Cataract Surgery in Uveitis‑Associated Cataract: A Clinical Review
Cataract is among the most common causes of visual impairment in patients with uveitis and represents a major indication for intraocular surgery in this population. Chronic intraocular inflammation, prolonged corticosteroid therapy, and structural ocular changes contribute to the development of uveitis-associated cataracts. Cataract surgery in patients with uveitis presents unique challenges compared with routine age-related cataract surgery because affected individuals are often younger and frequently present with coexisting ocular comorbidities, including posterior synechiae, small pupils, zonular weakness, and macular pathology. Advances in surgical techniques and perioperative management strategies have significantly improved visual outcomes in patients undergoing cataract extraction in the setting of uveitis. Preoperative control of inflammation for at least three months is widely recognized as the most important predictor of postoperative success. In addition, appropriate use of perioperative corticosteroid therapy and the selection of biocompatible intraocular lens materials play key roles in minimizing postoperative inflammation and complications. This review summarizes the current evidence regarding cataract surgery in patients with uveitis‑associated cataracts, including indications and optimal timing of surgery, preoperative assessment and management, intraoperative considerations, and postoperative outcomes and complications.
© Canadian Eye Care Today 2026 https://creativecommons.org/licenses/by-nc-nd/4.0
Advocacy is defined as” the act or process of supporting a cause or proposal; the act or process of advocating“. When thinking about advocacy in the context of this article, three thoughts came to mind: 1) Who was I advocating for–my patients? My profession? Myself? 2) How did I go about advocating? 3) What has changed because of my advocacy? The last question is perhaps the most difficult to address. Patient advocacy is a process in health care concerned with advocacy for patients, survivors, and caregivers. When considering our most vulnerable patients—the homeless, the elderly, refugees, minority groups such as our First Nations, those with poor access to care, those with disabilities (mental and physical), and children—advocating for their care is a daunting task. Providing eyecare for the most vulnerable and advocating for their care has been a major goal of my group over the past decade.
Updates in the Management of Thyroid Eye Disease
Introduction: Thyroid eye disease (TED) is an extrathyroidal manifestation of autoimmune thyroid diseases such as Graves’ disease (GD) and Hashimoto’s thyroiditis. TED frequently causes severe, sight‑threatening symptoms requiring prompt medical or surgical intervention. Recent therapeutic advances are revolutionizing TED treatment, prompting an updated review on TED management. Epidemiology and Classification: The estimated incidence of TED is 4.2/100,000 population/year, with a female-to-male ratio of 3.7:1. Risk factor control includes maintaining euthyroid function, smoking cessation and steroid prophylaxis following radioactive iodine therapy. The European Group on Graves’ Orbitopathy (EUGOGO) denotes TED severity, whereas the clinical activity score (CAS) describes disease activity. Medical and Surgical Management: Mild TED is treated conservatively using ophthalmic lubricants, selenium supplementation, cold compresses, and head elevation. Intravenous glucocorticoids are first‑line for sight-threatening and moderate-to-severe TED with low activity, and for patients experiencing pain and discomfort with moderate-to-high activity, without sight-threatening symptoms. Newer targeted therapies for moderate-to-severe TED, such as teprotumumab, have promising outcomes, although exact therapeutic indications require further investigation. Surgery is indicated in refractory hyperthyroidism, sight-threatening keratopathy, optic neuropathy, and fibrotic disease. Interventions include total thyroidectomy, orbital decompression, strabismus correction, eyelid surgery, and aesthetic considerations. Patients require close follow-up with reclassification of CAS and EUGUGO severity at each visit to address refractory disease early. Conclusions: TED is a severe extrathyroidal manifestation of autoimmune thyroid diseases, requiring precise disease stratification and longitudinal monitoring for optimal outcomes. Continued refinement of treatment algorithms is essential to improving long-term outcomes. Real-world data on emerging treatments will be critical in determining the future management of patients requiring intervention.
