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Alfalah M, Eng KT, Felfeli T, Chew H, Birt C, Maniyali F, Kertes PJ. Assessment of Zonular Integrity in Phakic Eyes Following Pars Plana Vitrectomy Using Ultrasound Biomicroscopy (UBM): A Prospective Paired Eye Comparative Study. Am J Ophthalmol 2024:S0002-9394(24)00141-7. [PMID: 38583581 DOI: 10.1016/j.ajo.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/01/2024] [Accepted: 04/01/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE To assess zonular integrity in phakic patients post vitrectomy using ultrasound biomicroscopy (UBM). STUDY DESIGN Prospective, comparative, non-randomized, double masked, paired eye study. METHODS We used ultrasound biomicroscopy (UBM) to evaluate phakic patients with history of unilateral pars-plana vitrectomy. INCLUSION CRITERIA 1.Phakic patients with history of pars plana vitrectomy in one eye as the only procedure. 2.Normal unoperated fellow eye. 3.Complete gas or air resolution from the vitreous cavity at the time of UBM assessment. EXCLUSION CRITERIA 1. Monocular patients. 2. History of intraoperative lenticular trauma. 3. The use of silicone oil tamponade. 4. History of trauma or pseudo-exfoliation in either eye.5. History of other ocular conditions that can affect the integrity of zonules, such as uveitis or ectopia lentis. 6. Eyes with extreme myopia/long axial length (> -8.00 D / > 30.0 mm). 7.History of intravitreal injection in either eye. 8. Age less than 18 years. TECHNIQUE A high frequency (50 MHz) UBM device was used by a masked technician to obtain radial section images from zonular bundles at 8 different clock positions. Image quality was assessed in real time, captured and saved. Two experienced masked observers (HC and CB) then assessed the quality of the images and graded the zonular findings. Only patients with adequate studies have been included. A unique grading system that was specifically devised for this study was used as the following: (0) clear, well-defined zonule(s); (1) uneven, disrupted zonules or stretched zonules; (2) extensive loss of zonules. Each clock hour was graded according to this system and the total score was then calculated for each eye. In the primary outcome, two main groups were analyzed: the vitrectomized, and healthy contralateral non-vitrectomized eyes. The mean total UBM score (TUS) from each group was compared and analyzed. RESULTS Thirty five patients were recruited into this study. Eleven patients were males and twenty four were females. The mean age was 66.3 years. Thirty patients had vitrectomy for vitreomacular interface disorders (either macular hole or epiretinal membrane), one patient had vitreous hemorrhage and the remaining four patients had rhegmatogenous retinal detachments. With regards to tamponade agents, SF6 was used in 21 (60%) patients, air in 9 (26%) patients, and C3F8 in 5 (14%) patients. The mean UBM total score (TUS) in the vitrectomized eyes was 2.28 (SD: 1.83) versus 2.24 (SD: 1.77) in the non-vitrectomized eyes (p=0.9531. Overall, in the comparative analysis of mean scores based on two-graders' assessments for each clock position in vitrectomized and non-vitrectomized eyes, there were no significant differences noted between the groups. CONCLUSION This study found no evidence for a difference in the mean total UBM score (TUS) in eyes following vitrectomy when compared to their contralateral healthy, non-vitrectomized eyes. This likely indicates that vitrectomy may not affect the integrity of zonules in phakic patients, at least for patients with vitreomacular interface disorders undergoing uncomplicated surgery.
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Affiliation(s)
- Mohammed Alfalah
- Department of Ophthalmology and Vision Sciences, University of Toronto, 340 College Street, Suite 400, Toronto, ON M5T3A9, Canada; College of Medicine, King Faisal University, P.O.BOX 400, Al-Ahsa 31982, Saudi Arabia
| | - Kenneth T Eng
- Department of Ophthalmology and Vision Sciences, University of Toronto, 340 College Street, Suite 400, Toronto, ON M5T3A9, Canada; The John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada
| | - Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, 340 College Street, Suite 400, Toronto, ON M5T3A9, Canada
| | - Hall Chew
- Department of Ophthalmology and Vision Sciences, University of Toronto, 340 College Street, Suite 400, Toronto, ON M5T3A9, Canada; The John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada
| | - Catherine Birt
- Department of Ophthalmology and Vision Sciences, University of Toronto, 340 College Street, Suite 400, Toronto, ON M5T3A9, Canada; The John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada
| | - Faryal Maniyali
- The John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto, 340 College Street, Suite 400, Toronto, ON M5T3A9, Canada; The John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada; The Kensington Eye Institute, 340 College St., Suite 400, Toronto, Ontario M5T 3A9.
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Junek M, Barra L, Kopp A, Felfeli T, Gatley J, Widdifield J. Phase Specific Health Care Costs Associated with Giant Cell Arteritis in Ontario, Canada. J Rheumatol 2024:jrheum.2023-1245. [PMID: 38561188 DOI: 10.3899/jrheum.2023-1245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To estimate the additional health care system costs associated with giant cell arteritis (GCA) in the year pre-diagnosis, post diagnosis, and over long-term follow up compared to individuals with similar demographics and comorbidities without GCA. METHODS We performed a population-based study using health administrative data. Newly diagnosed cases of GCA (between 2002 and 2017 and ages 66 years and older) were identified using a validated algorithm and matched 1:6 to comparators using propensity scores. Follow up data was accrued until death, outmigration, or March 31, 2020. The costs associated with care were determined across three phases: the year before the diagnosis of GCA, the year after, and ongoing costs thereafter. RESULTS The cohort consisted of 6,730 cases of GCA and 40,380 matched non-GCA comparators. The average age was 77 years (interquartile range 72-82) and 68.2% were female. A diagnosis of GCA was associated with an increased cost of $6,619.4 (95% CI 5,964.9 - 7274.0) per patient during the 1-year pre-diagnostic period; $12,150.3 (95% CI 11,233.1 - 13,067.6) per patient in the 1-year post-diagnostic phase, and $20,886.2 (95% CI 17,195.2 - 24,577.2) per patient during ongoing care for year 3 onwards. Increased costs were driven by inpatient hospitalizations, physician services, hospital outpatient clinic services, and emergency department visits. CONCLUSION A diagnosis of GCA was associated with increased health care costs during all three phases of care. Given the substantial economic burden, strategies to reduce the healthcare utilization and costs associated with GCA are warranted.
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Affiliation(s)
- Mats Junek
- Mats Junek MD, McMaster University, Hamilton, Ontario, Canada
| | - Lillian Barra
- Lillian Barra MD, Department of Medicine, Epidemiology and Biostatistics, Western University, Schulich School of Medicine & Dentistry, London, Ontario, Canada; Department of Medicine, St. Joseph's Health Care London, Ontario, Canada
| | | | - Tina Felfeli
- Tina Felfeli MD, Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Jodi Gatley
- Jodi Gatley MPH, ICES, Toronto, Ontario, Canada
| | - Jessica Widdifield
- Jessica Widdifield PhD, ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada; Holland Bone & Joint Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
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Pucchio A, Krance SH, Pur DR, Bhatti J, Bassi A, Manichavagan K, Brahmbhatt S, Aggarwal I, Singh P, Virani A, Stanley M, Miranda RN, Felfeli T. Applications of artificial intelligence and bioinformatics methodologies in the analysis of ocular biofluid markers: a scoping review. Graefes Arch Clin Exp Ophthalmol 2024; 262:1041-1091. [PMID: 37421481 DOI: 10.1007/s00417-023-06100-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 04/25/2023] [Accepted: 05/06/2023] [Indexed: 07/10/2023] Open
Abstract
PURPOSE This scoping review summarizes the applications of artificial intelligence (AI) and bioinformatics methodologies in analysis of ocular biofluid markers. The secondary objective was to explore supervised and unsupervised AI techniques and their predictive accuracies. We also evaluate the integration of bioinformatics with AI tools. METHODS This scoping review was conducted across five electronic databases including EMBASE, Medline, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Web of Science from inception to July 14, 2021. Studies pertaining to biofluid marker analysis using AI or bioinformatics were included. RESULTS A total of 10,262 articles were retrieved from all databases and 177 studies met the inclusion criteria. The most commonly studied ocular diseases were diabetic eye diseases, with 50 papers (28%), while glaucoma was explored in 25 studies (14%), age-related macular degeneration in 20 (11%), dry eye disease in 10 (6%), and uveitis in 9 (5%). Supervised learning was used in 91 papers (51%), unsupervised AI in 83 (46%), and bioinformatics in 85 (48%). Ninety-eight papers (55%) used more than one class of AI (e.g. > 1 of supervised, unsupervised, bioinformatics, or statistical techniques), while 79 (45%) used only one. Supervised learning techniques were often used to predict disease status or prognosis, and demonstrated strong accuracy. Unsupervised AI algorithms were used to bolster the accuracy of other algorithms, identify molecularly distinct subgroups, or cluster cases into distinct subgroups that are useful for prediction of the disease course. Finally, bioinformatic tools were used to translate complex biomarker profiles or findings into interpretable data. CONCLUSION AI analysis of biofluid markers displayed diagnostic accuracy, provided insight into mechanisms of molecular etiologies, and had the ability to provide individualized targeted therapeutic treatment for patients. Given the progression of AI towards use in both research and the clinic, ophthalmologists should be broadly aware of the commonly used algorithms and their applications. Future research may be aimed at validating algorithms and integrating them in clinical practice.
