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

{"title":"Applications of artificial intelligence in rural ophthalmology: a scoping review.","authors":"Thomas Scott Armstrong, Abdullahi Mohamed, Ojas Srivastava, Matthew T S Tennant","doi":"10.1016/j.jcjo.2026.08.005","DOIUrl":"10.1016/j.jcjo.2026.08.005","url":null,"abstract":"<p><strong>Objective: </strong>Artificial intelligence (AI) is increasingly utilized for screening within ophthalmology, yet its application in rural communities remains poorly understood. This scoping review mapped modalities, feasibility, and barriers to implementation of AI in rural ophthalmology.</p><p><strong>Design: </strong>A scoping review (adhering to PRISMA-ScR guidelines).</p><p><strong>Methods: </strong>A comprehensive literature search was conducted in August 2025. Eligible articles were original studies detailing clinical applications of AI in ophthalmology within a rural setting.</p><p><strong>Results: </strong>Eleven (78.6%) focused on diabetic retinopathy (DR), 2 (14.3%) focused on glaucoma, and 1 (7.1%) on multiple retinal lesions. AI modalities included cloud-based platforms and offline models. Sensitivities ranged from 81% to 100% with specificities of 84%-100% for DR screening, and 91% and 93%, respectively, in glaucoma detection. Multilesion screening demonstrated an area under the curve of 0.918. Patient acceptance ranged from 94% to 98.6%. Economic models supported the cost-effectiveness of AI in DR screening but not in glaucoma screening. Barriers included unreliable connectivity, lack of trained ophthalmic personnel, equipment fragility, and poor image quality.</p><p><strong>Conclusions: </strong>AI is a valuable ophthalmological tool in the rural setting and could benefit geographically dispersed nations like Canada by amplifying disease screening and increasing accessibility of care. Use of this technology in rural locations can be complemented by longitudinal studies and technological innovation.</p>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788621","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":"Predictors of loss to follow-up in neovascular age-related macular degeneration.","authors":"Ryan S Huang, Sumana C Naidu, Andrew Mihalache, Jim S Xie, Marko M Popovic, Peter J Kertes, David Sarraf, SriniVas R Sadda, Rajeev H Muni, Radha P Kohly","doi":"10.1016/j.jcjo.2026.08.006","DOIUrl":"https://doi.org/10.1016/j.jcjo.2026.08.006","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the demographic, clinical, and treatment-related risk factors associated with being lost to follow-up (LTFU) among patients with neovascular age-related macular degeneration (nAMD) receiving antivascular endothelial growth factor (anti-VEGF) intravitreal injections (IVIs).</p><p><strong>Methods: </strong>We conducted a multicentre retrospective cohort study of patients with nAMD treated with anti-VEGF IVIs in Toronto, Ontario, from January 2012 to December 2021. LTFU was defined as the absence of an ophthalmic visit within 1 year of the last retinal specialist appointment. Univariable and multivariable logistic regression analyses were conducted to examine associations between demographic, clinical, and treatment-related factors and becoming LTFU.</p><p><strong>Results: </strong>Among 2556 patients with nAMD, 527 (21%) were LTFU over a mean follow-up of 65.5 ± 15.2 months. In multivariable analysis, male sex (OR = 1.40; p < .001), greater travel distance (>200 km; OR = 2.51; p < .001), and multiple systemic comorbidities (≥3; OR = 1.39; p = .01) were associated with higher odds of LTFU. Compared with White patients, Black (OR = 2.07; p < .001) and Hispanic patients (OR = 1.70; p < .001) had increased odds of LTFU. In contrast, age ≥90 years (OR = 0.53; p < .001), worse baseline visual acuity (>20/200; OR = 0.72; p = .03), pseudophakia (OR = 0.80; p = .04), bilateral disease (OR = 0.72; p = .01), and higher first-year anti-VEGF injection burden (OR = 0.55; p < .001) were associated with lower odds of LTFU.</p><p><strong>Conclusions: </strong>Male sex, Black or Hispanic race/ethnicity, multiple systemic comorbidities, and greater travel distance were associated with increased odds of becoming LTFU, while older age, worse baseline visual acuity, pseudophakia, bilateral disease, and higher IVI burden were protective factors. These findings can inform the development of targeted retention strategies for high-risk patients.