Retinopathy of prematurity (ROP) is the most common cause of preventable blindness in preterm infants. First-line treatments include intravitreal bevacizumab (IVB) or laser photocoagulation (LPC).
...The aim of the study was to evaluate neurodevelopmental safety of IVB compared to LPC for ROP.
MEDLINE, Embase, and Cochrane library were searched up to September 2022. Studies were included with at least 12-month follow-up of primary outcomes such as severe neurodevelopmental impairment (sNDI), cerebral palsy (CP), and hearing impairment (HI). Secondary outcomes were moderate-to-severe neurodevelopmental impairment (msNDI), Bayley Scores of Infant Development (BSID-III), and visual impairment.
1,231 patients from 11 comparative studies were included. Quality of evidence was rated low for all outcomes. IVB was associated with a higher risk for sNDI (risk ratio RR = 1.25, 95% confidence interval CI: 1.01, 1.53, p = 0.04); and CP (RR = 1.40, CI: 1.08, 1.81, p = 0.01) compared to LPC. There was no significant difference between IVB and LPC for msNDI (RR = 1.15, CI: 0.98, 1.35, p = 0.08) and HI (RR = 1.43, CI: 0.86, 2.39, p = 0.17). BSID-III percentile scores were similar between IVB and LPC, with weighted mean differences of 1.51 CI = -1.25, 4.27, 2.43 CI = -1.36, 6.22, and 1.97 CI = -1.06, 5.01 for cognitive, language, and motor domains, respectively (p > 0.05).
To our knowledge, this is the largest meta-analysis on neurodevelopmental outcomes and the first to rigorously examine IVB monotherapy in ROP treatment. Compared to LPC, there was a marginally increased risk for sNDI and CP with IVB but little or no difference in the risk of msNDI and HI. Further randomized studies are needed to strengthen these findings.
OBJECTIVETo understand the physical, psychosocial, and practical challenges faced by Canadian patients with inherited retinal diseases (IRDs) and their families.DESIGNMixed methods.PARTICIPANTSA ...total of 408 Canadians living with or caring for someone with an IRD (mean age = 51.4 ± 16.7 years) completed an online survey. Twenty cohort respondents participated in additional telephone interviews.METHODSThe online survey was comprised of questions concerning demographics, self-reported vision, genetic testing, information preferences, health care experiences, treatment goals, and disease impact on daily life. Recruitment occurred through Fighting Blindness Canada's community database. Survey dissemination also occurred via social media and not-for-profit stakeholder outreach. Subsequent to survey completion, a subset of respondents participated in semistructured telephone interviews to further elucidate illness experience.RESULTSRespondents identified having 1 of more than 14 IRDs, with 72% specifying retinitis pigmentosa. Sixty-eight percent reported being legally blind, and more than 85% self-reported moderate to low vision or worse. IRDs impacted daily functioning, with 53% of respondents indicating that they affected employment or education. Psychological challenges were evident, with more than 70% worried about coping with daily life and more than 60% indicating fear and stress. Qualitative data described hopelessness around suitable work, loss of independence, and challenges with social interaction. Sixty-five percent reported a negative impact on family life. Many had not accessed social support services because of a lack of perceived need, awareness, or availability.CONCLUSIONCanadian patients with IRDs report moderate to severe visual impairment, and both patients and their families describe an impact on psychosocial well-being and functioning during daily activities. Vision rehabilitation with a psychosocial approach is necessary, alongside facilitating access to emerging treatments.
Program websites play a crucial role in providing information to prospective residency applicants. This research assesses the extent to which Canadian ophthalmology residency programs demonstrate ...their commitment to equity, diversity, and inclusion (EDI) through their websites and identifies areas for potential improvement.
A cross-sectional analysis of websites affiliated with 15 accredited Canadian ophthalmology residency training programs was performed. A score was assigned based on 16 EDI elements derived from recent literature. The relationship between program website EDI elements with language, geography, and regional population diversity was explored.