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Affiliation(s)
- Aidan Pucchio
- Department of Ophthalmology, Queen's University, Kingston, ON, Canada
- Queens School of Medicine, Kingston, ON, Canada
| | - Saffire H Krance
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Daiana R Pur
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Jasmine Bhatti
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Arshpreet Bassi
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | | | - Shaily Brahmbhatt
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | | | - Priyanka Singh
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Aleena Virani
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | | | - Rafael N Miranda
- The Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Tina Felfeli
- The Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
- Department of Ophthalmology and Vision Sciences, University of Toronto, 340 College Street, Suite 400, Toronto, ON, M5T 3A9, Canada.
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Pandya BU, Grinton M, Mandelcorn ED, Felfeli T. RETINAL OPTICAL COHERENCE TOMOGRAPHY IMAGING BIOMARKERS: A Review of the Literature. Retina 2024; 44:369-380. [PMID: 37903455 PMCID: PMC10885864 DOI: 10.1097/iae.0000000000003974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/19/2023] [Indexed: 11/01/2023]
Abstract
PURPOSE The aim of this literature review was to summarize novel optical coherence tomography (OCT) imaging biomarkers that have recently been described in the literature and are frequently encountered clinically. METHODS The literature was reviewed to identify novel OCT biomarkers reported to date. A descriptive summary of all terms and representative illustrations were provided to highlight the most relevant features. RESULTS Thirty-seven OCT terminologies were identified. The vitreomacular interface disorder group included the four stages of epiretinal membrane, macular pseudohole, tractional lamellar hole (LH), degenerative LH, cotton ball sign, and foveal crack sign. The age-related macular degeneration group included outer retinal tubulation, multilayered pigment epithelial detachment, prechoroidal cleft, onion sign, double-layer sign, complete outer retinal atrophy, complete retinal pigment epithelium and outer retinal atrophy, and reticular pseudodrusen. The uveitic disorder group consisted of bacillary layer detachment, syphilis placoid, rain-cloud sign, and pitchfork sign. The disorders relating to the toxicity group included flying saucer sign and mitogen-activated protein kinase (MEK) inhibitor-associated retinopathy. The disorders associated with the systemic condition group included choroidal nodules and needle sign. The pachychoroid spectrum group included pachychoroid and brush border pattern. The vascular disorder group included pearl necklace sign, diffuse retinal thickening, disorganization of retinal inner layers, inner nuclear layer microcysts, hyperreflective retinal spots, paracentral acute middle maculopathy, and acute macular neuroretinopathy. The miscellaneous group included omega sign (ω), macular telangiectasia (type 2), and omega sign (Ω). CONCLUSIONS Thirty-seven OCT terminologies were summarized, and detailed illustrations consolidating the features of each biomarker were included. A nuanced understanding of OCT biomarkers and their clinical significance is essential because of their predictive and prognostic value.
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Affiliation(s)
- Bhadra U. Pandya
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michael Grinton
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Efrem D. Mandelcorn
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- The Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; and
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
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Felfeli T, Rhee J, Eshtiaghi A, Balas M, Tai F, Kaplan AJ, Christakis PG, Mandelcorn ED, Rubin LA, Bakshi NK, Derzko-Dzulynsky LA. Characteristics of ocular hypertension and uveitic glaucoma among patients with noninfectious uveitis. Can J Ophthalmol 2024:S0008-4182(24)00035-8. [PMID: 38431271 DOI: 10.1016/j.jcjo.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 12/13/2023] [Accepted: 02/05/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE 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. DESIGN Retrospective cohort study. PARTICIPANTS All adults (≥18 years) with NIU under the care of uveitis subspecialty tertiary care clinics between 2010 and 2021 were included. METHODS The primary outcomes were baseline and final visual acuity. RESULTS 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). CONCLUSION 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.
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Affiliation(s)
- Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, ON.
| | - Jess Rhee
- Faculty of Medicine, Schulich School of Medicine and Dentistry, London, ON
| | - Arshia Eshtiaghi
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - Michael Balas
- The Temerty Faculty of Medicine, University of Toronto, Toronto, ON
| | - Felicia Tai
- Division of Ophthalmology, McMaster University, Hamilton, ON
| | - Alexander J Kaplan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, ON; The Kensington Vision and Research Centre, Kensington Health Institute, Toronto, ON
| | - Panos G Christakis
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; The Kensington Vision and Research Centre, Kensington Health Institute, Toronto, ON
| | - Efrem D Mandelcorn
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, ON; The Kensington Vision and Research Centre, Kensington Health Institute, Toronto, ON
| | - Laurence A Rubin
- Faculty of Medicine, Schulich School of Medicine and Dentistry, London, ON; Division of Rheumatology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON
| | - Nupura K Bakshi
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; The Kensington Vision and Research Centre, Kensington Health Institute, Toronto, ON; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON; Department of Ophthalmology, Mount Sinai Hospital, ON
| | - Larissa A Derzko-Dzulynsky
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; The Kensington Vision and Research Centre, Kensington Health Institute, Toronto, ON; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON
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Monson H, Demaine J, Perryman A, Felfeli T. Bibliometric analysis of the 3-year trends (2018-2021) in literature on artificial intelligence in ophthalmology and vision sciences. BMJ Health Care Inform 2024; 31:e100780. [PMID: 38418374 PMCID: PMC10910687 DOI: 10.1136/bmjhci-2023-100780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 01/31/2024] [Indexed: 03/01/2024] Open
Abstract
OBJECTIVES The objective of this analysis is to present a current view of the field of ophthalmology and vision research and artificial intelligence (AI) from topical and geographical perspectives. This will clarify the direction of the field in the future and aid clinicians in adapting to new technological developments. METHODS A comprehensive search of four different databases was conducted. Statistical and bibliometric analysis were done to characterise the literature. Softwares used included the R Studio bibliometrix package, and VOSviewer. RESULTS A total of 3939 articles were included in the final bibliometric analysis. Diabetic retinopathy (391, 6% of the top 100 keywords) was the most frequently occurring indexed keyword by a large margin. The highest impact literature was produced by the least populated countries and in those countries who collaborate internationally. This was confirmed via a hypothesis test where no correlation was found between gross number of published articles and average number of citations (p value=0.866, r=0.038), while graphing ratio of international collaboration against average citations produced a positive correlation (r=0.283). Majority of publications were found to be concentrated in journals specialising in vision and computer science, with this category of journals having the highest number of publications per journal (18.00 publications/journal), though they represented a small proportion of the total journals (<1%). CONCLUSION This study provides a unique characterisation of the literature at the intersection of AI and ophthalmology and presents correlations between article impact and geography, in addition to summarising popular research topics.
