Anti-vascular endothelial growth factor (anti-VEGF) therapy is the standard of care for reetinsl vein occlusion (RVO)-related macular edema, yet its influence on subfoveal choroidal thickness (SFCT,) a potential adjunctive biomarker of disease activity and treatment response, remains uncertain. We evaluated studies that quantify pooled changes in SFCT and best-corrected visual acuity (BCVA) following intravitreal anti-VEGF therapy in adults with RVO. Twenty-three studies (971 eyes) met inclusion criteria. Anti-VEGF therapy significantly reduced SFCT at 1 month (MD 10.25 µm; 95% CI 6.31-14.19), 3 months (25.94 µm; 15.57-36.32), 6 months (27.43 µm; 14.00-40.85), and 12 months (12.05 µm; 3.02-21.09). Branch RVO demonstrated early but transient thinning, while central RVO showed smaller yet more sustained changes. Bevacizumab yielded more consistent SFCT reduction than ranibizumab. BCVA improved across all time points, with the greatest gains (∼0.25 logMAR) within 6 months. Intravitreal anti-VEGF therapy induces moderate, early choroidal thinning and concurrent visual improvement in RVO. SFCT may represent an adjunct biomarker of response, warranting standardized prospective evaluation controlling for ocular biometry.

Background Understanding the perspectives of Canadian residency Program Directors (PDs) on workforce trends is vital for career guidance and healthcare planning. Methods A nationwide cross-sectional survey of 227 PDs from all medical schools and specialties was conducted in 2022. Response rates were 23% (Royal College of Physicians and Surgeons of Canada) and 24% (College of Family Physicians of Canada). Results Surgical specialties were reported as the most competitive, with continued increases predicted. Medical and Primary and direct-entry specialties had the most favourable job prospects, while surgical and pediatric specialties showed poorer outlooks, often requiring further training or locum work. Retention varied by province, and PDs identified rising healthcare needs and physician retirements as key employment factors. Conclusions This study highlights the mismatch between training pathways and job market realities. Findings can inform physician career counseling and policymaking, emphasizing the need for targeted workforce planning responsive to evolving healthcare demands.

Anophthalmia due to enucleation, evisceration, or exenteration, results in permanent vision loss that may have profound functional, psychological, and social consequences. The purpose of this study is to evaluate health-related quality of life, vision-related quality of life, and psychosocial outcomes among adults with anophthalmia. This systematic review was conducted in accordance with PRISMA 2020 guidelines and prospectively registered on PROSPERO (ID: CRD420251274476). MEDLINE, Embase, and CENTRAL were searched from inception to September 9, 2025. Eligible studies included participants with congenital or acquired anophthalmia and reported outcomes related to quality of life or psychosocial health. Risk of bias was assessed using the Cochrane RoB-2 tool for randomized trials and Joanna Briggs Institute critical appraisal tools for observational studies and results were synthesized narratively. Forty-two studies (1999–2025) including 4544 patients (56.0

PURPOSE:Systematically review and categorize the methods used to assess socket and prosthetic motility in anophthalmic patients following enucleation or evisceration. METHODS:A systematic review was conducted in accordance with PRISMA guidelines. PubMed, Embase, Web of Science, and Scopus were searched from inception through September 2024. Studies reporting qualitative or quantitative assessments of motility in anophthalmic sockets or ocular prostheses were included. Motility assessment methods were categorized as qualitative (descriptive or graded clinical evaluation) or quantitative (numerical measurements in millimeters, degrees, or objective tracking systems). RESULTS:Thirty-five studies encompassing 1,819 patients met inclusion criteria. Nineteen studies used qualitative assessment methods, including subjective observation, graded scales based on cardinal gaze positions, or comparison with the contralateral eye. Sixteen studies employed quantitative techniques, such as the Kestenbaum limbus test, Lister perimeter measurements, conjunctival or limbal markings, photographic image analysis, infrared eye-tracking systems, and magnetic search-coil technology. Considerable heterogeneity was observed in measurement techniques, reporting standards, timing of assessment, and distinction between socket and prosthetic motility. CONCLUSIONS:Substantial variability exists in the methods used to assess motility in anophthalmic sockets, limiting comparability across studies. Establishing standardized, feasible, and reproducible assessment approaches may improve outcome reporting and facilitate meaningful comparisons in future oculoplastic research.

