Canadian journal of ophthalmology. Journal canadien d'ophtalmologie最新文献

{"title":"Author reply.","authors":"Katherine O'Neill, Sanjana Jaiswal, Elizabeth Arogundade, Andrew Lee","doi":"10.1016/j.jcjo.2026.08.040","DOIUrl":"https://doi.org/10.1016/j.jcjo.2026.08.040","url":null,"abstract":"","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical outcomes of the SIBS microshunt in pediatric glaucoma: a retrospective study.","authors":"Edmond Sandouk, Kenan Bachour, Louis-Étienne Marcoux, Georges M Durr, Patrick Hamel","doi":"10.1016/j.jcjo.2026.09.003","DOIUrl":"https://doi.org/10.1016/j.jcjo.2026.09.003","url":null,"abstract":"<p><strong>Objective: </strong>To assess the surgical outcomes of the ab externo SIBS microshunt (PreserFlo MicroShunt; Glaukos Corporation, Aliso Viejo, CA) in the treatment of pediatric glaucoma.</p><p><strong>Methods: </strong>This single-centre retrospective case series was conducted at a tertiary pediatric care centre in Montreal, Ontario. All pediatric patients (<18 years of age) with primary or secondary glaucoma, who underwent SIBS microshunt implantation between January 2022 and April 2025, were included. The primary endpoint was surgical success (intraocular pressure 6-21 mm Hg), defined as complete without glaucoma medications and qualified with medications but without further surgery. Secondary outcomes included postoperative IOP, number of glaucoma medications, and postoperative complications.</p><p><strong>Results: </strong>Eighteen eyes from 14 patients were included. Mean age was 13.7 ± 4.2 years. Mean follow-up was 15.3 ± 9.2 months. Across all eyes, mean intraocular pressure decreased from 28.3±4.5 mm Hg preoperatively to 19.1 ± 7.7 mm Hg at 12 months (p = .02). The mean number of glaucoma medications decreased from 5.1 ± 0.6 preoperatively to 1.6 ± 2.2 at 12 months (p = .002). Complete surgical success rates were 61% at 6 months and 49% at 12 months, while qualified success rates were 67% and 55%, respectively. Postoperative complications occurred in 2 eyes: malignant glaucoma (n = 1) and choroidal and serous retinal detachment (n = 1).</p><p><strong>Conclusions: </strong>In pediatric glaucoma, the ab externo SIBS microshunt demonstrated reasonable 1-year surgical success rates with few complications, supporting its potential as a therapeutic alternative in selected cases within this population. Long-term, prospective studies are warranted to further assess its durability and safety in this population.</p>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Agreement between iCare HOME and Goldmann applanation tonometry: systematic review and meta-analysis.","authors":"Salem Abu Al-Burak, Kyran Sachdeva, Abu Bakar Butt, Fahad Butt, Andrew Mihalache, Michael Balas, Tal Sharon, David J Mathew","doi":"10.1016/j.jcjo.2026.09.004","DOIUrl":"https://doi.org/10.1016/j.jcjo.2026.09.004","url":null,"abstract":"<p><strong>Objective: </strong>This systematic review and meta-analysis evaluated agreement between the iCare HOME rebound self-tonometer and Goldmann applanation tonometry (GAT) for intraocular pressure (IOP) measurement in adults.</p><p><strong>Methods: </strong>Ovid MEDLINE, Embase, Scopus, Web of Science, and Cochrane CENTRAL were searched from January 2015 to May 2026. Eligible studies compared in-clinic or at-home iCare HOME, including HOME and HOME2 models, with GAT in adults using mean differences, limits of agreement, or intraclass correlation coefficients. Random-effects meta-analysis pooled the mean difference in IOP for iCare HOME minus GAT. Risk of bias was assessed using QUADAS-2, and certainty of evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Post hoc analyses addressed unit of analysis, operator, and measurement variability.</p><p><strong>Results: </strong>Twenty-two studies including 1857 eyes of 1517 patients were included; 16 studies involving 1333 eyes contributed to the meta-analysis. The pooled mean difference was -0.21 mm Hg (95% CI: -0.73 to 0.31; I² = 94.2%; p = 0.42). A prespecified REML Hartung-Knapp analysis was similar (95% CI: -0.82 to 0.39). The pooled standard deviation of paired differences was 2.66 mm Hg, corresponding to individual-level limits of agreement of approximately ±5 mm Hg. Leave-one-out, subgroup, and 1-eye-per-participant analyses did not materially change the results (1 eye per participant, -0.40 mm Hg; 95% CI: -1.18 to 0.38). Egger's test suggested possible small-study effects. GRADE certainty was very low because of inconsistency, imprecision, and possible publication bias.