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Affiliation(s)
- Hayley Monson
- Mathematics, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey Demaine
- Research Impact Services, McMaster University, Hamilton, Ontario, Canada
| | | | - Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evulation, University of Toronto, Toronto, Ontario, Canada
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Felfeli T, Park J, Nestor B, Altomare F, Rai AS, Mandelcorn ED, Chow DR, Wong DT. Evaluating the long-term biological stability of cytokine biomarkers in ocular fluid samples. BMJ Open Ophthalmol 2023; 8:e001346. [PMID: 38081779 PMCID: PMC10729172 DOI: 10.1136/bmjophth-2023-001346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 11/01/2023] [Indexed: 12/18/2023] Open
Abstract
PURPOSE The quality of biological fluid samples is vital for optimal preanalytical procedures and a requirement for effective translational biomarker research. This study aims to determine the effects of storage duration and freeze-thawing on the levels of various cytokines in the human aqueous humour and vitreous samples. METHODS AND ANALYSIS Human ocular aqueous humour and vitreous samples were obtained from 25 eyes and stored at -80°C for analysis. All samples were assayed for 27 cytokine biomarker concentrations (pg/mL) using a multiplex assay. Four sample storage durations following sample collection were evaluated (1 week, 3 months, 9 months and 15 months). Additionally, samples underwent up to three freeze-thaw cycles within the study period. RESULTS Among the 27 cytokine biomarkers, concentrations of four cytokines (Interleukin (IL)-2, IL-10, IL-12 and platelet-derived growth factor-BB) were significantly decreased by storage duration at all time points, as early as 3 months following sample collection (range of 9%-37% decline between 1 week and 15 months, p<0.001). Freeze-thawing of up to three cycles did not significantly impact the cytokine biomarker concentrations in aqueous humour or vitreous. Separability of patient-specific cytokine biomarker profiles in the principal component analysis remained relatively the same over the 15 months of storage duration. CONCLUSION The findings from this study suggest that several intraocular cytokine biomarkers in human aqueous humour and vitreous samples may be susceptible to degradation with long-term storage, as early as 3 months after collection. The overall patient-specific cytokine biomarker profiles are more stable than concentrations of individual cytokines. Future studies should focus on developing guidelines for optimal and standardised sample handling methods to ensure correct research findings about intraocular biomarkers are translated into clinical practice.
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Affiliation(s)
- Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Jeff Park
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Bret Nestor
- Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, Washington, USA
| | - Filiberto Altomare
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Amandeep S Rai
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Kensington Eye Institute, University of Toronto, Toronto, Ontario, Canada
| | - Efrem D Mandelcorn
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - David R Chow
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - David T Wong
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
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Felfeli T, Grewal PS, Mandelcorn ED. Applications of the Guarded-Needle External Drainage Technique in Vitreoretinal Surgery. Retina 2023; 43:2130-2133. [PMID: 35604721 DOI: 10.1097/iae.0000000000003483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the surgical technique using the guarded-needle external drainage for a wide variety of applications in vitreoretinal surgery. METHODS A step-by-step procedure and a surgical video using the guarded-needle external drainage technique are presented. In addition, a series of representative cases with wide-ranging diagnoses who underwent the technique is reviewed. DESCRIPTION AND TECHNIQUE The guarded-needle using a 27-gauge thin-walled TSK needle (TSK Laboratory International) and a trimmed 70 buckle sleeve are connected to the active extrusion tubing of the vitrectomy machine. External drainage is performed by actively aspirating subretinal fluid using low active vacuum. The guarded-needle external drainage technique is used in cases with bullous detachments, and small and anterior breaks, when performing scleral buckle, for prevention of underfill when using oil tamponade in cases with choroidal effusion, addressing subretinal gas/air, lysing a subretinal band, draining a suprachoroidal hemorrhage, for diabetic tractional retinal detachments, detachments with no definitive break, and subretinal biopsy in exudative detachments. CONCLUSION The guarded-needle external drainage has a wide range of applications in vitreoretinal surgery.
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Affiliation(s)
- Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Parampal S Grewal
- Department of Ophthalmology, University of Alberta, Edmonton, Alberta, Canada ; and
| | - Efrem D Mandelcorn
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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Felfeli T, Eshtiaghi A, Rhee J, Balas M, Tai F, Kaplan AJ, Christakis PG, Dzulynsky K, Monson H, Mandelcorn ED, Rubin LA, Bakshi NK, Derzko-Dzulynsky LA. Clinical characteristics of non-infectious uveitis treated with and without systemic immunomodulatory therapy. Can J Ophthalmol 2023:S0008-4182(23)00308-3. [PMID: 37972648 DOI: 10.1016/j.jcjo.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/28/2023] [Accepted: 10/04/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE To compare the patient characteristics and long-term outcomes for those treated with and without systemic immunomodulatory therapy (IMT) for non-infectious uveitis (NIU). DESIGN Retrospective cohort study. PARTICIPANTS All consecutive adults with NIU receiving care at 5 uveitis subspecialty tertiary care clinics between 2010 and 2021. METHODS Clinical outcomes were evaluated on initial presentation and at the last available follow-up. The main outcome measures were baseline characteristics and final visual acuity. RESULTS A 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). CONCLUSIONS NIU 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.
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Affiliation(s)
- Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, ON.
| | - Arshia Eshtiaghi
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - Jess Rhee
- Faculty of Medicine, Schulich School of Medicine and Dentistry, London, ON
| | - Michael Balas
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON
| | - Felicia Tai
- Division of Ophthalmology, McMaster University, Hamilton, ON
| | - Alexander J Kaplan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, ON; Kensington Vision and Research Centre, Kensington Health Institute, Toronto, ON
| | - Panos G Christakis
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Kensington Vision and Research Centre, Kensington Health Institute, Toronto, ON
| | - Kira Dzulynsky
- Faculty of Engineering, McGill University, Montreal, Que
| | - Hayley Monson
- Faculty of Mathematics, McMaster University, Hamilton, ON
| | - Efrem D Mandelcorn
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, ON; Kensington Vision and Research Centre, Kensington Health Institute, Toronto, ON
| | - Laurence A Rubin
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON; Division of Rheumatology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON
| | - Nupura K Bakshi
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Kensington Vision and Research Centre, Kensington Health Institute, Toronto, ON; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON; Department of Ophthalmology, Mount Sinai Hospital, Toronto, ON
| | - Larissa A Derzko-Dzulynsky
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Kensington Vision and Research Centre, Kensington Health Institute, Toronto, ON; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON
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10
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Felfeli T, Corrin M, Papanikolaou J, Mandelcorn ED. MACULAR HOLE HYDRODISSECTION TECHNIQUE WITH HUMAN AMNIOTIC MEMBRANE FOR REPAIR OF LARGE MACULAR HOLES. Retin Cases Brief Rep 2023; 17:767-770. [PMID: 35970750 PMCID: PMC10597415 DOI: 10.1097/icb.0000000000001293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE To describe a combined surgical technique using the macular hole hydrodissection (MHH) with human amniotic membrane for repair of large macular holes. METHODS A step-by-step procedure and a surgical video using the combined MHH and human amniotic membrane technique are presented. DESCRIPTION AND TECHNIQUE As the first step, the MHH separates the adhesions of the macular hole to the underlying retinal pigment epithelium with a soft-tipped cannula through proportional reflux followed by gentle passive aspiration. The human amniotic membrane graft is marked to identify the nonsticky epithelial side and ensure that the stromal layer (sticky and nonshinny) is facing downward toward the retinal pigment epithelium. The graft is then tucked into the space created with MHH between the macular hole edges and the retinal pigment epithelium with closed forceps to decrease the likelihood of the graft from dislocating postoperatively. CONCLUSION The MHH in combination with the human amniotic membrane is a practical and effective technique for addressing challenging large macular holes.