Premium Intraocular Lenses: A Framework for Patient Selection and Expectation Management
Cataract extraction with intraocular lens (IOL) implantation is among the most performed and safest operations in ophthalmology. In Canada, cataract surgery demand is projected to more than double over the next 25 years, driven by population aging. As surgical volumes rise, parallel advances in IOL design have expanded the range of postoperative visual outcomes that can be offered. Modern IOLs vary substantially in optical strategy and performance profile, each offering distinct benefits, compromises, and contraindications. This expanding landscape has made preoperative counselling more complex. Many patients arrive having prior exposure to information on “premium lenses” from online sources or through friends and family, information that can be helpful, but is often incomplete, inaccurate, or not tailored to their ocular status. A surgeon-led approach that is standardized yet individualized can improve clarity and help align patient expectations with realistic surgical outcomes. Many practices further streamline counselling by adopting a team-based approach that incorporates a dedicated surgical coordinator as part of the preoperative pathway. After the surgeon has assessed candidacy and discussed clinically appropriate IOL categories, the coordinator then meets with the patient to reinforce lens education and operationalize the plan. This role typically includes explaining IOL function in practical terms, outlining pricing and any surgeon recommendations, discussing payment options and financing, completing consent and administrative documentation, and coordinating appointments alongside pre- and postoperative instructions. In addition to improving efficiency and reducing repetition across visits, this structure helps separate the clinical decision (what is safest and most appropriate) from the financial conversation (how elective upgrades are funded), which can reduce perceived pressure and support patient trust. In a pragmatic workflow, the initial visit therefore concludes with the coordinator reviewing consent, confirming waitlist placement and expected timelines, measurement planning for IOL calculations, reinforcing key counselling points (including the importance of ocular surface optimization for accurate biometry), and providing a clear summary of the selected pathway and associated costs.
Congenital Hypertrophy of the Retinal Pigment Epithelium: Following the Bear Tracks
Congenital hypertrophy of the retinal pigment epithelium (CHRPE) is a well-recognized benign ocular finding, characterized by flat, pigmented lesions. CHRPE lesions are typically unilateral and solitary but can also present as multiple or bilateral occurrences. They are relatively common, asymptomatic, and usually diagnosed incidentally during routine eye examinations. While generally benign, CHRPE or CHRPE-like lesions may warrant further evaluation to rule out systemic disorders such as familial adenomatous polyposis (FAP) or other differential diagnoses, especially in atypical or multiple lesions.
Adverse Events Associated With Novel Cancer Therapies
Advancements in novel anticancer therapeutics have enhanced the precision with which cancerous cells can be selectively identified and destroyed. Breakthroughs in adoptive cell therapy, checkpoint inhibitors, and anti-drug conjugates have been at the forefront of these advancements. The purpose of this review is to highlight the mechanisms of action underlying these novel anticancer therapeutics, provide an overview of their reported ocular adverse effects (AE), and where possible, provide a starting point for ocular AE prophylaxis and management.
© Canadian Eye Care Today 2025 https://creativecommons.org/licenses/by-nc-nd/4.0
Integrating Virtual Reality Visual Perimetry Into Clinical Practice: A Review of Devices, Applications, and Limitations
Visual field testing has long been a cornerstone of glaucoma diagnosis, monitoring, and management. The evolution of perimetry, from the early Tangent screen formalized by Julius Hirschberg in the 1870s to modern standard automated perimetry (SAP) such as the Humphrey Visual Field Analyzer (HFA), has aimed to improve accuracy and accessibility. In the 1940s and 1950s, the Goldmann perimeter and Tübingen perimeter were developed, with the Goldmann retaining a limited but important role in specific clinical scenarios. The Tübingen perimeter is now rarely used. By the 1980s, automated perimetry had become the standard, leveraging computational advances to reduce human involvement while preserving the spatial testing strategies introduced by earlier kinetic methods. Devices such as the Humphrey and Octopus perimeters became widely adopted and remain in clinical use today. Among these, the HFA is widely regarded as the gold standard for automated visual field testing. Although the HFA is the gold standard for automated perimetry, it has well-known limitations. The device is expensive, requires substantial physical space, and requires a trained technician to operate. Importantly, many patients find the test uncomfortable or frustrating and often dread the experience. It is rare to encounter a patient who enjoys visual field testing, and poor tolerance can lead to unreliable results. Nevertheless, perimetry remains a cornerstone of glaucoma care, offering functional insights not captured by structural imaging alone. Improving patient compliance and enhancing the test experience are therefore critical.