Of the 15 Canadian ophthalmology residency programs, 12 (80%) met at least 1 of 16 EDI elements, with a mean program score of 2.4 (SD = 1.92). The program that attained the highest score met 7 of 16 EDI elements. Anglophone programs had a higher mean score (2.92; SD = 1.78) when compared with their Francophone counterparts (0.33; SD = 0.58; p = 0.023). No significant difference was found between programs in western, central, and eastern Canada (p = 0.86). The regional minorities proportion associated with each program was not found to influence scores (p = 0.088).
EDI elements were seldom addressed on Canadian ophthalmology residency program affiliated websites. We propose recommendations in 4 domains: showcasing team diversity, clear discourse in recruitment, inclusive resources, and program organization. Improving EDI visibility on program websites through revisions of existing websites or through creation of new promotional websites may foster recruitment of a diverse resident body.
Background/aimsTo characterise the baseline prevalence of subretinal fluid (SRF) and its effects on anatomical and visual acuity (VA) outcomes in diabetic macular oedema (DME) and retinal vein ...occlusion (RVO) following anti-vascular endothelial growth factor (VEGF).MethodsThis is a retrospective cohort study of 122 DME and 54 RVO patients who were initiated on anti-VEGF therapy with real-world variable dosing. The DME and RVO cohorts were subclassified based on the presence of SRF at presentation. Snellen VA was measured and converted to logarithm of the minimum angle of resolution (LogMAR). Changes in VA and central subfield thickness (CST) were assessed up to 24 months.ResultsSRF was present in 22% and 41% in DME and RVO patients, respectively. In the DME subcohort, eyes with SRF showed an improvement of 0.166 logMAR (1.7 Snellen chart lines) at 12 months and 0.251 logMAR (2.6 Snellen chart lines) at 24 months, which were significantly greater compared with those of the non-SRF group. A significantly greater reduction in CST was noted in the SRF eyes compared with the non-SRF eyes at 3 months and 1 month in the DME and RVO subcohorts, respectively.ConclusionBaseline SRF is a good marker for a greater reduction in CST in both DME and RVO, but an improvement in VA associated with SRF may be only noted in DME.
Increased awareness of the role of power and privilege in medical education demands reevaluation and critical reflection on the role of pimping, both in name and practice. The authors use an ...intersectional approach to explore the ways in which the term
pimping
is rooted in sexist, racist, and classist stereotypes. In using this term to describe a pedagogical approach rooted in hierarchical power and stark knowledge differentials, the medical community intentionally or unintentionally reinforces racist stereotypes, acts of carceral violence, gender-based violence, and harmful ways of referring to sex work. The authors suggest drawing on principles of trauma-informed care, often considered solely in the context of clinical care, as a means of engaging in transformative pedagogy. Embracing such a trauma-informed, transformative pedagogical approach can help dismantle entrenched hierarchies and create a liberatory learning environment grounded in knowledge cocreation and reimagination of teacher–learner binaries. Decentralization of power in teaching relationships can further empower trainees to become active knowledge partners alongside educators, encouraging shared responsibility, trust, and empathy in learning spaces.
Increased awareness of the role of power and privilege in medical education demands reevaluation and critical reflection on the role of pimping, both in name and practice. The authors use an ...intersectional approach to explore the ways in which the term pimping is rooted in sexist, racist, and classist stereotypes. In using this term to describe a pedagogical approach rooted in hierarchical power and stark knowledge differentials, the medical community intentionally or unintentionally reinforces racist stereotypes, acts of carceral violence, gender-based violence, and harmful ways of referring to sex work. The authors suggest drawing on principles of trauma-informed care, often considered solely in the context of clinical care, as a means of engaging in transformative pedagogy. Embracing such a trauma-informed, transformative pedagogical approach can help dismantle entrenched hierarchies and create a liberatory learning environment grounded in knowledge cocreation and re-imagination of teacher-learner binaries. Decentralization of power in teaching relationships can further empower trainees to become active knowledge partners alongside educators, encouraging shared responsibility, trust, and empathy in learning spaces.