</p>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148825019","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":"Vision care access programs for communities facing barriers to care in Canada: a systematic review.","authors":"Shayaan Kaleem, Dream Tuitt-Barnes, Umar Rahman, Sameen Kaleem, Carmen Balian, Manokaraananthan Chandrakumar, Myrna Lichter","doi":"10.1016/j.jcjo.2026.08.003","DOIUrl":"https://doi.org/10.1016/j.jcjo.2026.08.003","url":null,"abstract":"<p><strong>Objective: </strong>To systematically review Canadian programs designed to improve access to eye care for communities facing barriers to care and to summarise access outcomes, clinical yield, and implementation features.</p><p><strong>Methods: </strong>MEDLINE, Embase, and the Cumulative Index of Nursing and Allied Health were searched through July 30, 2025. Supplementary French-language searches in the 3 databases, as well as French- and English-language searches in Google Scholar, were conducted through June 14, 2026. Two reviewers independently screened records, extracted data, assessed risk of bias, and evaluated certainty of evidence.</p><p><strong>Results: </strong>Seventeen studies were included. Seven studies focused on Indigenous or First Nations communities, 5 on people experiencing homelessness or marginal housing, and 5 on low-income, immigrant, refugee, or school-based populations. Teleophthalmology, teleretinal, and mobile diabetes screening models were the most common program type (8/17, 47.1%), followed by shelter-based or outreach eye examination programs (5/17, 29.4%), primary care, newcomer, refugee, or policy-based access models (3/17, 17.6%), and school-based screening (1/17, 5.9%). Programs frequently identified unmet need, including high rates of uncorrected refractive error, vision impairment, diabetic retinopathy, glaucoma or glaucoma-suspect status, and referral need. However, referral completion, repeat screening, treatment receipt, and patient-reported outcomes were inconsistently reported.</p><p><strong>Conclusions: </strong>Canadian community-based, shelter-based, school-based, mobile, and teleophthalmology programs can reach populations that experience barriers to eye care. The evidence supports the importance of co-location, culturally safe partnerships, low-barrier referral pathways, and spectacle or treatment navigation, but certainty remains limited by observational designs, heterogeneity, and incomplete downstream outcome reporting.</p>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148825098","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":"Unilateral NAION with contralateral incipient NAION in severe iron-deficiency anemia: a case series.","authors":"Manlong Xu, Aljeena Rahat Qureshi, Rahul A Sharma, Edsel Ing, Arun N E Sundaram","doi":"10.1016/j.jcjo.2026.08.009","DOIUrl":"https://doi.org/10.1016/j.jcjo.2026.08.009","url":null,"abstract":"","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817521","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":"Clinical and magnetic resonance imaging outcomes of teprotumumab in a Japanese thyroid eye disease cohort: comparison of patients with and without dysthyroid optic neuropathy.","authors":"Muhammad Abumanhal, Mizuki Tagami, Taichi Higashida, Gen Kinari, Yasuhiro Takahashi","doi":"10.1016/j.jcjo.2026.08.002","DOIUrl":"https://doi.org/10.1016/j.jcjo.2026.08.002","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate and compare the clinical and magnetic resonance imaging (MRI)-based radiologic outcomes of teprotumumab treatment between patients with active thyroid eye disease (TED) with and without dysthyroid optic neuropathy (DON).</p><p><strong>Design: </strong>Retrospective multicentre study.</p><p><strong>Participants: </strong>Patients with active moderate-to-severe or sight-threatening TED who completed teprotumumab treatment and a 3-month follow-up after treatment completion.</p><p><strong>Methods: </strong>Patients were classified according to the presence or absence of DON. Clinical evaluation included clinical activity score, visual acuity, Hertel exophthalmometric values, and thyroid-stimulating antibody activity. MRI-based quantitative analyses included measurements of extraocular muscle (EOM) volume on T1-weighted images and signal intensity ratio on short tau inversion recovery MRI.</p><p><strong>Results: </strong>Thirty-one patients were included, comprising 24 patients without DON and 7 patients with DON. After teprotumumab treatment, significant improvements or reductions were observed in visual acuity, clinical activity score, Hertel exophthalmometric values, thyroid-stimulating antibody activity, EOM volume, and signal intensity ratio in all rectus muscles (all P < 0.05). Follow-up MRI showed complete resolution of high-signal inflammatory lesions in all patients. Patients with DON demonstrated significantly greater EOM volume reduction compared with patients without DON (P < 0.050). Adverse events occurred in 77.4% of patients, most commonly otologic symptoms and muscle cramps, although no patient required permanent treatment discontinuation.