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Affiliation(s)
- Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Michael Corrin
- Department of Biomedical Communications, University of Toronto, Toronto, Ontario, Canada
| | | | - Efrem D. Mandelcorn
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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11
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Felfeli T, Teja B, Miranda RN, Simbulan F, Sridhar J, Sander B, Naimark DM. Cost-Utility of Rhegmatogenous Retinal Detachment Repair With Pars Plana Vitrectomy, Scleral Buckle, and Pneumatic Retinopexy: A Microsimulation Model. Am J Ophthalmol 2023; 255:141-154. [PMID: 37327958 DOI: 10.1016/j.ajo.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 05/26/2023] [Accepted: 06/03/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE To assess the cost-effectiveness of primary noncomplex rhegmatogenous retinal detachment (RRD) repair, comparing 3 different strategies, pars plana vitrectomy (PPV), scleral buckle (SB), and pneumatic retinopexy (PnR) from the health care payer perspective over a lifetime. DESIGN Model-based cost-utility analysis. METHODS A simulated cohort of 100,000 adult patients (≥18 years old) requiring primary noncomplex RRD repair in theoretical surgical centers in the United States. Quality-adjusted life years (QALYs), lifetime costs (2022 United States dollars), and the incremental cost-effectiveness ratio (ICER) of the 3 interventions were projected over a lifetime horizon, with a cost-effectiveness threshold of ≤$50,000 per gained QALY. RESULTS Based on inputted parameters, the primary anatomical success was highest for PPV (95.00%) compared to SB (91.76%) and PnR (63.41%). The QALYs associated with PPV, SB, and PnR were (11.87, SD 1.62), (11.84, SD 1.63), and (11.59, SD 1.72), respectively. The incurred lifetime costs of RRD repair and associated postoperative surgeries for PPV, SB, and PnR were $4445.72 (SD 655.75), $4518.04 (662.92), and $3978.45 (728.50), respectively. Parameter-level simulations suggested that PPV was most likely to be the most cost-effective therapy compared to SB and PnR beyond a threshold of $3000/QALY. The incremental cost-effectiveness ratio for PPV compared to PnR was $1693.54. SB was dominant in all scenarios. Threshold analyses indicated that the success rate of PnR would have to be 100% and/or the cost would have to be $2000 or less over lifetime for it to be more cost-effective than PPV. CONCLUSIONS This study found PPV to be the most cost-effective primary procedure for RRD repair at a threshold of $50,000/QALY gained over a lifetime horizon from the health care payer perspective.
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Affiliation(s)
- Tina Felfeli
- From the Department of Ophthalmology and Vision Sciences, University of Toronto (T.F.), Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto (T.F., B.T., R.N.M., F.S., J.S., B.S., D.N.), Ontario, Canada.
| | - Bijan Teja
- Institute of Health Policy, Management and Evaluation, University of Toronto (T.F., B.T., R.N.M., F.S., J.S., B.S., D.N.), Ontario, Canada; Department of Anesthesiology and Pain Medicine and Interdepartmental Division of Critical Care Medicine, University of Toronto (B.T.), Ontario, Canada
| | - Rafael N Miranda
- Institute of Health Policy, Management and Evaluation, University of Toronto (T.F., B.T., R.N.M., F.S., J.S., B.S., D.N.), Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network (T.F., R.N.M., B.S.), Ontario, Canada
| | - Frances Simbulan
- Institute of Health Policy, Management and Evaluation, University of Toronto (T.F., B.T., R.N.M., F.S., J.S., B.S., D.N.), Ontario, Canada; The Hospital for Sick Children Research Institute, University of Toronto (F.S.), Ontario, Canada
| | - Jayanth Sridhar
- Institute of Health Policy, Management and Evaluation, University of Toronto (T.F., B.T., R.N.M., F.S., J.S., B.S., D.N.), Ontario, Canada; Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine (J.S.), Florida, USA
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation, University of Toronto (T.F., B.T., R.N.M., F.S., J.S., B.S., D.N.), Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network (T.F., R.N.M., B.S.), Ontario, Canada
| | - David M Naimark
- Institute of Health Policy, Management and Evaluation, University of Toronto (T.F., B.T., R.N.M., F.S., J.S., B.S., D.N.), Ontario, Canada; Department of Medicine, Sunnybrook Health Sciences Centre (D.N.), Ontario, Canada
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12
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Lamoureux D, Wong DT, Felfeli T. Variability of Replicates of Intraocular Inflammatory Biomarkers in Ocular Fluid Samples Analyzed with Multiplex Assays. Clin Ophthalmol 2023; 17:2653-2663. [PMID: 37705679 PMCID: PMC10497047 DOI: 10.2147/opth.s417821] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/20/2023] [Indexed: 09/15/2023] Open
Abstract
Purpose Certain factors such as instrumental and sample processing errors may contribute to variability of ocular biofluid samples when they are run as replicates with multiplex assays. There is a paucity of literature on the variability of replicates in multiplex assays. This study aims to evaluate whether there is significant variability in replicate analyses of multiplex assays. Methods A total of 152 human ocular biofluid samples (51 aqueous humor and 101 vitreous) were collected and assayed for 27 cytokine biomarker concentrations (pg/mL). Samples were evaluated as replicates (duplicate analysis) at four different time points. Statistical methods including paired samples t-test, 3-way ANOVA, intraclass correlation coefficient (ICC; <0.5-0.75=poor-moderate, 0.75->0.90 =good-excellent reliability), and coefficients of variation (CV) were employed to evaluate for statistical significance, with Bonferroni corrected P=0.002. Results Among the 4104 biomarker replicate assays for aqueous humor and vitreous, two analytes (PDGF-BB and IL-7) had a statistically significant difference between the sampled concentrations of the replicates in vitreous samples (mean (diff)=2.05, P<0.001, mean (diff)=1.56, P<0.001, respectively). Majority of the ICC values fell within the good-excellent range (86% of samples) with a minority falling in the poor-moderate range (14% of samples). More variability was noted in the vitreous humour, with five analytes (IL-2, IL-10, IL-12(p70), IL-13, IL-17) demonstrating an average ICC of less than 0.5. The CV calculated for each set of replicates suggested that 93% of replicates had an acceptable level of quantitative assay variability (CV<20%). Conclusion This study demonstrates that the analysis of most biomarkers in ocular fluids may not require the use of replicates. However, certain analytes such as PDGF-BB and IL-7 may require the use of replicates to ensure reliable results. Caution should be taken when applying these findings to other laboratory settings as our study was conducted by an experienced technician using a standardized protocol. In less standardized settings, replicates may be required in order to ensure accuracy of results. These findings may guide researchers with the design of their studies on ophthalmic biomarker analysis.
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Affiliation(s)
- Daniel Lamoureux
- Northern Ontario School of Medicine University, Thunder Bay, ON, Canada
| | - David T Wong
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
- Department of Ophthalmology, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
- The Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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13
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Gao T, Monson H, Felfeli T. Bibliometric analysis of the uveitis literature and research trends over the past two decades. BMJ Open Ophthalmol 2023; 8:e001330. [PMID: 37714667 PMCID: PMC10510855 DOI: 10.1136/bmjophth-2023-001330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/19/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVE This study aimed to examine the publication patterns and present a current view of the field of uveitis using a bibliometric analysis. DESIGN Bibliometric analysis. METHODS AND ANALYSIS A comprehensive search of three databases including MEDLINE, EMBASE and Cochrane was conducted from 1 January 2000 to 31 December 2022. Search results from all three databases were subjected to analysis by Bibliometrix, an R programme that analyses large literature dataset with statistical and mathematical models. Visualisation of collaboration networks and relevance between countries was presented with VOSviewer. RESULTS A total of 26 296 articles were included in the analysis. The field of uveitis has undergone a significant exponential growth since 2000, with an average growth rate of 4.14%. The most substantial annual growth was between the years 2021 and 2022 (36%). According to the corresponding author's countries, the three most productive countries were Turkey (3288, 12.6%), the USA (3136, 12%) and Japan (1981, 7.6%). The USA (243, 31.4%), England (117, 15%) and Germany (62, 8%) are the top three countries that contributed to clinical trials. The average international collaboration of all countries was 2.5%. CONCLUSIONS Uveitis literature has undergone significant growth in the past two decades. The demographic factors of publishing countries lead to their various productivity and types of these uveitis studies, which is closely associated with the countries' scientific research resources and patient populations.