Background There is an undersupply of neuro-ophthalmologists in North America compared to care demand, which may be further compounded by barriers to care access, such as geography, education, and socioeconomic status. In this study, we sought to analyze the national distribution of neuro-ophthalmologists in Canada and evaluate factors associated with impeded care access. Methods A list of all neuro-ophthalmologists in Canada was compiled using the North American Neuro-Ophthalmology Society directory, Canadian Neuro-ophthalmology Group directory, and additional input from the authors. Canadian Census data from 2021 was collected at the level of aggregated dissemination areas (ADAs). The 3-step floating catchment area (3SFCA) method was used to assess accessibility to neuro-ophthalmologists across ADAs. Logistic regression models were created using the accessibility score to determine factors that impact accessibility. Results Of the 5 433 ADAs in Canada, 1 817 (33%) are located further than 100 km from the nearest neuro-ophthalmologist. The mean distance to a neuro-ophthalmologist was 155.0 km, while the median was 33.0 km. The overall 3SFCA-adjusted rate of accessibility in Canada was 0.015 neuro-ophthalmologists per 100,000 people. Regression analysis found rural residency (odds ratio [OR] = 0.56; p < 0.001) to be the most significant factor associated with reduced access to neuro-ophthalmological care, while areas with higher Indigenous population percentages were associated with reduced access to care (OR = 0.36; p < 0.001). Conclusions There are disparities in access to neuro-ophthalmologists across Canada. Rural residence and an increased Indigenous population were found to be significant factors associated with reduced access to neuro-ophthalmological care. Further research should investigate strategies to mitigate these discrepancies.

PURPOSE:To develop a consensus-based classification system and questionnaire for the standardized assessment and reporting of dysphotopsias following ophthalmic procedures. DESIGN:Systematic review and Delphi consensus process. PARTICIPANTS:Twenty ophthalmic specialists with expertise in glaucoma, cataract/refractive surgery, and cornea participated in this Delphi consensus survey. METHODS:A systematic literature search was conducted using Ovid MEDLINE and Embase to identify randomized controlled trials and observational studies reporting on dysphotopsias. Reported symptoms, assessment questionnaires, and individual question items were extracted to create a comprehensive list of potential classification items. These items were refined through iterative Delphi consensus surveys involving ophthalmic specialists, who evaluated each item for inclusion, exclusion, or rewording, and could propose the addition of new items. Consensus was defined a priori as ≥80% agreement among panelists. This iterative process allowed for progressive refinement of the classification system and continued until at least 80% of all proposed items achieved consensus. MAIN OUTCOME MEASURES:The proportion of ophthalmic specialists who chose to include or exclude specific dysphotopsia symptoms, and additional items of the questionnaire including baseline characteristics, environmental modifiers, quality of life, and attempted management strategies. RESULTS:Following the screening of 5,059 articles, 142 studies met inclusion criteria, identifying 34 unique dysphotopsia symptoms and 76 individual questionnaire items. Participants reached consensus on 53 of 63 items (84.1%) over two rounds of Delphi surveys. Items that did not meet inclusion or exclusion thresholds after the second round were excluded from the final classification system. The finalized classification system included 11 baseline clinical variables, 7 positive dysphotopsia symptoms (halos, glare/dazzle, starbursts, arcs, lines/streaks, ghosting, and flickering/shimmering), 1 negative dysphotopsia symptom (peripheral crescent/shadow), 5 environmental modifiers, 2 quality-of-life and mental health items, and 8 attempted interventions. These elements were consolidated into the DYsphotopsia Symptom Questionnaire and Outcomes (DYSQO) intended for clinical and research applications. CONCLUSION:A standardized classification system for the reporting of dysphotopsias following ophthalmic procedures was developed using the Delphi consensus process. The adoption of this tool in research and clinical practice may enhance the consistency, clarity, and quality of dysphotopsia reporting, enabling comparisons across interventions and enhancing evidence-based patient care.