Approach to The Patient With Hypertensive Uveitis and Uveitic Glaucoma
Elevated intraocular pressure (IOP) and glaucomatous optic neuropathy are common complications in patients with uveitis. Ocular hypertension occurs in approximately 25% of uveitic patients. In addition, retrospective observational studies have found that 31-77% of patients with ocular hypertension had converted to glaucomatous optic neuropathy over a 10 year period. Ocular hypertension occurs in approximately 35% of children with uveitis, with secondary glaucoma occurring in 11-38%. Many of these children will require surgical glaucoma interventions: 11.5% at 1 year after a diagnosis of ocular hypertension, increasing to 50% by 5 years. In adults with non-infectious uveitis, the rate of surgical glaucoma interventions is between 20-40%.
From Peel to Plug: Sealing The Gap With Surgical Innovations For Macular Hole Repair
The surgical management of macular holes (MH) has evolved significantly over the past few decades. In 1991, Kelly and Wendel revolutionized MH repair by introducing pars plana vitrectomy combined with air fluid exchange. Eckardt et al. in 1997 further advanced and improved the success of macular hole closure by introducing internal limiting membrane (ILM) peeling, establishing the gold standard for idiopathic MH treatment. The subsequent development of micro-incision vitrectomy systems, particularly 25- and 27-gauge instrumentation, has resulted in better wound sealing, reduced postoperative inflammation, and faster visual recovery. These technological advancements laid the foundation for more complex surgical approaches, especially in complex cases such as large, recurrent, persistent, traumatic or myopic MHs. Contemporary techniques now include a variety of ILM flap methods (e.g., inverted, temporal, single-layer, and multilayered/petal flaps), autologous ILM transplantation (AILMT), human amniotic membrane (hAM) grafts, and autologous retinal transplantation (ART).
Unmasking Ocular Rosacea: Diagnostic Challenges and Evolving Management
Ocular rosacea is a chronic inflammatory condition affecting the eyes, and is often associated with cutaneous rosacea. It is a common yet frequently underdiagnosed disorder that can lead to significant ocular morbidity and, in severe cases, vision loss.
Taking a Different Point of View: The Utility of Endoscopic Vitrectomy
Pars plana vitrectomy (PPV), introduced by Dr. Robert Machemer in the 1970s, revolutionized the treatment of vitreoretinal diseases. Technological advancements, such as the development of small-gauge instrumentation and wide-angle viewing systems, have since enhanced the precision and safety of these procedures. However, microscope-based visualization remains limited in scenarios involving limited anterior segment transparency, or when accessing anatomical areassuch as the anterior vitreous base, ciliary body, and retroirideal space. Endoscopic vitrectomy overcomes these limitations by offering direct intraocular imaging from the probe tip, bypassing anterior segment opacities, and yielding an unobstructed, distortion-free view of otherwise hidden structures (Figure 1). This technique allows for dynamic adjustment of perspective and orientation, enabling access to the peripheral retina, anterior vitreous base, and retroirideal structures not easily visualized with traditional top-down microscope-based views (Figure 2 and Table 1). Modern endoscopy systems combine miniaturized probes, high-resolution video capture, coaxial illumination, and enhanced manoeuvrability, making them valuable tools in both routine and complex cases. This review explores the evolving role of endoscopic vitrectomy by examining its principles, instrumentation, clinical applications, surgical techniques, limitations, and future directions—demonstrating how a shift in visual perspective can broaden the capabilities of modern vitreoretinal surgery.