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Affiliation(s)
- Tingxiao Gao
- Medical Biophysics, University of Toronto - St George Campus, Toronto, Ontario, Canada
| | - Hayley Monson
- Department of Mathematics and Statistics, McMaster University, Hamilton, Ontario, Canada
| | - Tina Felfeli
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Ontario, Canada
- The Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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14
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Pucchio A, Krance S, Pur DR, Bassi A, Miranda R, Felfeli T. The role of artificial intelligence in analysis of biofluid markers for diagnosis and management of glaucoma: A systematic review. Eur J Ophthalmol 2023; 33:1816-1833. [PMID: 36426575 PMCID: PMC10469503 DOI: 10.1177/11206721221140948] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 11/01/2022] [Indexed: 08/31/2023]
Abstract
PURPOSE This review focuses on utility of artificial intelligence (AI) in analysis of biofluid markers in glaucoma. We detail the accuracy and validity of AI in the exploration of biomarkers to provide insight into glaucoma pathogenesis. METHODS A comprehensive search was conducted across five electronic databases including Embase, Medline, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Web of Science. Studies pertaining to biofluid marker analysis using AI or bioinformatics in glaucoma were included. Identified studies were critically appraised and assessed for risk of bias using the Joanna Briggs Institute Critical Appraisal tools. RESULTS A total of 10,258 studies were screened and 39 studies met the inclusion criteria, including 23 cross-sectional studies (59%), nine prospective cohort studies (23%), six retrospective cohort studies (15%), and one case-control study (3%). Primary open angle glaucoma (POAG) was the most commonly studied subtype (55% of included studies). Twenty-four studies examined disease characteristics, 10 explored treatment decisions, and 5 provided diagnostic clarification. While studies examined at entire metabolomic or proteomic profiles to determine changes in POAG, there was heterogeneity in the data with over 175 unique, differentially expressed biomarkers reported. Discriminant analysis and artificial neural network predictive models displayed strong differentiating ability between glaucoma patients and controls, although these tools were untested in a clinical context. CONCLUSION The use of AI models could inform glaucoma diagnosis with high sensitivity and specificity. While insight into differentially expressed biomarkers is valuable in pathogenic exploration, no clear pathogenic mechanism in glaucoma has emerged.
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Affiliation(s)
- Aidan Pucchio
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Saffire Krance
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Daiana R Pur
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Arshpreet Bassi
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Rafael Miranda
- Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, Ontario, Canada
- The Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Tina Felfeli
- Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Ontario, Canada
- The Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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15
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Felfeli T, Katsnelson G, Kiss A, Plumptre L, Paterson JM, Ballios BG, Mandelcorn ED, Glazier RH, Brent MH, Wong DT. Prevalence and predictors for being unscreened for diabetic retinopathy: a population-based study over a decade. Can J Ophthalmol 2023; 58:278-286. [PMID: 35577027 DOI: 10.1016/j.jcjo.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/08/2022] [Accepted: 04/01/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine the population-level predictors for being unscreened for diabetic retinopathy (DR) among individuals with diabetes in a developed country. DESIGN A retrospective population-based repeated-cross-sectional study. PARTICIPANTS 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. METHODS The Mantel-Haenszel test was used for the relative risk (RR) comparison of subcategories stratified by the 2 cross-sectional time periods. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON; ICES, Toronto, ON.
| | | | - Alex Kiss
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON; ICES, Toronto, ON; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON
| | | | - J Michael Paterson
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON; ICES, Toronto, ON
| | - Brian G Ballios
- Department of Ophthalmology, Toronto Western Hospital, Toronto, ON; Department of Ophthalmology, Sunnybrook Health Sciences Centre, Toronto, ON
| | - Efrem D Mandelcorn
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Department of Ophthalmology, Toronto Western Hospital, Toronto, ON
| | - Richard H Glazier
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON; ICES, Toronto, ON; MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, ON; Department of Family and Community Medicine, St. Michael's Hospital and University of Toronto, Toronto, ON
| | - Michael H Brent
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Department of Ophthalmology, Toronto Western Hospital, Toronto, ON
| | - David T Wong
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON
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Pattathil N, Zhao JZL, Sam-Oyerinde O, Felfeli T. Adherence of randomised controlled trials using artificial intelligence in ophthalmology to CONSORT-AI guidelines: a systematic review and critical appraisal. BMJ Health Care Inform 2023; 30:e100757. [PMID: 37463773 DOI: 10.1136/bmjhci-2023-100757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/15/2023] [Indexed: 07/20/2023] Open
Abstract
PURPOSE Many efforts have been made to explore the potential of deep learning and artificial intelligence (AI) in disciplines such as medicine, including ophthalmology. This systematic review aims to evaluate the reporting quality of randomised controlled trials (RCTs) that evaluate AI technologies applied to ophthalmology. METHODS A comprehensive search of three relevant databases (EMBASE, Medline, Cochrane) from 1 January 2010 to 5 February 2022 was conducted. The reporting quality of these papers was scored using the Consolidated Standards of Reporting Trials-Artificial Intelligence (CONSORT-AI) checklist and further risk of bias was assessed using the RoB-2 tool. RESULTS The initial search yielded 2973 citations from which 5 articles satisfied the inclusion/exclusion criteria. These articles featured AI technologies applied to diabetic retinopathy screening, ophthalmologic education, fungal keratitis detection and paediatric cataract diagnosis. None of the articles reported all items in the CONSORT-AI checklist. The overall mean CONSORT-AI score of the included RCTs was 53% (range 37%-78%). The individual scores of the articles were 37% (19/51), 39% (20), 49% (25), 61% (31) and 78% (40). All articles were scored as being moderate risk, or 'some concerns present', regarding potential risk of bias according to the RoB-2 tool. CONCLUSION A small number of RCTs have been published to date on the applications of AI in ophthalmology and vision science. Adherence to the 2020 CONSORT-AI reporting guidelines is suboptimal with notable reporting items often missed. Greater adherence will help facilitate reproducibility of AI research which can be a stimulus for more AI-based RCTs and clinical applications in ophthalmology.
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Affiliation(s)
- Niveditha Pattathil
- Queen's University School of Medicine, Faculty of Health Sciences, Kingston, Ontario, Canada
| | - Jonathan Z L Zhao
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
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Felfeli T, Mandelcorn MS, Trussart R, Mandelcorn ED. PREOPERATIVE GAS FOR PARS PLANA VITRECTOMY: A SURGICAL TECHNIQUE FOR REPAIR OF RHEGMATOGENOUS RETINAL DETACHMENTS WITH MULTIPLE, LARGE, OR INFERIOR BREAKS. Retin Cases Brief Rep 2023; 17:374-379. [PMID: 34652305 PMCID: PMC10284130 DOI: 10.1097/icb.0000000000001197] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the role of preoperative gas for pars plana vitrectomy (PGP) as an adjunct to surgical repair of rhegmatogenous retinal detachment (RRD). METHODS This is a retrospective consecutive case series of all rhegmatogenous retinal detachments with multiple breaks in more than one quadrant, large breaks extending greater than one clock hour, and/or inferior breaks requiring PPV, who received intravitreal injection of sulfur hexafluoride (SF 6 ) or perfluoropropane (C 3 F 8 ) 1-2 weeks before PPV between 2016 and 2020 at a tertiary care center. RESULTS A total of 109 eyes underwent the PGP technique, 73% of which had macular involvement. The rhegmatogenous retinal detachments on average involved 5.5 (SD 2.1) clock hours with inferior retinal breaks in 51%. Based on clinical examination, subretinal fluid was noted to be dissipated in parts of the detached retina before PPV in 57% of cases. The use of perfluorocarbon heavy liquid or posterior drainage retinotomy was required in 16% of cases. A 95% primary anatomical success rate was achieved over the median 177 (interquartile range 105-526) follow-up days. A final visual acuity of 20/50 or better was achieved in 65%. CONCLUSION PGP as an adjunct to PPV may facilitate ease of surgery, as well as anatomical and functional success for rhegmatogenous retinal detachments with multiple, large, and/or inferior breaks.
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Affiliation(s)
- Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- The Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mark S. Mandelcorn
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; and
| | - Rachel Trussart
- Hospital Affiliated University Regional, Trois-Rivières, Quebec, Canada
| | - Efrem D. Mandelcorn
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; and
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Pur DR, Krance SH, Pucchio A, Miranda RN, Felfeli T. Current uses of artificial intelligence in the analysis of biofluid markers involved in corneal and ocular surface diseases: a systematic review. Eye (Lond) 2023; 37:2007-2019. [PMID: 36380089 PMCID: PMC10333344 DOI: 10.1038/s41433-022-02307-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 10/03/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022] Open
Abstract
Corneal and ocular surface diseases (OSDs) carry significant psychosocial and economic burden worldwide. We set out to review the literature on the application of artificial intelligence (AI) and bioinformatics for analysis of biofluid biomarkers in corneal and OSDs and evaluate their utility in clinical decision making. MEDLINE, EMBASE, Cochrane and Web of Science were systematically queried for articles using AI or bioinformatics methodology in corneal and OSDs and examining biofluids from inception to August 2021. In total, 10,264 articles were screened, and 23 articles consisting of 1058 individuals were included. Using various AI/bioinformatics tools, changes in certain tear film cytokines that are proinflammatory such as increased expression of apolipoprotein, haptoglobin, annexin 1, S100A8, S100A9, Glutathione S-transferase, and decreased expression of supportive tear film components such as lipocalin-1, prolactin inducible protein, lysozyme C, lactotransferrin, cystatin S, and mammaglobin-b, proline rich protein, were found to be correlated with pathogenesis and/or treatment outcomes of dry eye, keratoconus, meibomian gland dysfunction, and Sjögren's. Overall, most AI/bioinformatics tools were used to classify biofluids into diseases subgroups, distinguish between OSD, identify risk factors, or make predictions about treatment response, and/or prognosis. To conclude, AI models such as artificial neural networks, hierarchical clustering, random forest, etc., in conjunction with proteomic or metabolomic profiling using bioinformatics tools such as Gene Ontology or Kyoto Encylopedia of Genes and Genomes pathway analysis, were found to inform biomarker discovery, distinguish between OSDs, help define subgroups with OSDs and make predictions about treatment response in a clinical setting.
