To present a multifaceted approach to ophthalmology undergraduate medical education and to assess the efficacy of an eye dissection laboratory in enhancing medical student learning.
Curriculum ...review, validation, and student feedback evaluations.
Year 2 medical students enrolled in the University of Toronto's Doctor of Medicine Program.
Student feedback evaluations were compiled from the University of Toronto undergraduate medical education student surveys before 2012–2016 and following introduction of the redesigned foundations ophthalmology curriculum at the University of Toronto (2017–2018). Students who participated in the Eye Dissection Lab as part of the newly designed curriculum completed the pre- and postsession satisfaction and overall interest in ophthalmology questionnaires and a knowledge-based test.
Analysis of 1640 student evaluations demonstrated an increase in ophthalmology curriculum rating following the launch of the foundations ophthalmology curriculum (p = 0.015). Among the 335 students who completed the eye dissection lab, there was a significant increase in the average scores for the satisfaction questionnaire, knowledge-based test, and level of interest in the field of ophthalmology from before and after the session, with improvements in scores noted in 91%, 42%, and 36% of the educational parameters of the participants, respectively (p < 0.001).
The newly designed foundations ophthalmology curriculum and the eye dissection lab at the University of Toronto serve as effective means for enhancing ophthalmology teaching in medical schools across Canada.
Présenter une démarche multidimensionnelle dans le cadre de la formation médicale de premier cycle en ophtalmologie et évaluer l'efficacité d'un laboratoire de dissection oculaire pour ce qui est d'améliorer l'apprentissage des étudiants en médecine.
Révision et validation du programme d’études et évaluation de ce dernier par les étudiants.
Étudiants de deuxième année du programme de doctorat en médecine de l'Université de Toronto.
Les évaluations des étudiants ont été compilées à partir des sondages d’étudiants du programme de premier cycle en médecine avant (2012–2016) et après (2017–2018) la mise en œuvre du nouveau programme préparatoire en ophtalmologie à l'Université de Toronto. Les étudiants qui ont participé au laboratoire de dissection oculaire dans le cadre de la nouvelle version du programme ont répondu à des questionnaires de satisfaction avant et après la session de même qu’à des questionnaires d'intérêt général en ophtalmologie; ils ont également passé un test de connaissances.
L'analyse des évaluations de 1640 étudiants a fait ressortir une amélioration de la cote du programme d'ophtalmologie après la mise en œuvre du programme préparatoire en ophtalmologie (p = 0,015). Parmi les 335 étudiants qui ont terminé le cursus du laboratoire de dissection oculaire, on a noté une hausse significative des cotes moyennes du questionnaire de satisfaction, du test de connaissances et du niveau d'intérêt envers l'ophtalmologie, comparativement à ce qui avait été observé avant la session. On a enregistré une amélioration des cotes pour 91 %, 42 % et 36 % des paramètres pédagogiques des participants, respectivement (p < 0,001).
Le nouveau programme préparatoire en ophtalmologie et le laboratoire de dissection oculaire de l'Université de Toronto représentent une approche efficace pour améliorer l'enseignement en ophtalmologie dans les facultés de médecine du Canada.
To study the clinical characteristics and long-term outcomes of patients with noninfectious uveitis (NIU) who are treated with systemic immunomodulatory therapy (IMT).
Retrospective case series.
All ...consecutive cases of adults with NIU under the care of 5 uveitis subspecialty tertiary care clinics between 2010 to 2021 were included.
Patient outcomes were assessed at initial presentation and at the latest available follow-up.
A total of 418 NIU patients receiving IMT therapy with a median age of 46.0 years and 59.3% female were identified. Each patient required an average of 1.4 agents until achieving an optimal response. Following initial treatment with prednisone, patients were most commonly initiated on methotrexate. The top 3 treatments with the highest proportion of optimal treatment response when taken alone or in combination with other agents were infliximab (79.3%), cyclosporine (75%), and adalimumab (70%). The strongest predictors for requiring a greater number of IMTs trialed were younger age, panuveitis, and a chronic or recurrent disease course. Multivariable linear regression analysis suggested that baseline visual acuity at diagnosis was the only significant predictor of final visual acuity (p < 0.001).