PURPOSE:Evidence linking medications to lacrimal drainage obstruction is limited, primarily consisting of case reports. This study investigated associations between drugs and lacrimal drainage obstruction-related adverse events (AEs) using real-world data from the Food and Drug Administration Adverse Event Reporting System (FAERS). METHODS:A pharmacovigilance analysis of lacrimal drainage obstruction-related AEs reported to FAERS from October 2003 through December 2024 was conducted using Open Vigil 2.1 (Kiel, Germany). Disproportionality analyses were performed using reporting odds ratios (RORs) and Bayesian confidence propagation neural network algorithms to identify adverse drug reaction signals. RESULTS:Fourteen pharmacological agents were disproportionately associated with lacrimal drainage obstruction-related AEs. Sodium iodide I-131 (ROR = 399.7, 95%CI=[262.8, 608.0]), netarsudil (ROR = 350.6, 95%CI=[242.7, 506.5]) and docetaxel (ROR = 168.7, 95%CI=[145.8, 195.3]) showed the highest disproportionate reporting of lacrimal drainage obstruction-related AEs. These were followed by carboxymethylcellulose (ROR = 39.4, 95%CI=[16.4, 95.1]), ketotifen (ROR = 32.9, 95%CI=[12.3, 88.0]), and glycerin (ROR = 31.7, 95%CI=[11.8, 84.6]). The most common drug classes were radiopharmaceuticals, chemotherapy agents, and ophthalmic agents. CONCLUSIONS:This study represents the first pharmacovigilance analysis of lacrimal drainage obstruction-related AEs using FAERS data. Significant associations were identified with several medications, notably sodium iodide I-131, netarsudil, and docetaxel. Clinician awareness is important, particularly for patients at elevated risk. Further research is needed to clarify causality and inform prevention strategies.

Background and ObjectivesWomen's health advice in people living with idiopathic intracranial hypertension (IIH) is inconsistent, primarily due to an enduring concern that hormonal contraception (HC), including oral contraceptive pills (OCPs) and hormonal intrauterine devices (IUDs), might be associated with a higher prevalence of IIH. This systematic review and meta-analysis examines whether a meaningful association exists between HC use and IIH prevalence.MethodsSystematic searches of Ovid MEDLINE, Embase, and the Cochrane Library were conducted from their inception to May 14, 2025. Gray literature and citation lists were also reviewed. Observational studies comparing HC use among women with IIH to controls without IIH were included. Noncomparative studies and pharmacovigilance analyses were excluded. Two independent reviewers conducted data extraction, assessed the quality of studies using the Newcastle-Ottawa Scale, and appraised the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation framework. A random-effects meta-analysis using the Mantel-Haenszel method in Review Manager 5.4 was conducted to evaluate the association between HC use and IIH prevalence, the primary outcome of interest, with leave-one-out sensitivity analyses and subgroup analyses stratified by HC modality.ResultsA total of 13 studies (nIIH = 5,351 and ncontrol = 669,260; mean age = 33.3 years; 100% female) were included. HC use was not significantly associated with IIH prevalence (odds ratio [OR] 0.93, 95% CI 0.69-1.24, p = 0.60, I2 = 82%; n = 12 studies). Subgroup analyses revealed no significant associations for OCPs (OR 0.91, 95% CI 0.72-1.16, p = 0.45, I2 = 25%; n = 6 studies), IUDs (OR 1.45, 95% CI 0.61-3.44, p = 0.39, I2 = 92%; n = 5 studies), or medroxyprogesterone acetate injections (OR 1.21, 95% CI 0.84-1.74, p = 0.30, I2 = 2%; n = 2 studies). Findings were largely robust in sensitivity analyses. Quality assessments ranged from poor to good, with the certainty of evidence rated as very low to low.DiscussionThe meta-analysis found no significant association between HC use and IIH prevalence, with consistent results across various HC modalities. This evidence provides confidence to reassure patients with IIH and clinicians that the directed use of HC should be continued as appropriate. The limited quality of available evidence and considerable heterogeneity highlights the necessity for large-scale, well-designed studies, particularly in diverse patient populations, to validate these findings.