Next-Generation Ophthalmology: How Artificial Intelligence Is Shaping the Future of Eye Care
When Canada hosted the inaugural “Artificial Intelligence, Digital Health, and the Eye” conference in April 2023, it quietly launched what has become a defining forum at the intersection of technology and vision science in the country. A year later, the conference found a new stage at the Royal Society of Medicine in London, drawing global attention. This was largely because the keynote address was delivered by Professor Geoffrey Hinton, co-recipient of the 2024 Nobel Prize in Physics, and widely regarded as one of the founding fathers of deep learning. As modern medicine continues to be shaped by artificial intelligence (AI), the tone is unmistakably clear: the future is not only digital, but also intelligent. Few medical specialties are as naturally aligned with AI as ophthalmology. Its high-resolution imaging and quantitative data make ophthalmology particularly well-suited for the integration of AI technologies. Beyond automating image interpretation, AI now holds promise in risk stratification, disease progression modelling, and even in democratizing access to subspecialty-level diagnostics—advances that could meaningfully alter the delivery of eye care across the globe. Significant strides have been achieved in applying both machine learning (ML) and deep learning (DL) algorithms to major ophthalmic diseases, including diabetic retinopathy, age-related macular degeneration, glaucoma, cataracts, and various corneal pathologies. The U.S. Food and Drug Administration (FDA) has approved several AI-based platforms for clinical use, many of which are showing tremendous potential. Large language model AI systems, such as Generative Pre-Training–Model 4 (better known as GPT-4 by OpenAI), have demonstrated the ability to either match or outperform human ophthalmologists in diagnosing and treating various ophthalmic diseases.1 This article aims to provide a comprehensive review of the role of AI in ophthalmology, with particular attention to current clinical applications, emerging innovations, and the challenges that lie ahead.
Common Side Effects With Glaucoma Medications
Glaucoma is a progressive optic neuropathy that affects more than 400 000 Canadians and up to 111 million are expected to be afflicted with the disease worldwide by 2040. Despite trends toward increasing utility of laser and surgical interventions for glaucoma treatment, topical medications remain a mainstay of treatment. These medications often comprise the initial treatment alongside selective laser trabeculoplasty (in open angle subtypes). Additionally, given the progressive nature of glaucoma, many patients who undergo laser or surgery treatments may eventually require the use of topical medications. Although glaucoma drops are generally accepted as safe and low risk for patients, each type carries its own side effect profiles and contraindications. No glaucoma drop is completely benign and can significantly affect patient wellbeing if not selected correctly. Therefore, it is important for ophthalmologists and eye care professionals, who will undoubtedly have numerous glaucoma patients in their care, to be aware of common side effects and contraindications associated with ocular anti-hypertensive agents. This article will outline the side effects and contraindications of the ocular anti-hypertensive agents currently available in Canada.
The Evolution of Endothelial Therapeutics
Corneal endothelial diseases comprise a spectrum of conditions that critically affect the health and transparency of the cornea, posing unique challenges for ophthalmologists. The most prevalent among these is Fuchs’ endothelial corneal dystrophy (FECD), which accounts for approximately 39% of all corneal transplants globally. Bullous keratopathy (BK) can affect the entire cornea, leading to painful blisters that may become infected. Other rarer pathologies, such as iridocorneal endothelial syndrome, posterior polymorphous corneal dystrophy, and congenital hereditary endothelial dystrophy, present unique diagnostic and therapeutic challenges. Additionally, graft failure remains a notable indication for treatment. High-risk cases experience failure rates exceeding 35% within 3 years, with endothelial rejection accounting for half of the cases. Corneal transplants have been considered the gold standard for decades, with advancements in surgical techniques leading to shorter operating times, faster visual recovery, and improved outcomes. However, the growing global shortage of transplant-grade donor tissue further complicates treatment, underscoring the urgent need for innovative approaches such as genetic and cell-based therapies.
Pterygium, a common ocular surface disorder, manifests as a wing-shaped degenerative fibrovascular benign growth characterized by the fibrovascular proliferation of conjunctival tissue onto the cornea (Figure 1). This condition often results from prolonged exposure to ultraviolet light, dry eye conditions, or chronic irritation. On histopathology, there is classically elastotic degeneration of the conjunctival stroma with overgrowth of blood vessels and fibrous tissue, i.e., a fibro-proliferative reaction. While small and asymptomatic lesions may be managed conservatively, surgical excision becomes necessary when the lesion threatens vision, causes significant discomfort, or results in cosmetic concerns. A pterygium with documented growth that extends toward the visual axis should be removed before it reaches the central cornea. However, due to its high recurrence rate and variability in presentation, surgical management of pterygium requires attention to detail and a thorough understanding of optimal techniques.