NIU patients on IMT are often trialed on multiple therapeutic agents before achieving an optimal treatment response. Visual acuity at diagnosis is a predictor of final visual outcomes, whereas chronic or recurrent disease course, younger age, and panuveitis are predictors of requiring multiagent treatment regimens.
To characterize patients referred for diabetic retinopathy (DR) screening in a unique multidisciplinary diabetes care clinic at a tertiary care centre.
A retrospective study was conducted involving ...patients who were referred to the Cardiac and Renal Endocrine Clinic at a tertiary care centre (University Health Network) for DR screening between April 2019-March 2020 and November 2020-August 2021. Patients' demographics; micro- and macrovascular disease measurements; visual acuity, intraocular pressure, fundus imaging, and optical coherence tomography results were collected and analyzed.
Of the 64 patients who attended the clinic, 21 patients (33%) with type 2 diabetes had on-site DR screening. The remaining 43 patients had DR screening within 6 months of the appointment or were under ophthalmology care with annual screening visits elsewhere. Of the 21 patients who underwent retinopathy screening, 7 patients (33%) had DR: 4 had mild nonproliferative DR, 2 had moderate nonproliferative DR, 1 had proliferative DR, and 1 had macular edema. Patients with DR had a significantly longer diabetes duration than patients without DR (24.5 ± 10.2 years vs 12.5 ± 5.8 years; p = 0.0247). No significant differences were observed in glycemic control, blood pressure, lipid profiles, kidney function, visual acuity, or intraocular pressure.
Our analysis suggests a potential benefit of integrated DR screening in patients with long-standing diabetes as part of a multidisciplinary diabetes care clinic to diagnose and manage DR. Future work is needed to further develop such clinics and investigate their long-term effect on patient outcomes.
Purpose: To present a a case study that aims to investigate the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
in the ocular tissue samples of a patient previously infected ...with COVID-19 and determine its transmissibility.
Study Design: Case Report
Results: In this case study, SARS-CoV-2 was not detected in the vitreous and uveal tissue samples by RT-PCR for detection of three gene targets in a patient with a past COVID-19 infection 15 days prior to presention with a globe rupture.
Conclusions: Our findings suggest that patients with long-term existence of SARS-CoV-2 at low detectable levels may not have active intraocular viral shedding. This is of particular importance as ophthalmic surgical procedures may potentiate virus spread from patients infected with SARS-CoV-2.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Ocular hypertension and uveitic glaucoma are important downstream sequela of noninfectious uveitis (NIU). Herein, we describe the clinical outcomes of NIU cases with ocular hypertension and uveitic ...glaucoma.
Retrospective cohort study.
All adults (≥18 years) with NIU under the care of uveitis subspecialty tertiary care clinics between 2010 and 2021 were included.
The primary outcomes were baseline and final visual acuity.
A total of 216 patients out of 914 (23.6%) cases with NIU had ocular hypertension or uveitic glaucoma over the study period. Of all patients with ocular hypertension or uveitic glaucoma, 46% were corticosteroid responders. Baseline and last median visual acuities were better for the ocular hypertension patients compared with patients with uveitic glaucoma (p < 0.001). A higher proportion of patients with uveitic glaucoma than patients with ocular hypertension required glaucoma surgery (p < 0.001). The regression analyses suggested that baseline visual acuity and anatomical classification are significant predictors of last visual acuity, whereas diagnosis of ocular hypertension versus uveitic glaucoma were significant predictors of requirement for glaucoma surgery (p < 0.001).