BACKGROUND AND OBJECTIVES:Women's health advice in people living with idiopathic intracranial hypertension (IIH) is inconsistent, primarily due to an enduring concern that hormonal contraception (HC), including oral contraceptive pills (OCPs) and hormonal intrauterine devices (IUDs), might be associated with a higher prevalence of IIH. This systematic review and meta-analysis examines whether a meaningful association exists between HC use and IIH prevalence. METHODS:Systematic searches of Ovid MEDLINE, Embase, and the Cochrane Library were conducted from their inception to May 14, 2025. Gray literature and citation lists were also reviewed. Observational studies comparing HC use among women with IIH to controls without IIH were included. Noncomparative studies and pharmacovigilance analyses were excluded. Two independent reviewers conducted data extraction, assessed the quality of studies using the Newcastle-Ottawa Scale, and appraised the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation framework. A random-effects meta-analysis using the Mantel-Haenszel method in Review Manager 5.4 was conducted to evaluate the association between HC use and IIH prevalence, the primary outcome of interest, with leave-one-out sensitivity analyses and subgroup analyses stratified by HC modality. RESULTS:A total of 13 studies (nIIH = 5,351 and ncontrol = 669,260; mean age = 33.3 years; 100% female) were included. HC use was not significantly associated with IIH prevalence (odds ratio [OR] 0.93, 95% CI 0.69-1.24, p = 0.60, I2 = 82%; n = 12 studies). Subgroup analyses revealed no significant associations for OCPs (OR 0.91, 95% CI 0.72-1.16, p = 0.45, I2 = 25%; n = 6 studies), IUDs (OR 1.45, 95% CI 0.61-3.44, p = 0.39, I2 = 92%; n = 5 studies), or medroxyprogesterone acetate injections (OR 1.21, 95% CI 0.84-1.74, p = 0.30, I2 = 2%; n = 2 studies). Findings were largely robust in sensitivity analyses. Quality assessments ranged from poor to good, with the certainty of evidence rated as very low to low. DISCUSSION:The meta-analysis found no significant association between HC use and IIH prevalence, with consistent results across various HC modalities. This evidence provides confidence to reassure patients with IIH and clinicians that the directed use of HC should be continued as appropriate. The limited quality of available evidence and considerable heterogeneity highlights the necessity for large-scale, well-designed studies, particularly in diverse patient populations, to validate these findings.

Immune checkpoint inhibitors (ICIs) targeting the programmed cell death-1 (PD-1) pathway have revolutionized cancer therapy but are increasingly associated with immune-related adverse events, including rare neuro-ophthalmic complications. We describe a case of optic neuritis in a 57-year-old female with high-grade serous ovarian carcinoma undergoing combination therapy with dostarlimab, a PD-1 inhibitor, and niraparib, a poly (ADP-ribose) polymerase (PARP) inhibitor. She presented with rapidly progressive vision loss, pain with eye movements, and a right relative afferent pupillary defect. Imaging showed enhancement of the right optic nerve, and an extensive infectious, autoimmune, and malignant workup was unremarkable. High-dose corticosteroid therapy led to significant visual improvement and resolution of optic nerve edema. To our knowledge, this is the first reported case of optic neuritis associated with dostarlimab and the first in the setting of ovarian cancer. This case highlights the importance of early recognition and prompt immunosuppressive treatment of ICI-related optic neuropathy to prevent permanent vision loss.