</p><p><strong>Conclusions: </strong>Teprotumumab demonstrated significant clinical and radiologic efficacy in patients with active TED, including those with DON. MRI revealed marked reductions in orbital inflammation and EOM enlargement after treatment, supporting the value of MRI as an objective tool for assessing disease activity and treatment response.</p>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812031","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":"Best vitelliform macular dystrophy masquerading as pachyvitelliform maculopathy in an elderly patient.","authors":"Thanaporn Kritfuangfoo, Akanksha Pandit, Alessandro Feo, Shahin Faghihi, David Sarraf","doi":"10.1016/j.jcjo.2026.08.008","DOIUrl":"https://doi.org/10.1016/j.jcjo.2026.08.008","url":null,"abstract":"","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788581","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":"Predicting patient satisfaction with post-small incision lenticule extraction surgery using open-source machine learning software.","authors":"Rebecca M Cairns, Richard N McNeely, Mark Dunne, Raquel Gil-Cazorla, Shehzad A Naroo, Jonathan E Moore","doi":"10.1016/j.jcjo.2026.08.004","DOIUrl":"https://doi.org/10.1016/j.jcjo.2026.08.004","url":null,"abstract":"<p><strong>Objective: </strong>To predict patient satisfaction 6 months after small-incision lenticule extraction (SMILE) surgery from preoperative clinical data demonstrating the methodological utility of open-source orange data mining software (Orange) feature selection and machine learning (ML) for practice-based evidence.</p><p><strong>Design: </strong>A retrospective study.</p><p><strong>Participants: </strong>Seventy-eight patients who had undergone bilateral uncomplicated SMILE surgery at a private ophthalmology clinic for treatment of their myopic refractive error with complete records available for analysis.</p><p><strong>Methods: </strong>Open-source data mining software Orange was applied to the data. Ten preoperative features (predictors) were investigated. The target (predicted variable) was patient expectations met or exceeded 6 months postoperatively. To simplify downstream clinical interpretation, continuous metrics were discretized using a median-split protocol. Fast correlation-based filter (FCBF) feature selection and Naïve Bayes supervised ML were applied. Optimistic and realistic ML performance were expressed as the area under the receiver operating characteristic (AUC) and Matthews' correlation coefficient (MCC). A nomogram generated log-odds ratios for estimating how each feature influenced the probability of exceeded expectations.</p><p><strong>Main outcome measures: </strong>Primary outcome was ML performance assessed using AUC and MCC.</p><p><strong>Results: </strong>Only 4 clinically relevant features (mean sphere equivalent, sex, quality of vision [QoV] night, corneal staining) were selected using FCBF. Comparable ML performance arose using these 4 features (optimistic: AUC = 0.792, MCC = 0.441; realistic 10-fold cross-validation: AUC = 0.749, MCC = 0.335) or all 10 (optimistic: AUC = 0.778, MCC = 0.447; realistic: AUC = 0.679, MCC = 0.329). Similarity between optimistic and realistic performance indicated sample sufficiency and model stability. The probability of a patient's expectations being exceeded increased by 13.68% for lower magnitude MSE (≥ -3.875 D), 15.15% for males, 10.17% for QoV night scores ≥9, and 8.73% when corneal staining was present, with Orange restricting log-odds measurements to point estimates.</p><p><strong>Conclusions: </strong>Open-source ML software was applied for preoperative prediction of patient satisfaction following SMILE surgery. By using feature selection to ensure feature independence, ML enables clinicians to identify the most relevant preoperative factors, improving surgical counselling and patient expectation management. Reducing redundant clinical tests could optimize preoperative screening, making no-code visual ML decision support tools valuable and accessible in real-world clinical settings.</p>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788649","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":"Intermediate outcomes of SIBS microshunt in cases of refractory and nonrefractory glaucoma.","authors":"Edward Tran, Ticiana De Francesco, Anastasiya Vinokurtseva, Matthew B Schlenker, Iqbal Ike K Ahmed","doi":"10.1016/j.jcjo.2026.07.010","DOIUrl":"https://doi.org/10.1016/j.jcjo.2026.07.010","url":null,"abstract":"<p><strong>Objective: </strong>To compare the intraocular pressure (IOP)-lowering, adverse event profile, and risk factors for failure of the SIBS (poly[styrene-block-isobutylene-block-styrene]) microshunt implantation in refractory versus nonrefractory glaucoma.