A quarter of patients with NIU in this study developed ocular hypertension or uveitic glaucoma. Approximately half of the patients with ocular hypertension or uveitic glaucoma were deemed to be corticosteroid responders. Baseline and last visual acuity outcomes are better amongst ocular hypertension patients compared with those with uveitic glaucoma. Poor baseline visual acuity and panuveitis are predictors of worse vision at last follow-up. Additionally, diagnosis of uveitic glaucoma was a significant predictor of requirement for glaucoma surgery.
Silicone oil intraocular retinal tamponade is a useful adjunct to pars plana vitrectomy (PPV) in the treatment of complex vitreoretinal conditions. Siluron2000, a modified silicone oil product ...containing an additional small, high molecular weight and low viscosity, very-long-chain silicone molecule, was developed to reduce post-operative silicone oil emulsification, a non-infrequent complication that occurs with low molecular weight silicone oil. This study was designed to assess the safety and efficacy of long-term Siluron2000.
This was a single-center, retrospective, observational study. All consecutive patients undergoing PPV with intravitreal Siluron2000 injection between January 2017 and September 2019 with at least 6-month follow-up were identified based on billing codes.
A total of 57 eyes of 57 consecutive patients comprising 51 cases of proliferative vitreoretinopathy and 6 cases of recurrent full thickness macular hole were included. Median follow-up was 18 months. Emulsification occurred in 9 patients (15%). Retinal re-attachment was achieved in 47 patients (82%). The median time without silicone oil emulsification was 17 months. Of the cases with residual retinal detachment (RD) despite intravitreal Siluron2000, 4 (7%) were total RDs and 6 (10%) were inferior RDs with attached macula. The most common complications were glaucoma 12 (21%), cataract 11 (19%), and epiretinal membrane 2 (3.5%). There was no association between the duration of Siluron2000 and visual outcomes.
Siluron2000 is an effective long-term tamponade agent in the treatment of complex vitreoretinopathy. Visual and anatomical outcomes are similar to those reported with higher mw silicone oil tamponade agents but with a lower emulsification rate.
OBJECTIVETo compare the patient characteristics and long-term outcomes for those treated with and without systemic immunomodulatory therapy (IMT) for non-infectious uveitis (NIU).DESIGNRetrospective ...cohort study.PARTICIPANTSAll consecutive adults with NIU receiving care at 5 uveitis subspecialty tertiary care clinics between 2010 and 2021.METHODSClinical outcomes were evaluated on initial presentation and at the last available follow-up. The main outcome measures were baseline characteristics and final visual acuity.RESULTSA total of 914 NIU patients (418 IMT, 496 non-IMT) with a median age of 51.0 years and 57.4% female were identified. Over half the patients had bilateral disease, with a significantly higher proportion of bilateral cases in the IMT group compared with the non-IMT group (p < 0.001). The IMT group was more likely to have chronic uveitis (p < 0.001), with a higher proportion of patients experiencing cataracts and cystoid macular edema (p < 0.001 for both). A significantly higher proportion of non-IMT patients had anterior uveitis and an idiopathic etiology (p < 0.001). Overall, visual acuity improved significantly from baseline to last follow-up in the entire cohort (p < 0.001), with a slightly better improvement in the IMT group. Multivariable linear regression analysis suggested that baseline visual acuity and panuveitis were significant predictors of final visual acuity (p < 0.001 for both).CONCLUSIONSNIU patients on IMT are often younger, suffer from bilateral and chronic uveitis, and are more likely to have ocular complications. Those in the non-IMT group are more likely to have anterior idiopathic NIU. Baseline visual acuity and panuveitis are the main predictors of final vision outcomes among patients with NIU.
To determine the population-level predictors for being unscreened for diabetic retinopathy (DR) among individuals with diabetes in a developed country.
A retrospective population-based ...repeated-cross-sectional study.
All individuals with diabetes (types 1 and 2) aged ≥20 years in the universal health care system in Ontario were identified in the 2011–2013 and 2017–2019 time periods.