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Affiliation(s)
- Daiana Roxana Pur
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Saffire H Krance
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Aidan Pucchio
- School of Medicine, Queen's University, Kingston, ON, Canada
| | - Rafael N Miranda
- Toronto Health Economics and Technology Assessment Collaborative, Toronto, ON, Canada
- The Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Tina Felfeli
- Toronto Health Economics and Technology Assessment Collaborative, Toronto, ON, Canada.
- The Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, ON, Canada.
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19
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Balas M, Vasiliu D, Austria G, Felfeli T. The Impact of the COVID-19 Pandemic on Wait-Times for Ophthalmic Surgery in Ontario, Canada: A Population-Based Study. Clin Ophthalmol 2023; 17:1823-1831. [PMID: 37397955 PMCID: PMC10312341 DOI: 10.2147/opth.s409479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/02/2023] [Indexed: 07/04/2023] Open
Abstract
Objective To investigate the effects of the COVID-19 pandemic on case volumes and wait-times for ophthalmic surgery in Ontario, Canada. Design Population-based retrospective cohort study. Participants Patients undergoing ophthalmic surgery in Ontario, Canada, from 2010 to 2021, collected from the Ontario Health Wait Times Information System (WTIS) database. Methods The WTIS contains non-emergent surgical case volume and wait-time data for six ophthalmic subspecialty surgery types, three priority levels (low, medium, high) and 14 different regions in Ontario. Case volume and wait-times were compared between the COVID-19 pandemic (2020-2021) and the preceding time period (2010-2019) across all stratifications. Results There was a significant decrease in case volumes and significant increase in wait-times across geographic regions, priority levels, and subspecialty surgeries from the pre-pandemic to pandemic period. Moreover, COVID-19 exacerbated pre-existing wait-time disparities between sexes, with females waiting 4.1 days longer than males overall to receive surgery in 2010-2019 compared to waiting 8.8 days longer in 2020-2021 (117% increase). Conclusion These findings highlight the impact of the COVID-19 pandemic on ophthalmic surgical wait times in Ontario. Cataract, strabismus and oculoplastic surgeries, the Waterloo Wellington, Central, and South East regions of Ontario, and those with female sex had the greatest relative increases in wait-times during the pandemic.
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Affiliation(s)
- Michael Balas
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Diana Vasiliu
- Health System Intelligence Team, Health System Performance & Support Portfolio, Ontario Health, Toronto, ON, Canada
| | - Gener Austria
- Health System Intelligence Team, Health System Performance & Support Portfolio, Ontario Health, Toronto, ON, Canada
| | - Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, ON, Canada
- The Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada
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20
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Balas M, Vasiliu D, Austria G, Felfeli T. Demographic trends of patients undergoing ophthalmic surgery in Ontario, Canada: a population-based study. BMJ Open Ophthalmol 2023; 8:e001253. [PMID: 37278413 PMCID: PMC10230992 DOI: 10.1136/bmjophth-2023-001253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/18/2023] [Indexed: 06/07/2023] Open
Abstract
OBJECTIVE In this study, we investigated the demographic trends of patients undergoing ophthalmic surgeries based on geographic region, priority level, and sex. METHODS AND ANALYSIS This population-based retrospective cohort study used the Ontario Health Wait Times Information System (WTIS) database from 2010 to 2021. The WTIS contains non-emergent surgical case volume and wait time data for 14 different regions, three priority levels (high, medium and low) and six ophthalmic subspecialty procedures. RESULTS Over the study period, on average 83 783 women and 65 555 men underwent ophthalmic surgery annually in Ontario. Overall, women waited an aggregate mean of 4.9 days longer than men to undergo surgery, and this disparity persisted across all geographic and priority stratifications. The average age at the time of surgery has been increasing slowly at a rate of 0.02 years/year (95% CI 0.00 to 0.05), with women being 0.6 years older than men overall. CONCLUSION These findings indicate that women have consistently longer wait times than men. The results of this study may be a sign of systemic sex-based differences that could be affecting women who need to be further explored for health equity.
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Affiliation(s)
- Michael Balas
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Diana Vasiliu
- Health System Intelligence Team, Health System Performance & Support Portfolio, Ontario Health, Toronto, Ontario, Canada
| | - Gener Austria
- Health System Intelligence Team, Health System Performance & Support Portfolio, Ontario Health, Toronto, Ontario, Canada
| | - Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- The Institute of Health Policy Management and Evaluation (IHPME), University of Toronto, Ontario, Canada, Canada
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21
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Lytvyn Y, Felfeli T, Dubrofsky L, Dharia A, Lee JF, Sutakovic O, Nash C, Oliver T, Ong SW, Udell JA, Farkouh ME, Lawler PR, Weisman A, Lovshin JA, Cherney DZ, Brent MH. Diabetic retinopathy screening integrated in a multidisciplinary diabetes care clinic: a pilot project of cardiac and renal endocrine clinic. Canadian Journal of Ophthalmology 2023:S0008-4182(23)00067-4. [PMID: 37023796 DOI: 10.1016/j.jcjo.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 02/07/2023] [Accepted: 02/26/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVE To characterize patients referred for diabetic retinopathy (DR) screening in a unique multidisciplinary diabetes care clinic at a tertiary care centre. METHODS 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; and visual acuity, intraocular pressure, fundus imaging, and optical coherence tomography results were collected and analyzed. RESULTS 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. CONCLUSIONS 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.
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22
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Felfeli T, Murtaza F, Herman J, Pereira AM, Mandelcorn MS, Mandelcorn ED. Anatomical and functional outcomes of short-term DensironXTRA heavy silicone oil for rhegmatogenous retinal detachments: a comparative case series. Sci Rep 2023; 13:3729. [PMID: 36878935 PMCID: PMC9988839 DOI: 10.1038/s41598-023-30210-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 02/17/2023] [Indexed: 03/08/2023] Open
Abstract
To assess the safety and efficacy of short-term DensironXTRA tamponade for repair of complicated rhegmatogenous retinal detachments (RRD). This is a retrospective consecutive case series of patients undergoing pars plana vitrectomy (PPV) with intravitreal DensironXTRA and a comparator group with gas (sulfur hexafluoride (SF6) or perfluoropropane (C3F8)) tamponades by a single surgeon between January 2017 and November 2020 at a tertiary care centre. A total of 121 eyes with DensironXTRA and 81 comparator eyes with a gas tamponade were included. The DensironXTRA group had a significantly higher number of cases with inferior breaks (82% vs. 48%; p < 0.0001) and a history of previous PPV for RRD (64% vs. 12%; p < 0.0001). DensironXTRA was removed after a median period of 70 (IQR: 48.5-105.5) days. There was similar anatomical success in both the comparator gas tamponade and DensironXTRA groups (98.8% vs. 97.5%, p = 0.6506). Although both groups experienced a significant improvement in visual acuity, this change was significantly higher in the comparator gas tamponade group versus DensironXTRA group (p = 0.0017). There was no significant change in IOP in the DensironXTRA group (mean difference - 0.7; 95% CI - 1.753 to 0.331, p = 0.1785). The rates of complications were low and not significantly different between the two groups. There was no evidence for central macular thinning with DensironXTRA compared to the contralateral eye without RRD as well as with DensironXTRA in situ versus after its removal. DensironXTRA is a promising short-term tamponade agent with good anatomical and functional outcomes and low rates of complications for the repair of complicated RRDs.