Targeted BRAF/MEK inhibitor therapies have improved survival outcomes for patients with BRAF V600-positive cutaneous melanoma. However, rare neuro-ophthalmic complications attributed to these therapies warrant heightened clinical vigilance. We describe a distinct case of bilateral optic disc oedema and unilateral central serous chorioretinopathy induced by dabrafenib and trametinib in a 79-year-old male undergoing treatment for metastatic cutaneous melanoma. Three months after starting BRAF/MEK inhibitor therapy, the patient developed progressive, painless central vision loss OD and transient blurry vision OS. Clinical examination excluded uveitis and conditions such as Vogt-Koyanagi Harada syndrome, while contrast-enhanced magnetic resonance imaging revealed no optic nerve or chiasm abnormalities. Following prompt discontinuation of dabrafenib and trametinib, along with the initiation of oral prednisone, the patient's visual acuity significantly improved over three weeks, accompanied by resolution of optic disc oedema. At two months of follow-up, visual acuity remained stable, with complete resolution of optic disc oedema and no symptom recurrence. This case emphasises the importance of early recognition, prompt drug discontinuation, and timely corticosteroid administration to optimise visual prognosis in this setting.

Ocular extraintestinal manifestations (O-EIMs) of inflammatory bowel disease (IBD) are known to include uveitis, scleritis and episcleritis; however, the relationship of dry eye syndrome (DES) with IBD is unclear. We aimed to determine if IBD is associated with DES. A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, searching four databases for studies comparing DES in patients with IBD versus non-IBD. OR and weighted mean differences (WMDs) of objective ocular parameters (ie, Schirmer I test (tear production); tear breakup time (TBUT; tear film stability) and Ocular Surface Disease Index (OSDI; dry eye symptom rating scale)) were meta-analysed using a random-effects model. We included eight cohort studies for a total of 55 211 patients with IBD and 54 870 patients without IBD. Compared with non-IBD controls, patients with IBD had significantly increased odds of DES (OR=2.54; 95% CI: 1.47 to 4.36, p=0.0008) and increased OSDI score (WMD=4.57 points, 95% CI: 1.80 to 7.35, p=0.0012). For the Schirmer I test, patients with IBD had significantly lower tear production compared with controls (WMD=−3.63 mm, 95% CI: −5.52 to −1.74, p=0.0002). For TBUT, patients with IBD had greater tear film instability compared with controls (WMD=−3.33 s, 95% CI: −4.97 to −1.70, p<0.0001). DES may be an underappreciated EIM of IBD. Clinicians should consider screening for the presence of DES during a review of EIMs, as treatment of DES can significantly improve quality of life. CRD420251076843.

OBJECTIVE:To develop and validate a logMAR Early Treatment Diabetic Retinopathy Study (ETDRS)-style visual acuity chart imprinted with Canadian Aboriginal Syllabics (CAS) optotypes. DESIGN:Prospective, nonrandomized, within-subject analysis. PARTICIPANTS:22 Indigenous patients from the Ullivik residence (Montreal, QC) for Inuit patients who were able to interpret Latin and CAS characteristics. METHODS:Python and LaTeX scripts were created to generate PDFs of standard ETDRS charts, which could be readily modified for alphabet (CAS or Latin), font, and optotype sizing. We used CAS characters that were preserved across Cree, Ojibwe, and Inuktitut languages. A 60" television screen (4K resolution) was used to display the eye charts to scale. For each subject, the best-corrected visual acuity (BCVA) of each eye was assessed on each chart (4 measurements per patient). RESULTS:The median difference between visual acuities (logMAR) acquired by the Latin and CAS charts was 0 (Q1: -0.08; Q3: 0). Band-Altman analysis revealed a bias of -0.01 (SD: 0.03), which was near zero (indicating favourable agreement), and one outlier (of 22 patients), whose deviation was attributed to random error. The visual acuity differences between eye charts were not statistically significant (p = 0.1). CONCLUSIONS:We developed and validated the first CAS-imprinted ETDRS chart for measuring visual acuity. Given its use of preserved characters across Cree, Ojibwe, and Inuktitut languages, this chart has additional applicability to several Indigenous populations in Canada. Future work should develop near reading cards and other methods of optimizing culturally competent eye care for Indigenous patients.