</p><p><strong>Conclusions: </strong>iCare HOME showed no significant systematic bias relative to GAT, including with 1 eye per participant, but substantial heterogeneity and wide individual-level agreement limits preclude routine interchangeability.</p>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adult-onset Wolfram syndrome: a case report of bilateral optic atrophy and compound heterozygous WFS1 gene mutations.","authors":"Mark Sabau, Hamza Arshad, Brooklyn Rawlyk, Melody Wong, Maria Gabriela Campos-Baniak","doi":"10.1016/j.jcjo.2026.08.031","DOIUrl":"https://doi.org/10.1016/j.jcjo.2026.08.031","url":null,"abstract":"","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilization patterns of intravitreal corticosteroids in the Medicare population (2013-2022).","authors":"Salem Abu Al-Burak, Andrew Mihalache, Fahad Butt, Ryan S Huang, Sean T Berkowitz, Shriji Patel, Jayanth Sridhar, Rajeev H Muni, Marko M Popovic","doi":"10.1016/j.jcjo.2026.08.032","DOIUrl":"https://doi.org/10.1016/j.jcjo.2026.08.032","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate national trends in intravitreal corticosteroid utilization among Medicare beneficiaries from 2013 to 2022, focusing on services billed, beneficiaries treated, and reimbursements.</p><p><strong>Design: </strong>A retrospective population-based analysis.</p><p><strong>Participants: </strong>Medicare Part B beneficiaries receiving intravitreal corticosteroid injections.</p><p><strong>Methods: </strong>Medicare Provider Utilization and Payment Data (2013-2022) were analyzed for intravitreal triamcinolone acetonide (TA; J3300) and dexamethasone implants (DEX; J7312). Each billed service represents a drug unit (1 mg TA; 0.1 mg DEX, with one 0.7 mg implant equaling seven units) rather than a discrete injection, so beneficiaries treated served as the primary, dose-independent metric. Temporal trends were assessed using the Mann-Kendall test, with linear regression used as a sensitivity analysis.</p><p><strong>Results: </strong>TA was billed by 753 providers (104,522 beneficiaries) and DEX by 1057 providers (187,929 beneficiaries). Because TA and DEX services measure milligrams rather than injection events, they are not directly comparable. TA beneficiaries declined 88% (p = .002), with the steepest drop in 2019-2020, paralleling an 89% fall in TA milligrams billed (p = .002). DEX billed units rose 275% (p = .02). DEX beneficiaries increased 188% overall but did not reach Mann-Kendall significance (p = .07) because the trend was nonmonotonic, plateauing after 2018; linear regression confirmed a significant increase (p = .02). Standardized drug-supply reimbursement was $1,093.33 per DEX implant versus $3.29-$13.16 per TA injection.</p><p><strong>Conclusions: </strong>TA utilization declined substantially while DEX billing increased, likely reflecting differences in efficacy, safety, durability, cost, and availability, including TRIESCENCE supply limitations.</p>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149029933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrocorneal pigmented membrane simulating iris melanoma.","authors":"Antonio Bechara Ghobril, Salaam Botros, Carol L Shields","doi":"10.1016/j.jcjo.2026.08.001","DOIUrl":"10.1016/j.jcjo.2026.08.001","url":null,"abstract":"","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cataract surgery complications in individuals who previously received intravitreal injections: a population-based cohort analysis.","authors":"Winnie W Yu, Marko M Popovic, Ya-Ping Jin, Rajeev H Muni, Amandeep S Rai, David T Wong, Peter J Kertes","doi":"10.1016/j.jcjo.2026.09.002","DOIUrl":"https://doi.org/10.1016/j.jcjo.2026.09.002","url":null,"abstract":"<p><strong>Objective: </strong>To determine differences in the risk of cataract surgery-related complications in patients with retinal disease who previously received intravitreal injections (IVI) compared with those without a history of IVI.</p><p><strong>Design: </strong>A retrospective population-based cohort study was conducted using physician billing data from a publicly funded health care system.