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Affiliation(s)
- Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada. .,Management and Evaluation (IHPME), Dalla Lana School of Public Health, The Institute of Health Policy, University of Toronto, Toronto, ON, Canada. .,Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital, Eaton Building, 10th Floor, Toronto, ON, M5G 2C4, Canada.
| | - Fahmeeda Murtaza
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Joshua Herman
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Austin M Pereira
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Mark S Mandelcorn
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada.,Department of Ophthalmology, Toronto Western Hospital, University Health Network, 6E-432, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada
| | - Efrem D Mandelcorn
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada. .,Department of Ophthalmology, Toronto Western Hospital, University Health Network, 6E-432, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada.
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23
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Felfeli T, Miranda RN, Kaur J, Chan CC, Naimark DMJ. Cost-Effectiveness of Preoperative Topical Antibiotic Prophylaxis for Endophthalmitis Following Cataract Surgery. Am J Ophthalmol 2023; 247:152-160. [PMID: 36375588 DOI: 10.1016/j.ajo.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE To determine the cost-effectiveness of preoperative topical antibiotic prophylaxis for the prevention of endophthalmitis following cataract surgery. DESIGN Cost-effectiveness analysis using a decision-analytic microsimulation model. METHODS Preoperative topical antibiotic prophylaxis vs no-prophylaxis costs and effects were projected over a life-time horizon for a simulated cohort of 500 000 adult patients (≥18 years old) requiring cataract surgery in theoretical surgical centers in the United States. Efficacy and cost (2021 US dollars) values were obtained from the literature and discounted at 3% per year. RESULTS Based on inputted parameters, the mean incidence of endophthalmitis following cataract surgery for preoperative topical antibiotic prophylaxis vs no-prophylaxis was 0.034% (95% CI 0%-0.2%) and 0.042% (95% CI 0%-0.3%), respectively-an absolute risk reduction of 0.008%. The mean life-time costs for cataract surgery with prophylaxis and no-prophylaxis were $2486.67 (95% CI $2193.61-$2802.44) and $2409.03 (95% CI $2129.94-$2706.69), respectively. The quality-adjusted life-years (QALYs) associated with prophylaxis and no-prophylaxis were 10.33495 (95% CI 7.81629-12.38158) and 10.33498 (95% CI 7.81284-12.38316), respectively. Assuming a cost-effectiveness criterion of ≤$50 000 per QALY gained, the threshold analyses indicated that prophylaxis would be cost-effective if the incidence of endophthalmitis after cataract surgery was greater than 5.5% or if the price of the preoperative topical antibiotic prophylaxis was less than $0.75. CONCLUSIONS General use of preoperative topical antibiotic prophylaxis is not cost-effective compared with no-prophylaxis for the prevention of endophthalmitis following cataract surgery. Preoperative topical antibiotic prophylaxis, however, would be cost-effective at a higher incidence of endophthalmitis and/or a substantially lower price for prophylaxis.
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Affiliation(s)
- Tina Felfeli
- From the Department of Ophthalmology and Vision Sciences, University of Toronto (T.F., C.C.C.); Institute of Health Policy, Management and Evaluation, University of Toronto (T.F., R.N.M., D.M.J.N.); Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network (T.F., R.N.M., D.M.J.N.).
| | - Rafael N Miranda
- Institute of Health Policy, Management and Evaluation, University of Toronto (T.F., R.N.M., D.M.J.N.); Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network (T.F., R.N.M., D.M.J.N.)
| | | | - Clara C Chan
- From the Department of Ophthalmology and Vision Sciences, University of Toronto (T.F., C.C.C.); Department of Ophthalmology, Toronto Western Hospital, University Health Network (C.C.C.)
| | - David M J Naimark
- Institute of Health Policy, Management and Evaluation, University of Toronto (T.F., R.N.M., D.M.J.N.); Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network (T.F., R.N.M., D.M.J.N.); and Department of Medicine, Sunnybrook Health Sciences Centre (D.M.J.N.), Ontario, Canada
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24
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Park J, Felfeli T, Kherani IZ, Altomare F, Chow DR, Wong DT. Prevalence and clinical implications of subretinal fluid in retinal diseases: a real-world cohort study. BMJ Open Ophthalmol 2023; 8:bmjophth-2022-001214. [PMID: 37039095 PMCID: PMC9945046 DOI: 10.1136/bmjophth-2022-001214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/15/2023] [Indexed: 02/23/2023] Open
Abstract
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.
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Affiliation(s)
- Jeff Park
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tina Felfeli
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Imaan Z Kherani
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Filiberto Altomare
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, St Michael's Hospital, Toronto, Ontario, Canada
| | - David R Chow
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, St Michael's Hospital, Toronto, Ontario, Canada
| | - David T Wong
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, St Michael's Hospital, Toronto, Ontario, Canada
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25
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Felfeli T, Weisbrod DJ, Cao J, Cao KY, El-Defrawy SR, Chiu HH. University of Toronto's redesigned ophthalmology curriculum and eye dissection lab. Can J Ophthalmol 2022; 57:394-401. [PMID: 34303638 DOI: 10.1016/j.jcjo.2021.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/16/2021] [Accepted: 06/23/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVE 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. DESIGN Curriculum review, validation, and student feedback evaluations. PARTICIPANTS Year 2 medical students enrolled in the University of Toronto's Doctor of Medicine Program. METHODS 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. RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
- Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.; Dalla Lana School of Public Health, University of Toronto, Toronto, Ont..
| | - Daniel J Weisbrod
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.; Department of Ophthalmology, Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Jessica Cao
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont
| | - Kathy Y Cao
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.; Department of Ophthalmology, Kensington Eye Institute, Toronto, Ont.; Department of Ophthalmology, Mount Sinai Hospital, Toronto, Ont
| | - Sherif R El-Defrawy
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.; Department of Ophthalmology, Kensington Eye Institute, Toronto, Ont
| | - Hannah H Chiu
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.; William Osler Health System, Brampton, Ont.; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Toronto, Ont..
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Pimentel MC, Felfeli T, Mandelcorn E. Comments on "Scleral Transillumination With Digital Heads-Up Display: A Novel Technique for Visualization During Vitrectomy Surgery". Ophthalmic Surg Lasers Imaging Retina 2022; 53:718-719. [PMID: 36547958 DOI: 10.3928/23258160-20220920-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Felfeli T, Balas M, Austria G, Menalo R, Vasiliu D, Zanchetta C. Regional trends in ophthalmic surgical wait times in Ontario, Canada. Canadian Journal of Ophthalmology 2022; 58:e104-e106. [PMID: 36356651 DOI: 10.1016/j.jcjo.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/27/2022] [Accepted: 10/15/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, ON.
| | - Michael Balas
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON
| | - Gener Austria
- Access to Care Program, Health System Performance and Support Portfolio, Ontario Health, Toronto, ON
| | - Reeza Menalo
- Access to Care Program, Health System Performance and Support Portfolio, Ontario Health, Toronto, ON
| | - Diana Vasiliu
- Access to Care Program, Health System Performance and Support Portfolio, Ontario Health, Toronto, ON
| | - Claudia Zanchetta
- Access to Care Program, Health System Performance and Support Portfolio, Ontario Health, Toronto, ON
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28
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Monson H, Demaine J, Banfield L, Felfeli T. Three-year trends in literature on artificial intelligence in ophthalmology and vision sciences: a protocol for bibliometric analysis. BMJ Health Care Inform 2022; 29:bmjhci-2022-100594. [PMID: 36202424 PMCID: PMC9540841 DOI: 10.1136/bmjhci-2022-100594] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/14/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The aim of this study is to provide an insight into the literature at the intersection of artificial intelligence and ophthalmology. METHODS AND ANALYSIS The project will be performed in four key stages: formulation of search terms, literature collection, literature screening and literature analysis. A comprehensive search of databases including Scopus, Web of Science, Dimensions and Cochrane will be conducted. The Distiller SR software will be used for manual screening all relevant articles. The selected articles will be analysed via R Bibliometrix, a program for mathematical analysis of large sets of literature, and VOSviewer, which creates visual representations of connections between articles. ETHICS AND DISSEMINATION This study did not require research ethics approval given the use of publicly available data and lack of human subjects. The results will be presented at scientific meetings and published in peer-reviewed journals.