Background: Ectropion is a common eyelid problem and is defined as eversion of the eyelid margin and typically involves the lower eyelid. The main acquired causes of ectropion include involutional, cicatricial, paralytic, and mechanical. A severe manifestation of ectropion is tarsal ectropion, where much of the tarsal conjunctiva is visible, often with keratinization of the conjunctiva. causes. Common techniques for ectropion repair include horizontal tightening of the lid with lateral tarsal strip or Bick procedure, lateral tarsorraphy, inverting sutures and the sub-orbicularis oculi fat lift. However, all surgical techniques are prone to ectropion recurrence. We review the techniques for ectropion repair and describe a novel adjunctive technique called the superotemporal skin transposition (STS), which is well suited for patients with recurrent or tarsal ectropion. Methods: The STS is combined with a lateral tarsal strip or Bick procedure. For the STS, all of the anterior lamellae of the lateral lower lid is retained. The posterior lamellae is sutured to the lateral orbital tubercle. A triangular bed of skin is excised superotemporally, and the lower lid anterior lamellae is transposed and secured with multiple sutures. The STS can be combined with inverting sutures, or skin graft for cicatricial cases. Results: We used the STS with Bick procedure and optional inverting sutures on 23 patients, 4 of whom required bilateral ectropion repair. At 1–6 month followup all patients achieved satisfactory outcomes with a well-positioned eyelid and improved symptoms. The STS had more lateral cutaneous scarring than with a Bick procedure alone, but patients did not find this objectionable. No reoperations were required. Conclusion: The STS is a straightforward and useful adjunct for patients with severe, recurrent or tarsal ectropion. Further studies are needed to determine the long-term efficacy of this technique.

Artificial intelligence (AI) and augmented intelligence have significant potential in oculoplastics, offering tools for diagnosis, treatment recommendations, and administrative efficiency. This article discusses current and potential applications of AI in ptosis, eyelid and conjunctival cancer, thyroid-associated orbitopathy (TAO), giant cell arteritis (GCA), and orbital fractures. AI-based programs can assist in screening, predicting surgical outcomes, and improving patient care through data-driven decisions. Privacy concerns, particularly with the use of facial and ocular photographs, require robust solutions, including blockchain, federated learning and steganography. Large generalizable datasets with adequate validation are crucial for future AI development. While AI can assist in clinical decision-making and administrative tasks, physician oversight remains critical to prevent potential errors. Large language models like ChatGPT also have the potential to counsel patients, although further validation is needed to ensure accuracy and patient safety. Ultimately, AI should be regarded as an augmentative tool that supports, rather than replaces, physician expertise in oculoplastic care.

OBJECTIVES:To understand the level of equity considerations within Cochrane systematic reviews (CSR) on glaucoma and their primary studies. METHODS:A review of equity considerations in systematic reviews on glaucoma published in The Cochrane Library from inception (2003) to January 31, 2024 and a sample of recently published primary studies included in those reviews (n = 122). Extraction was performed by two independent reviewers using a prepiloted extraction form based on a validated, contemporary, structured equity framework. If consensus could not be reached, a third reviewer was involved. RESULTS:A total of 40 CSRs on glaucoma were identified, all of which exclusively included randomized control trials (RCTs) or quasi-RCTs. Twenty-nine (72.5%) reviews acknowledged populations experiencing inequities in glaucoma care; none were able to perform subgroup analysis due to data unavailability in primary studies. Six (15.0%) reviews considered equity-relevant factors when discussing applicability or limitations of study findings to specific populations. Seventy-four (46.8%) review authors were women, while 84 (53.2%) were men. Most review authors were primarily affiliated with institutions in the European Region (85, 53.8%) or the Americas (55, 34.8%), while none were primarily affiliated with institutions in Africa or low-income countries. Most RCTs were conducted in the Americas (32.8%), European Region (27.9%), or in high-income countries (72.1%). While most RCTs reported gender or sex of participants (107, 87.7%), only half reported race or ethnicity (61, 50.0%). No RCTs reported place of residence, occupation, socioeconomic status (SES), or social capital of participants. Approximately half (51.7%) of the participants in these RCTs were female. CONCLUSION:Equity considerations can be better addressed in research on glaucoma. Reporting of patient sociodemographic in RCTs, particularly race and ethnicity, as well as global representation were insufficient. This may limit the generalizability and applicability of intervention efficacy to populations experiencing inequities and people from low-income countries.