</p><p><strong>Participants: </strong>Adults (≥20 years) with retinal disease who had cataract surgery between 2009 and 2018 were identified.</p><p><strong>Methods: </strong>Patients who received bilateral IVI were in the exposed group, and those without any record of IVI were in the unexposed group. Nonclearing vitreous hemorrhage, retinal tear, retinal detachment, and retained lens fragments at 3 months, and intraocular lens exchange, intraocular lensrepositioning, lens dislocation, anterior vitrectomy, glaucoma surgery, and corneal transplant at 2 years postoperatively were examined. Adjusted hazards ratios (aHRs) with 95% confidence intervals (CIs) were derived from multivariable Cox proportional-hazards models.</p><p><strong>Results: </strong>Of the 55 030 adults identified, 1453 had previously received IVI. Patients who previously received IVI and underwent cataract surgery were associated with a greater risk of nonclearing vitreous hemorrhage (aHR 2.90, 95% CI 2.07-4.06), retinal detachment (aHR 3.01, 95% CI 1.84-4.91), retinal tear (aHR 3.56, 95% CI 2.43-5.21), and glaucoma surgery (aHR 2.38, 95% CI 1.47-3.85). No significant risk associations were detected for other examined outcomes.</p><p><strong>Conclusions: </strong>Patients with retinal disease who underwent cataract surgery and had IVI had a greater risk of multiple cataract surgery-related complications compared with those without IVI history. Findings should be considered in informed operative counselling.</p>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149029945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic performance of deep learning models in retinal vein occlusion: a systematic review and meta-analysis.","authors":"Fahad R Butt, Kyran Sachdeva, Thanansayan Dhivagaran, Ahmed Eltom Mohamed, Salem Abu Al-Burak, Brendan K Tao, Andrew Mihalache, Ryan S Huang, Rajeev H Muni, Marko M Popovic","doi":"10.1016/j.jcjo.2026.08.036","DOIUrl":"https://doi.org/10.1016/j.jcjo.2026.08.036","url":null,"abstract":"<p><strong>Background: </strong>The diagnosis of retinal vein occlusion (RVO) requires specialised imaging and clinician expertise. This systematic review and meta-analysis aimed to quantitatively synthesise the current state of artificial intelligence models dedicated to RVO diagnosis.</p><p><strong>Methods: </strong>Cochrane Central, Embase, Ovid Medline, and PubMed were searched from inception to June 28, 2025. We included studies that evaluated deep learning models for RVO diagnosis and were validated on clinical datasets. The primary outcomes were the accuracy, sensitivity, and specificity of deep learning models for RVO diagnosis. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool.</p><p><strong>Results: </strong>Of 612 studies screened, 27 met the inclusion criteria, and 15 were included in the meta-analysis. Pooled deep learning model performance for RVO diagnosis was as follows: 97.4% accuracy (95% confidence interval [CI] 95.0%-98.7%), 89.9% sensitivity (95% CI 85.3%-93.3%), and 98.6% specificity (95% CI 96.5%-99.4%). Models predominantly used colour fundus photography (n = 18), OCT (n = 6), and ultra-widefield imaging (n = 2). Despite substantial heterogeneity, overall study quality was acceptable. In the Grading of Recommendations Assessment, Development, and Evaluation assessment, reasons for downgrading were inconsistency and imprecision.</p><p><strong>Conclusions: </strong>Deep learning models showed high diagnostic accuracy in detecting retinal vein occlusion across different imaging modalities. However, the certainty of the evidence, assessed using Grading of Recommendations Assessment, Development, and Evaluation, was low for all outcomes. Future research should investigate the feasibility and costs of implementing deep learning for RVO diagnosis in real-world clinical environments.</p>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149029874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eye care use trends in Ontario's public health care system:a 22-year population-based study.","authors":"Kiko Zi Yi Huang, David Jin, Marko Popovic, Peng Yan, Yvonne M Buys, Graham E Trope, Tianwei Ellen Zhou, Ya-Ping Jin","doi":"10.1016/j.jcjo.2026.08.038","DOIUrl":"https://doi.org/10.1016/j.jcjo.2026.08.038","url":null,"abstract":"<p><strong>Objective: </strong>To investigate patterns of eye care use by Ontarians from 1997 to 2019.