better understand its impact on the Canadian patient and health care system, a cost-effectiveness analysi...OBJECTIVE: Selective laser trabeculoplasty (SLT) has increasingly been used as a first-line glaucoma treatment. To better understand its impact on the Canadian patient and health care system, a cost-effectiveness analysis was performed to compare SLT against topical eye medications for patients with newly diagnosed open-angle glaucoma. METHODS: Using a Markov model with a 20-year horizon from a health care payer perspective, the incremental cost-effectiveness ratio (ICER) of treating newly diagnosed mild open-angle glaucoma with SLT and medication was calculated. A discount rate of 1.5% was applied to all costs and health outcomes. Sensitivity and probabilistic analyses were performed to test the uncertainty of the model. RESULTS: The base case analysis indicated that patients who received the SLT treatment had a lower health care system cost of $1,671.48 and a higher quality-adjusted life year of 0.09 per patient compared with the medication treatment. As a result, the SLT treatment dominates medication treatment. The one-way cost-effectiveness sensitivity analysis showed that SLT dominates the medication treatment at all discount rates between 0% and 3%. The largest effects on the ICER value were variations in medication utility of ocular hypertension and mild glaucoma state, and SLT utility of mild glaucoma state, based on the tornado diagram. Probabilistic sensitivity analyses also demonstrated that the SLT treatment dominated the medication treatment. CONCLUSIONS: Our model suggests that SLT as the initial treatment strategy for glaucoma patients and investment in SLT could lead to improved clinical outcomes, costs, and resource utilization within the Canadian health care system.
Can J Ophthalmol
· 2026 Jun · PMID 42263776
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OBJECTIVE: This study aimed to validate administrative data case definitions for identifying individuals with uveitis within health administrative data and to assess case definition performance in different age groups. M...OBJECTIVE: This study aimed to validate administrative data case definitions for identifying individuals with uveitis within health administrative data and to assess case definition performance in different age groups. METHODS: Among 200,386 eligible patients in a large, province-wide, multisite primary care electronic medical record data repository in Ontario, Canada, 1 020 individuals were selected for medical review based on uveitis-related search terms. After medical record review, 431 cases were identified as having uveitis, in addition to 10,000 nonuveitis cases, which were used to make up the validation reference sample. After the reference standard was linked with administrative data, the performance characteristics (sensitivity and positive predictive value [PPV]) of case definitions using combinations of data sources and time windows were assessed overall, and stratified by age groups. RESULTS: Within the validation sample, the median age of identified uveitis patients was 55 years, with the majority falling within the 26-64 age group. Females represented 59.9% of cases. Family physicians (72.2%) and ophthalmologists (60.6%) were the most common sources of diagnosis documentation, and anterior uveitis was the most prevalent classification (64.0%). At least 1 diagnosis code for uveitis had the highest sensitivity at 74.0% (95% CI: 69.9-78.2) with a PPV of 54.3% (95% CI: 50.2-58.3). PPV increased with more physician diagnosis codes but was accompanied by decreased sensitivity. Case definitions demonstrated variations in sensitivity and PPV across different age groups. CONCLUSIONS: This study identified administrative data case definitions for identifying uveitis, with varying sensitivity and PPV for a range of research purposes and data availability.