Considerations for Adding Minimally/Microinvasive Glaucoma Surgery (MIGS) to a Planned Cataract Surgery
Glaucoma is a progressive optic neuropathy defined by retinal ganglion cells loss and characteristic visual field loss. It is a leading cause of irreversible blindness and affects over 60 million people worldwide. Its prevalence is estimated to increase to 111.8 million by 2040. Intraocular pressure (IOP) is a major clinically modifiable risk factor for glaucoma. Thus, glaucoma therapy aims to reduce the IOP using medications, lasers (e.g., selective laser trabeculoplasty) or surgery. Historically, surgery has been reserved for advanced glaucoma and in cases with poorly controlled pressure despite medical and laser treatment. For decades, trabeculectomy and tube shunt devices have been the predominant surgical methods for lowering ocular pressure. However, these traditional surgeries are invasive requiring significant manipulation of ocular tissue and have significant post-operative complication rates. Many patients have fallen in the gap of needing more pressure lowering but not enough to justify a higher risk surgery. Fortunately, the landscape of glaucoma surgery has rapidly evolved over the past 20 years with the emergence of minimally/micro- invasive glaucoma surgery (MIGS). MIGS is often performed as an adjunct to cataract surgery. As such, there is minimal added long-term risk if the procedure is done in the same space as the already planned cataract surgery. This represents a large group of patients, some of whom would not have been considered as glaucoma surgical candidates in the past. The clinician is now faced with the question, “Should I add MIGS to the cataract surgery?” In this paper, we suggest a series of questions to ask about each case in order to help make a patient-centred decision.
© Canadian Eye Care Today 2024 https://creativecommons.org/licenses/by-nc-nd/4.0
Update on Giant Cell Arteritis: Essential Information for Ophthalmologists
Giant cell arteritis (GCA) is an important cause of irreversible vision loss in the elderly population. For any physician, making this diagnosis can be difficult due to the highly variable clinical presentation of this large-vessel vasculitis. The 1990 American College of Rheumatology (ACR) classification criteria for GCA are frequently used, however, they were developed to classify GCA patients vs those with other forms of vasculitis and are not true diagnostic criteria. Despite the high predilection of GCA for ocular circulations, the original 1990 criteria did not include any signs or symptoms related to vision. The classification criteria were updated by the ACR and European Alliance of Associations for Rheumatology (EULAR) in 2022 with the significant inclusion of “Sudden vision loss” (Table 1).
Ocular Fundus Tumours: A Simplified Clinical Classification
The diagnosis of the most common ocular fundus tumours can be achieved according to clinical features including their malignant potential, anatomical location within the eye, and relation to systemic disease, as well as imaging features. The majority of these tumours can be classified into four major categories according to their clinical presentation.
Standard of Care for First-line Therapy in Newly Diagnosed Glaucoma and Update on SLT from the LiGHT Trial
Glaucoma is a progressive, multifactorial disease marked by ganglion cell loss, optic nerve damage and progressive vision loss, which can result in blindness if not treated. Glaucoma accounts for 11% of registrations for blindness. The disease is closely linked to increased intraocular pressure (IOP) and reducing this pressure is the sole available treatment to slow disease progression. The epidemiology of glaucoma presents a significant public health challenge, with primary open‑angle glaucoma (POAG) being the most common form, affecting approximately 2–3% of adults over the age of forty. Many patients can be initially managed with medications; however, the treatment has significant limitations. Issues such as complications, side effects, adherence, nonresponse, reduced effectiveness over time (tachyphylaxis), and financial costs pose challenges to controlling IOP with eye drops. The global burden of glaucoma is expected to increase as the population ages, highlighting the urgency for effective management strategies. The landmark LiGHT (Laser in Glaucoma and Ocular Hypertension) trial, published in 2019, with an initial 36 months of follow-up, later extended to 72 months of follow‑up, has conceptually influenced the management of POAG and Ocular hypertension (OHT). By demonstrating the efficacy and safety of selective laser trabeculoplasty (SLT), a “dropless” and “knifeless” alternative as a first-line treatment option, the LiGHT trial challenged the conventional treatment paradigm. The six-year results further consolidate SLT’s role as a fundamental treatment option, indicating its long-term effectiveness and durability in managing glaucoma, potentially redefining standard care protocols.