</p><p><strong>Design: </strong>Population-based, repeated cross-sectional analyses.</p><p><strong>Participants: </strong>Ontarians insured under the Ontario Health Insurance Plan.</p><p><strong>Methods: </strong>Ontario Health Insurance Plan claims from 1997 to 2019 were analysed. Eye care use was identified using provider-submitted eye disease diagnoses. Annual eye visits (including revisits) and distinct eye patients (excluding revisits) per 100 population were calculated by age group, urban/rural residence, emergency versus nonemergency visits, and provider type (ophthalmologist, optometrist, primary care providers, and emergency physicians).</p><p><strong>Results: </strong>From 1997 to 2019, per 100 population, nonemergency eye visits increased from 59.4 to 76.9, whereas emergency visits decreased (1.2 to 0.9). Distinct eye patients per 100 population decreased for both nonemergency cases (32.0 to 25.1) and emergency cases (1.0 to 0.8). Average visits per patient increased from 1.9 to 3.1 for non-emergency cases and remained at 1.2 for emergency cases. Among nonemergency cases, visits per patient to ophthalmologists more than doubled (3.5 to 8.7). After 2004, optometrist visits declined among Ontarians aged 20-64 years, whereas ophthalmologist visits increased substantially. For other age groups, visits to both providers were stable or slightly increased. Rural residents had fewer nonemergency visits than urban residents (60.5 vs 64.6 per 100 population) but more than twice the emergency visit rate (2.3 vs 1.0).</p><p><strong>Conclusions: </strong>From 1997 to 2019, Ontarians' nonemergency eye visits, especially to ophthalmologists, increased, with fewer patients making more visits, whereas emergency visits declined. Rural residents had lower nonemergency but higher emergency visit rates. After 2004, optometrist visits among working-age Ontarians decrease, whereas ophthalmologist visits increased.</p>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of delisting routine eye exams on optometric glaucoma diagnosis billings in Ontario.","authors":"Kiko Zi Yi Huang, Graham E Trope, Wendy Hatch, Yvonne M Buys, Ya-Ping Jin","doi":"10.1016/j.jcjo.2026.08.035","DOIUrl":"https://doi.org/10.1016/j.jcjo.2026.08.035","url":null,"abstract":"<p><strong>Objective: </strong>Routine eye examinations (REEs) are critical for glaucoma detection. In 2004, Ontario discontinued coverage for REEs for healthy individuals aged 20-64. We assessed whether this \"delisting\" policy affected the rate of new glaucoma diagnoses identified through REE billings.</p><p><strong>Design: </strong>A population-level intervention study PARTICIPANTS: Ontarians aged 20+ insured under Ontario's universal health coverage.</p><p><strong>Methods: </strong>Using Ontario health administrative data and segmented regression analysis, we assessed changes in the rate (per 10,000 population) of new glaucoma diagnoses billed by optometrists during REEs before (1998-2004) and after (2005-2019) coverage delisting individuals aged 20-64. A comparison group of seniors unaffected by the policy were also assessed across the same 2 periods.</p><p><strong>Results: </strong>The rate of new glaucoma diagnosis billings by optometrists per 10,000 people, during REEs significantly decreased postdelisting versus predelisting in affected age groups: -10.4 (95% CI: -10.9 to -9.9; p < .0001) for those aged 20-39 and -38.8 (95% CI: -40.9 to -36.8; p < .0001) for those aged 40-64. In unaffected seniors, the rate remained stable postdelisting versus predelisting (+0.1 per 10,000, 95% CI: -3.0 to 3.2; p > .05).</p><p><strong>Conclusions: </strong>Discontinuation of public funding for REEs in 2004 was associated with significant declines in new glaucoma diagnosis billings submitted by optometrists during REEs in delisted-affected individuals aged 20-64, but not in unaffected seniors. This suggests that delisting of publicly funded REEs may hinder detection of new glaucoma cases. Further study is warranted to investigate whether this decline in new glaucoma diagnosis billings is associated with more advanced glaucoma at first diagnosis.</p>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}