Abbas K, Sibulo M, Al-Ani A
… +7 more, Advincula KED, Duran JWT, Malabanan JRC, Collantes ERA, Martinez JM, de Guzman H, Crichton A
Can J Ophthalmol
· 2026 Jun · PMID 42250580
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PURPOSE: Visual field testing is essential for monitoring field defects, but traditional devices are bulky and resource intensive. This study evaluated the agreement and usability of the RetinaLogik RVF100 virtual realit...PURPOSE: Visual field testing is essential for monitoring field defects, but traditional devices are bulky and resource intensive. This study evaluated the agreement and usability of the RetinaLogik RVF100 virtual reality perimetry device compared with the Humphrey visual field analyzer (HVF) among Filipino adults. DESIGN: A comparative cross-sectional study. PARTICIPANTS: Participants were Filipino adults presenting to 2 major eye centres in the Philippines from January to October 2024. A total of 46 participants (76 eyes) were included. METHODS: Participants were categorized as normal, glaucoma, or other diagnoses (e.g., optic neuritis, ocular hypertension). Both devices tested visual fields using the 30-2 grid, measuring mean deviation (MD), pattern standard deviation (PSD), fixation losses (FL), false positives (FP), false negatives, and test duration. Agreement was assessed using Bland-Altman analysis and Pearson correlation. Pointwise analyses with heatmap visualizations were also used. Usability was evaluated using a postexamination Likert-scale questionnaire. RESULTS: RVF100 demonstrated strong agreement with HVF (MD: r = 0.979, PSD: r = 0.837; p < .0001). The Bland-Altman analysis showed a mean difference in sensitivity of -1.06 decibels (dB) (95% CI: -4.2 to 2 dB). RVF100 had shorter test durations (5.41 vs 6.96 min; p < 0.001), fewer FL (1.79% vs 5.59%; p < 0.001), and slightly higher FP rates (3.44% vs 1.92%; p < 0.001). Usability results showed 90% preferred RVF100 over HVF for comfort (86.4%) and engagement (95.3%). CONCLUSIONS: RVF100 is a comparable alternative to HVF, offering comparable accuracy with improved patient comfort. Further research is warranted to assess its efficacy in detecting early and advanced disease stages and in broader populations.
Kamali Zonouzi S, Jafari S, Margolin E
… +1 more, Micieli JA
Can J Ophthalmol
· 2026 Jun · PMID 42248212
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OBJECTIVE: Optic neuritis is often managed by neuro-ophthalmologists. Neuro-imaging plays an important role in diagnosis. Radiologists can influence care by communicating pertinent findings and recommending next steps. I...OBJECTIVE: Optic neuritis is often managed by neuro-ophthalmologists. Neuro-imaging plays an important role in diagnosis. Radiologists can influence care by communicating pertinent findings and recommending next steps. Increasingly, patients have direct access to their reports, which may affect their understanding, anxiety, and interactions with clinicians. This study aimed to characterize the frequency and nature of radiologists' recommendations in magnetic resonance imaging (MRI) reports for optic neuritis. DESIGN: A retrospective chart review. PARTICIPANTS: Patients referred to a tertiary neuro-ophthalmology clinic between November 2007 and May 2025 with new-onset optic neuritis and no prior demyelinating disease METHODS: Data on imaging protocols, diagnostic terminology, differential diagnoses, recommendations, and incidental findings were obtained from electronic medical records. RESULTS: We included 219 MRI reports (73.1% female; mean age: 37.4 ± 13.1 years). MRI of the brain and orbit was the most common protocol (73.5%). Signs of demyelination or possible demyelination were noted in 109 cases (49.8%). Overall, recommendations were provided in 16.0% (35/219) to patients, with 20.2% (22/109) of those showing demyelination compared with 2.7% (3/110) without demyelination. The top 3 recommendations were an MRI of the spine (17/22; 77.3%), follow-up imaging (2/22; 9.1%), and follow-up appointment with patient and MRI of orbit (1/22; 4.5% each). CONCLUSIONS: Among participating radiologists, recommendations were given to patients in a minority of optic neuritis cases, with MRI of the spine being the most common recommendation. There was a higher likelihood of a recommendation if there were brain changes (20%) compared with no brain changes (3%). These findings highlight variability in reporting practices and support the adoption of standardized language for describing optic nerve abnormalities and appropriate follow-up, reducing unnecessary testing and potential patient anxiety.
Santos CRNM, Cheema A, Nakanami R
… +3 more, Coblentz J, Marcotte E, Burnier MN
Can J Ophthalmol
· 2026 Jun · PMID 42248211
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OBJECTIVE: Actinic Keratosis (AK) is a precancerous lesion related to radiation exposure, leading to malignant transformation (MT). This study aims to assess the epidemiological, clinical and histopathological features o...OBJECTIVE: Actinic Keratosis (AK) is a precancerous lesion related to radiation exposure, leading to malignant transformation (MT). This study aims to assess the epidemiological, clinical and histopathological features of AK in the eyelid to allow early diagnosis and treatment. METHODS: The McGill University Ocular Pathology & Translational Research Laboratory studied 200 biopsied lesions from 192 patients with a final diagnosis of AK amidst 1993 and 2023. Out of the total, 16 patients and 17 lesions were excluded due to insufficient data about the lesion's location. Samples from 176 patients (183 lesions) were analyzed. RESULTS: The mean age of diagnosis for eyelid AK (EAK) was 73 years old. The co-occurrence of AK and squamous neoplasia within the same specimen was 18.6% for EAK. The typical histopathological variant was the more prevalent representing 53% of all EAK lesions. The most common lesion site in the eyelid was the lower eyelid, constituting for 52.2%. CONCLUSION: To the best of our knowledge, this is the largest series of patients with EAK. This study emphasizes the importance of early excision with safety margins as a primary choice of treatment due to the risk of co-occurrence of AK and squamous neoplasia.