</p><p><strong>Design: </strong>A multicentre, retrospective interventional cohort study.</p><p><strong>Participants: </strong>A total of 236 glaucoma eyes were analyzed with an IOP above target or progressing on maximal medical therapy. Refractory glaucoma was defined as a history of prior subconjunctival filtering surgery. One-to-one nearest-neighbor matching yielded 118 refractory eyes (111 patients) and 118 nonrefractory eyes (105 patients).</p><p><strong>Methods: </strong>This study evaluated 1-year outcomes of consecutive eyes undergoing ab externo SIBS microshunt implantation with mitomycin-C (MMC) between July 2015 and August 2020.</p><p><strong>Main outcome measures: </strong>Primary outcome was surgical success, defined as IOP 6-17 mm Hg with ≥20% reduction, classified as complete (without medications) or qualified (with medications). Secondary outcomes included success at IOP thresholds 14 and 21 mm Hg, median IOP, medication burden, risk factors for failure, and postoperative complications, interventions, and reoperations.</p><p><strong>Results: </strong>Complete success was lower in refractory compared with nonrefractory eyes (63.6% vs 77.9%; p = .022). Refractory status (hazard ratio [HR] 1.98; 95% CI: 1.11-3.55) and MMC dose <0.4 mg/mL (HR 2.08; 95% CI 1.21-3.58) were significant risk factors for failure. Serious adverse events were more frequent in refractory eyes (7.6% vs 0.8%; p = .0097), as were reoperations (9.3% vs 1.7%; p = 0.019).</p><p><strong>Conclusions: </strong>In SIBS microshunt implantation, refractory eyes demonstrated lower surgical success and higher rates of serious adverse events and reoperations compared with nonrefractory eyes.</p>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788595","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":"Infraorbital fog light sign: bilateral infraorbital nerve thickening and enhancement in IgG4-related ophthalmic disease.","authors":"Kamaljeet Singh, Shivaprakash Basavanthaiah Hiremath, Santanu Chakraborty","doi":"10.1016/j.jcjo.2026.06.014","DOIUrl":"10.1016/j.jcjo.2026.06.014","url":null,"abstract":"","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469290","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":"Barriers and challenges to accessing and utilizing low vision services among people with visual impairment in Canada: a systematic review.","authors":"Salem Abu Al-Burak, Amrit Das, Khaldon F Abbas, Thomas Sheidow, Monali S Malvankar-Mehta","doi":"10.1016/j.jcjo.2026.07.005","DOIUrl":"10.1016/j.jcjo.2026.07.005","url":null,"abstract":"<p><strong>Objective: </strong>Visual impairment affects ∼2.18 million Canadians and is associated with reduced quality of life and substantial economic burden. Although low-vision services (LVS) improve independence and functioning, utilization remains low. This systematic review examines barriers to accessing and utilizing LVS in Canada.</p><p><strong>Methods: </strong>A systematic search of MEDLINE, EMBASE, Cochrane Library, CINAHL, grey literature sources, and Google Scholar was conducted from inception to June 15, 2025, and registered with PROSPERO: (CRD420251082000). English-language studies examining barriers to accessing or utilizing LVS in Canada were included. Screening and data extraction were performed independently by multiple reviewers following PRISMA guidelines. Thematic analysis categorized barriers into systemic/structural, personal, and societal domains. Study quality was assessed using the Mixed-Methods Appraisal Tool (MMAT).</p><p><strong>Results: </strong>Of 730 records identified, 25 studies met inclusion criteria. Systemic barriers included limited-service availability, inconsistent provincial funding, high out-of-pocket costs, geographic maldistribution, and provider-related gaps in referral knowledge and training. Personal barriers included lack of awareness of LVS, financial insecurity, lower educational attainment, comorbid health conditions, and psychosocial resistance, such as stigma or denial. Societal barriers included negative attitudes toward disability, limited family support, cultural and linguistic challenges, and inaccessible public infrastructure. Study quality was moderate to high, with 60% rated 4 stars or higher on MMAT.</p><p><strong>Discussion: </strong>Access to LVS in Canada is limited by intersecting structural, personal, and societal factors. Coordinated reforms in provider education, public awareness, funding policy, and inclusive design are needed to improve equitable access and reduce underutilization of low-vision rehabilitation services.</p>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648311","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}