Preventing Work-related Musculoskeletal Injuries
“… the primary focus in healthcare has been on immediate patient care rather than the long‑term well-being of healthcare workers. This has often led to ergonomic considerations being overlooked.” Work-related musculoskeletal disorders (WMSD) are very common among ophthalmologists. The literature suggests that anywhere from 35 to 93% of ophthalmologists experience WMSDs. These disorders and injuries predominantly affect the neck, lower back and shoulders. As discussed in past issues of Canadian Eye Care Today, WMSDs are associated with suboptimal ergonomics related to the slit lamp and operating microscope, both of which promote the adoption of a forward head posture (FHP).
Review of Nutritional Supplementation Options for the Anterior Segment: An Evidence Based Approach
The anterior segment of the eye is a metabolically active system, which includes the ocular surface of the eye and extends posteriorly to the crystalline lens. Ocular surface diseases often disrupt the complex interplay of cornea, conjunctiva, meibomian glands, eyelids, and the lacrimal system, leading to diminished visual acuity and discomfort, and occasionally to frank pain. This can negatively impact the patient’s quality of life. Other anterior segment diseases including keratoconus, glaucoma, and cataract may also affect visual acuity. Oxidative stress and inflammation have been investigated in pathogenesis of these diseases. There has been an increase in the number of studies investigating various nutritional supplements benefiting the anterior segment structures. This review discusses the role of these supplements with supported clinical evidence.
Fuchs endothelial corneal dystrophy (FECD) was first described by Ernst Fuchs in 1910. It is a bilateral corneal endothelial dystrophy characterized by progressive loss of corneal endothelial cells and formation of excrescences at the level of Descemet’s membrane called guttae. The diseased endothelium leads to corneal edema and loss of corneal clarity. FECD typically manifests in the fifth and sixth decade of life coinciding with the development of cataracts. Careful preoperative evaluation and surgical technique allows for selection of patients who can safely undergo cataract surgery alone. Some patients, however, would benefit from both cataract surgery and endothelial transplantation (EK). This can be done as a staged surgery (cataract surgery then EK or vice versa) or in combination as a single procedure. This review evaluates the management strategies for individuals with cataract and FECD to help guide surgical decision-making and planning.
Peripheral Retinal Diseases: Indications for Prophylactic Laser Treatment Versus Observation
Peripheral retinal diseases encompass a diverse group of conditions that can impact visual health and function. While some of these conditions are asymptomatic and may have a benign course, others can progress to potentially sight-threatening complications, such as retinal detachment, especially in the context of visual symptoms. Careful clinical evaluation and timely intervention are essential in managing peripheral retinal diseases to prevent loss of visual acuity, particularly when predisposing risk factors are present. Obtaining a proper history may help identify some genetic conditions associated with higher incidence of retinal tears and detachment such as high myopia or Stickler syndrome. Other factors to consider include the new onset of symptoms of posterior vitreous detachment, prior history of trauma or relatively recent intraocular surgery such as cataract surgery, intravitreal injection or YAG capsulotomy.
Challenges in the Diagnosis and Management of Anterior Blepharitis
Blepharitis is defined as inflammation of the eyelids, classified according to anatomical location: anterior (eyelid skin, base of the lashes including the eyelash follicle) or posterior (meibomian glands) blepharitis. Although blepharitis is one of the most common ocular disorders, epidemiological data on the condition is lacking, making prevalence difficult to assess. A 2009 survey of eyecare practitioners reported observing blepharitis in 37%–47% of patients in their clinical practice. This observation may vary depending on the age, sex, and types of patients (i.e., dry eye) in the practice. Younger females are found to have more acute short-term presentation of blepharitis, whereas older, more fair-skinned females present with chronic blepharitis often concurrent with rosacea. Large population‑based studies, using a standardized definition and diagnostic technique, are needed to properly assess the prevalence and incidence of blepharitis and to allow for study comparisons among various age groups. The ocular surface, including the lid margin, has a natural flora or microbiome, which is imperative in maintaining the health and defence mechanism of the ocular surface. This can be affected by age, gender, inflammation, disease, medication, cosmetics, and treatment (systemic or topical). An overgrowth of microbes or an imbalance of the natural flora may result in an inflammatory response, leading to blepharitis, conjunctivitis, keratitis, or a combination of these.