OBJECTIVE: To examine the association between self-reported, age-related macular degeneration (AMD), statin use, and sociodemographic factors in a nationally representative sample of U.S. adults. DESIGN: Cross-sectional...OBJECTIVE: To examine the association between self-reported, age-related macular degeneration (AMD), statin use, and sociodemographic factors in a nationally representative sample of U.S. adults. DESIGN: Cross-sectional study using 2023 National Health Interview Survey data. METHODS: Analyses were restricted to adults aged 50 years and older. The descriptive sample included 16,924 participants, and 7 566 participants with complete covariate data were included in the multivariable analysis. The primary outcome was self-reported AMD. Univariable and multivariable logistic regression models assessed associations between AMD, statin use, and sociodemographic and health-related variables using complex survey weighting. RESULTS: The descriptive sample included 16,924 adults aged 50 years and older; 55.41% were female, and 73.52% were non-Hispanic White. In adjusted analysis, statin use was not significantly associated with self-reported AMD (OR: 0.88, 95% CI: 0.66-1.18; p = .401). Older age, female sex, unemployment, and fair self-reported health were associated with higher odds of self-reported AMD, whereas Hispanic ethnicity was associated with lower odds of self-reported AMD. CONCLUSIONS: Statin use was not independently associated with self-reported AMD after adjustment. Self-reported AMD was associated with older age, female sex, unemployment, and fair self-reported health, and with lower odds among Hispanic participants.
Al-Burak SA, Voznyy V, Elganga M
… +4 more, Zajner C, Juncal V, Sheidow TG, Malvankar-Mehta MS
Can J Ophthalmol
· 2026 Jun · PMID 42242293
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BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are widely used for type II diabetes and obesity because of their cardiometabolic benefits. However, concerns regarding potential ocular adverse effects, p...BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are widely used for type II diabetes and obesity because of their cardiometabolic benefits. However, concerns regarding potential ocular adverse effects, particularly diabetic macular edema (DME), have prompted the need to clarify their retinal safety. METHODS: A systematic review and meta-analysis study was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analysis of Observational Studies in Epidemiology statements (PROSPERO registration: CRD420251176164). MEDLINE (Ovid), EMBASE (Ovid), CENTRAL (Ovid), Web of Science, and PubMed were searched from inception to October 24, 2025. Randomized trials and observational cohort or case-control studies, including individuals with diabetes without baseline DME and exposed to GLP-1RAs were eligible. Two reviewers independently screened studies, extracted data, and assessed risk of bias using ROBINS-I. Certainty of evidence was evaluated using Grading of Recommendations, Assessment, Development, and Evaluation. Random-effects models were used to pool incidence proportions and hazard ratios (HRs). RESULTS: Thirteen retrospective cohort studies (2021-2025) using large real-world databases were included. Across 6 studies, the pooled proportion of incident DME among GLP-1RA users was 0.14 (95% CI: 0.07-0.23; I² = 99.8%). Compared with mixed antihyperglycemic therapies, GLP-1RA use was not associated with increased DME risk (pooled HR: 0.81, 95% CI: 0.52-1.26). GLP-1RAs were associated with a higher relative risk of DME compared with sodium-glucose cotransporter-2 inhibitors (HR: 1.50, 95% CI: 1.17-1.94) but not compared with dipeptidyl peptidase-4 inhibitors (HR: 0.90, 95% CI: 0.69-1.19). Evidence certainty was very low. CONCLUSION: Current low-certainty observational evidence does not support an overall increased risk of DME with GLP-1RA use. Prospective studies are needed to clarify comparative retinal safety.