To describe the characteristics of rhegmatogenous retinal detachments (RD) that developed after endophthalmitis and to provide insight regarding incidence, management, and outcomes.
Retrospective ...chart review of consecutive patients diagnosed with endophthalmitis at two Canadian institutions and from one surgeon at a third center over a 10-year period.
316 eyes presented with endophthalmitis of which 32 (10%) were complicated by subsequent RD. The mean age (SD) of patients was 72.0 (13.77). Intravitreal injections (33%) and cataract surgery (31%) were the most common inciting events for the endophthalmitis. Cases were managed with tap and inject (16%), vitrectomy (30%) or both (47%). There were no differences in the rate of RD when comparing the inciting events, microbial growth, or management approaches. Baseline visual acuity was the only predictor of RD (p=0.009). There was an improvement in VA following management of the RD (logMAR 2.33 vs 1.69 or Snellen HM vs 20/980, p=0.009) but final VA in these patients was worse than in those who did not develop RD (logMAR 1.69 vs 1.27 or Snellen 20/980 vs 20/372, p=0.029).
All patients with RD post endophthalmitis required additional surgery and functional outcomes remained poor. Nevertheless, repair of these RDs can preserve some vision and be globe saving.
Direct ophthalmoscopy continues to be the gold standard method for retinal and optic nerve evaluation despite known challenges for learners to acquire this clinical skill and minimal opportunities ...for patient facing practice. Here we review current literature regarding smartphone fundoscopy (SF) as an alternative learning tool which remains under-utilized in Canadian medical schools. SF has significant advantages compared to DO such as enhanced learner visualization of ocular structure and pathologies, greater learner usability in comparison, and improved fundus assessment during more difficult ocular examinations such as with pediatric patients. Furthermore, SF provides opportunities for instructor exchange and feedback, group learning, increased learner confidence, and most importantly, an improved patient experience. Yet, challenges remain with SF including patient confidentiality during data capturing and sharing, and meaningful integration into an already limited and saturated curriculum. Our review finds SF to be a pedagogical tool with the potential to reinvigorate fundoscopy learning to improve competency in this important clinical skill.
Revised edition of widely acclaimed medical training resource features extensive and invaluable additions Performing clinical examinations is an important skill developed throughout medical training ...and vocational experience. For nearly a quarter century, this learner-friendly handbook has filled a gap in the literature by providing an affordable and portable resource on clinical examination best practices. Essentials of Clinical Examination, 9th Edition reflects contributions from 119 medical students, 44 residents, 16 artists, 6 layout editors, and 38 esteemed faculty members at the University of Toronto. Supported by Toronto Medical Student Publications, each chapter has been thoroughly reviewed by expert residents and faculty members in their respective specialties to ensure the highest caliber content. Created by health learners for health learners, this highly accessible, evidence-informed reference is indispensable for clinical rotations and OSCE preparation. All 24 chapters underwent extensive revisions to reflect the most pertinent, up-to-date information. Section one provides overviews of major anatomy and body systems, while section two is organized by subspecialty. Each of the subspecialty chapters is consistently formatted with detailed and clear explanations covering clinical history, common presentations, differential diagnoses with distinguishing clinical features, and physical examination maneuvers. Key Highlights * The addition of new summary tables, detailed diagrams, and improved graphics enhance understanding and retention of knowledge * New social, pediatric, and geriatric awareness pearls help learners better contextualize concepts through a culturally and socially sensitive lens * Integrated clinical questions at the end of each chapter enable readers to consolidate knowledge and apply it to real-life situations encountered during rotations The latest edition of this long heralded guide is must-have reading for residents, clerks, and medical students to inform and practice core clinical examination skills that are essential to effective patient management.