The Mantel–Haenszel test was used for the relative risk (RR) comparison of subcategories stratified by the 2 cross-sectional time periods.
A total of 1 145 645 and 1 346 578 individuals with diabetes were identified in 2011–2013 and 2017–2019, respectively. The proportion of patients unscreened for DR declined very slightly from 35% (n = 405 967) in 2011–2013 to 34% (n = 455 027) in 2017–2019 of the population with diabetes (RR = 0.967; 95% CI, 0.964–0.9693; p < 0.0001). Young adults aged 20–39 years of age had the highest proportion of unscreened patients (62% and 58% in 2011–2013 and 2017–2019, respectively). Additionally, those who had a lower income quintile (RR = 1.039; 95% CI, 1.036–1.044; p < 0.0001), were recent immigrants (RR = 1.286; 95% CI, 1.280–1.293; p < 0.0001), lived in urban areas (RR = 1.149; 95% CI, 1.145–1.154; p < 0.0001), had a mental health history (RR = 1.117; 95% CI, 1.112–1.122; p < 0.0001), or lacked a connection to a primary care provider (RR = 1.656; 95% CI, 1.644–1.668; p < 0.0001) had a higher risk of being unscreened.
This population-based study suggests that over 1 decade, 33% of individuals with diabetes are unscreened for DR, and young age, low income, immigration, residing in a large city, mental health illness, and no primary care access are the main predictors.
Déterminer les facteurs de prédiction d'une absence de dépistage de la rétinopathie diabétique (RD) au sein d'une population de patients diabétiques dans un pays industrialisé.
Étude populationnelle transversale, répétée et rétrospective.
Tous les patients présentant un diabète (de type 1 et de type 2) âgés de ≥ 20 ans et figurant dans le système de soins de santé universel de l'Ontario ont été recensés pendant 2 périodes (2011–2013 et 2017–2019).
Le test de Mantel–Haenszel a servi à calculer la comparaison du risque relatif (RR) dans les sous-catégories stratifiées en fonction des 2 périodes transversales.
Au total, 1 145 645 sujets diabétiques ont été recensés pendant la période 2011–2013 et 1 346 578, pendant la période 2017–2019. La proportion de patients qui n'ont subi aucun dépistage de la RD a diminué très légèrement pour passer de 35 % (n = 405 967) en 2011–2013 à 34 % (n = 455 027) en 2017–2019 de l'ensemble des sujets diabétiques (RR = 0,967; intervalle de confiance IC à 95 %: 0,964–0,9693; p < 0,0001). Les jeunes adultes (20–39 ans) constituaient la plus grande proportion de patients qui n'ont bénéficié d'aucun dépistage (62 % et 58 % en 2011–2013 et en 2017–2019, respectivement). Qui plus est, les sujets qui appartenaient à un quintile de revenus plus faibles (RR = 1,039; IC à 95% : 1,036–1,044; p < 0,0001), qui étaient des immigrants récents (RR = 1,286; IC à 95 % : 1,280–1,293; p < 0,0001), qui vivaient en milieu urbain (RR = 1,149; IC à 95 % : 1,145–1,154; p < 0,0001), qui avaient des antécédents de troubles de la santé mentale (RR = 1,117; IC à 95 % : 1,112–1,122; p < 0,0001) ou qui n'avaient pas accès à un médecin de soins primaires (RR = 1,656; IC à 95 % : 1,644–1,668; p < 0,0001) couraient un risque plus élevé d’échapper au dépistage.
Selon notre étude populationnelle qui s'est étalée sur une décennie, 33 % des patients diabétiques ne font l'objet d'aucun dépistage de la RD. Les principaux facteurs de prédiction d'une absence de dépistage sont le jeune âge, le revenu faible, l'immigration, la résidence dans une grande ville, les troubles de la santé mentale et l'absence d'accès à un médecin de soins primaires.
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