Pediatric Blepharokeratoconjunctivitis: An Update
Pediatric blepharokeratoconjunctivitis (BKC) is a form of ocular surface inflammation which is a unique clinical entity in children. It is also known as phlyctenular conjunctivitis and rosacea keratitis. A recent definition obtained with a modified Delphi method by a group of experts defined BKC as “a frequently underdiagnosed, sight‑threatening, chronic, and recurrent inflammatory eyelid margin disease associated with ocular surface involvement affecting children and adolescents. Its clinical spectrum includes chronic blepharitis, meibomitis, conjunctivitis, and corneal involvement, ranging from superficial punctate keratitis to corneal infiltrates with vascularization and scarring.” The pathophysiology of BKC is poorly understood but is believed to be related to staphylococcal hypersensitivity, with Staphylococcus aureus being the most common flora cultured from the lids in BKC. The robustness of the inflammatory response is thought to be age‑related. The age of onset of BKC is often as early as age 3–5 but can present in adolescence. Gender predilection varies between studies but is roughly equal in incidence for males and females. There is little good natural history data reported on the time course of the disease, but it can become chronic with multiple exacerbations over a period of years. In one study from the United Kingdom, there is the observation of increased incidence of severe disease in younger boys with South Asian or Middle Eastern background.2 In our experience, however, severe disease can present in all ages and ethnic groups.
Musculoskeletal Injuries and Ophthalmologists: Prevention Requires a System-Level Approach
Musculoskeletal injuries make up about 15% of physicians’ insurance claims. These injuries lead to patient care disruptions, cancelled surgeries, significant disability, and early retirement. Dr. Rookaya Mather sat down with three fellow advocates for physician wellness and WMSD prevention, including two fellow ophthalmologists and a disability insurance expert. They discussed the factors that contribute to injury – from the culture of medicine to suboptimal ergonomic design of examination and surgical equipment – and the role that insurance companies, practising ophthalmologists, academic institutions, and manufacturers can play in preventing injury.
Approach to Infectious Keratitis: Clinical Pearls While on Call
Microbial keratitis is a vision-threatening infection of the cornea and an important cause of ocular morbidity that can result in blindness. It is estimated that over 1.5 million people worldwide will develop blindness from infectious corneal ulceration each year. If left untreated or treated incorrectly, it can result in progressive tissue destruction with corneal perforation or extension of the infection to the adjacent tissue. Outcomes of these patients depend on timely diagnosis and treatment with close follow-up.
Retinal Artery Occlusion and Neurovascular Risk
An occlusion of the central retinal artery (CRA) or one of its branches can lead to severe acute vision loss. Patients rarely recover functional visual acuity (VA) in the affected eye, however good visual recovery can occur in transient retinal artery occlusion (RAO). Several treatment strategies have been described in the acute setting of a retinal artery occlusion (RAO). However, to date, no evidence- based treatments exist for this condition. Recently, several clinical studies have emphasized the higher risk of stroke and cardiovascular events (CVE) in patients with RAOs. As a result, urgent assessment of neurovascular risk factors in the context of an acute RAO is widely recommended.
Patients present to the ophthalmologist with various corneal pathologies, and it is imperative to differentiate the benign from the malignant at the slit lamp to provide them proper guidance and treatment. These conditions tend to play a more significant role in the pre-operative cataract evaluation as they typically affect post-operative visual rehabilitation. In this review, we aim to examine the differentiating factors of the many lumps and bumps that affect the cornea and the available ways for surgeons to treat them in Canada.
Recent Advances in the Evaluation and Treatment of Primary Angle Closure Disease
In the realm of ophthalmology, the clinical management of angle closure remains a disputed topic. An aging population, underperformance of gonioscopy, and a paucity of clear guidelines about management have contributed to the rising number of patients with primary angle closure glaucoma (PACG). The global prevalence of PACG based on a meta-analysis published in 2014 was 0.50%, with the highest prevalence occurring in Asian populations. This study also projected that the number of people with PACG worldwide will increase to 32 million by the year 2040. PACG is a visually devastating disease; around a quarter of individuals worldwide and one out of nine individuals in the United States with newly diagnosed PACG are affected by blindness (visual acuity of 20/200 or less). The rising burden of the visual morbidity associated with untreated PACG highlights the urgent need for more clearly defined, evidence-based practice guidelines in angle closure care.