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Affiliation(s)
- Hayley Monson
- Department of Mathematics and Statistics, McMaster University, Hamilton, Ontario, Canada
| | - Jeff Demaine
- Library Department, McMaster University, Hamilton, Ontario, Canada
| | - Laura Banfield
- Library Department, McMaster University, Hamilton, Ontario, Canada
| | - Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada,The Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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29
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Park J, Xue Y, Lim M, Tretiakov N, Felfeli T. Representation of women in ophthalmology journal editorial boards. BMJ Open Ophthalmol 2022; 7:bmjophth-2022-001127. [PMID: 36318698 PMCID: PMC9535156 DOI: 10.1136/bmjophth-2022-001127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jeff Park
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Yuanxin Xue
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michelle Lim
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nikol Tretiakov
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada,The Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Felfeli T, Georgakopoulos JR, Jo CE, Mimouni M, Piguet V, Drucker AM, Yeung J, Chan CC. Prevalence and Characteristics of Dupilumab-Induced Ocular Surface Disease in Adults With Atopic Dermatitis. Cornea 2022; 41:1242-1247. [PMID: 34843182 DOI: 10.1097/ico.0000000000002866] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 07/16/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Dupilumab-induced ocular surface disease (DIOSD) is a common reaction among patients treated for atopic dermatitis. This study aimed to identify the clinical characteristics, associated risk factors, treatment strategies, and long-term outcomes of DIOSD. METHODS We conducted a multicenter retrospective cohort study of consecutive adult outpatients treated with dupilumab for moderate-to-severe atopic dermatitis from 2017 through 2021 at 2 tertiary care centers. We used stepwise multivariable logistic regression to assess the association between patient characteristics and development of DIOSD. RESULTS Among 210 patients treated with dupilumab, 37% (n = 78) developed DIOSD over the 52-week follow-up period. Vision-threatening complications including corneal scarring and cicatricial ectropion were noted in 1% (n = 3) of patients. Clinical features were blepharoconjunctivitis (68%, n = 53), burning/stinging/dryness (14%, n = 29), epiphora (13%, n = 10), pruritus (13%, n = 10), blurred vision (3%, n = 2), and photophobia (1%, n = 1). DIOSD was associated with a history of asthma (odds ratio: 2.94, 95% confidence interval: 1.26-6.87, P = 0.01) and a family history of atopic dermatitis (odds ratio: 2.58, 95% confidence interval: 1.08-6.17, P = 0.03). Interventions were initiated for 63% of patients with DIOSD, with artificial tears (56%) and corticosteroid drops (29%) most commonly used. Dupilumab was discontinued because of DIOSD in 4% of patients. CONCLUSIONS DIOSD is a common adverse event that is usually mild but may lead to treatment interruption and vision-threatening complications. A personal history of asthma and family history of atopic dermatitis may be associated with a higher risk of developing DIOSD.
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Affiliation(s)
- Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, ON, Canada
| | | | - Christine E Jo
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Michael Mimouni
- Department of Ophthalmology, Toronto Western Hospital, University Health Network, ON, Canada
| | - Vincent Piguet
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
- Division of Dermatology, Department of Medicine, and Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Aaron M Drucker
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, ON, Canada
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
- Division of Dermatology, Department of Medicine, and Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Jensen Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
- Division of Dermatology, Department of Medicine, and Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Probity Medical Research Inc., Waterloo, ON, Canada; and
| | - Clara C Chan
- Department of Ophthalmology and Vision Sciences, University of Toronto, ON, Canada
- Department of Ophthalmology, Toronto Western Hospital, University Health Network, ON, Canada
- Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, ON, Canada
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Georgakopoulos JR, Felfeli T, Canizares M, Jin YP, Joseph M, Yeung J, Buys YM. Differences in Practice Patterns and Payments for Female and Male Dermatologists: A Canadian Population-Based Study Over 3 Decades. J Cutan Med Surg 2022; 26:575-585. [PMID: 36065083 DOI: 10.1177/12034754221119500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Canada's fee-for-service physician reimbursement system, where a set rate is provided for each service, suggests that a physician sex pay gap should not exist. However, recent evidence has questioned this presumption. OBJECTIVES To characterize trends in demographics and billing, overall and by sex, for dermatologists compared to other medical and surgical specialty groups in Ontario, Canada. METHODS Using population-based data, analysis of physician billing and clinical activity from Ontario, Canada, over 27 years (1992-2018) was performed. Multilevel regression models were used to examine unadjusted and adjusted differences in payments between females and males over time, while controlling for age, distinct patients seen, patient visits, and full-time equivalent. RESULTS A total of 22 389 physicians were included in the analyses, including 381 dermatologists. The proportion of female dermatologists increased from 32% in 1992 to 46% in 2018. Dermatologists' median Ontario Health Insurance Plan (OHIP) payments were $415 340 (IQR: 285 630-566 580) in 1992 compared to $296 750 (IQR: 164 480-493 180) in 2018. Male dermatologists' OHIP payments were 20% more than their female counterparts across the entire study period. After adjusting for practice volumes, there was no significant pay gap amongst female and male dermatologists (P = .42); however, the sex pay gap remained significant for the other specialty groups (P < .001). From 1992 to 2018, dermatologists on average saw 19% fewer distinct patients per year and 15% fewer visits per patient. CONCLUSIONS The overall sex pay gap within medical dermatology can be attributed to differences in practice patterns, whereas the sex pay gap remained significant in the other specialty groups.
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Affiliation(s)
- Jorge R Georgakopoulos
- 7938 Division of Dermatology, Department of Medicine, University of Toronto, Ontario, Canada
| | - Tina Felfeli
- 7938 Department of Ophthalmology and Vision Sciences, University of Toronto, Ontario, Canada.,7938 Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Mayilee Canizares
- 7989 Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, University Health Network, Ontario, Canada
| | - Ya-Ping Jin
- 7938 Department of Ophthalmology and Vision Sciences, University of Toronto, Ontario, Canada.,7938 Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Marissa Joseph
- 7938 Division of Dermatology, Department of Medicine, University of Toronto, Ontario, Canada.,7938 Women's College Hospital, Toronto, Ontario, Canada
| | - Jensen Yeung
- 7938 Division of Dermatology, Department of Medicine, University of Toronto, Ontario, Canada.,7938 Women's College Hospital, Toronto, Ontario, Canada.,7938 Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Yvonne M Buys
- 7938 Department of Ophthalmology and Vision Sciences, University of Toronto, Ontario, Canada
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Pucchio A, Krance SH, Pur DR, Miranda RN, Felfeli T. Artificial Intelligence Analysis of Biofluid Markers in Age-Related Macular Degeneration: A Systematic Review. Clin Ophthalmol 2022; 16:2463-2476. [PMID: 35968055 PMCID: PMC9369085 DOI: 10.2147/opth.s377262] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/26/2022] [Indexed: 11/23/2022] Open
Abstract
This systematic review explores the use of artificial intelligence (AI) in the analysis of biofluid markers in age-related macular degeneration (AMD). We detail the accuracy and validity of AI in diagnostic and prognostic models and biofluid markers that provide insight into AMD pathogenesis and progression. This review was conducted in accordance with the Preferred Reporting Items for a Systematic Review and Meta-analysis guidelines. A comprehensive search was conducted across 5 electronic databases including Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, EMBASE, Medline, and Web of Science from inception to July 14, 2021. Studies pertaining to biofluid marker analysis using AI or bioinformatics in AMD were included. Identified studies were assessed for risk of bias and critically appraised using the Joanna Briggs Institute Critical Appraisal tools. A total of 10,264 articles were retrieved from all databases and 37 studies met the inclusion criteria, including 15 cross-sectional studies, 15 prospective cohort studies, five retrospective cohort studies, one randomized controlled trial, and one case–control study. The majority of studies had a general focus on AMD (58%), while neovascular AMD (nAMD) was the focus in 11 studies (30%), and geographic atrophy (GA) was highlighted by three studies. Fifteen studies examined disease characteristics, 15 studied risk factors, and seven guided treatment decisions. Altered lipid metabolism (HDL-cholesterol, total serum triglycerides), inflammation (c-reactive protein), oxidative stress, and protein digestion were implicated in AMD development and progression. AI tools were able to both accurately differentiate controls and AMD patients with accuracies as high as 87% and predict responsiveness to anti-VEGF therapy in nAMD patients. Use of AI models such as discriminant analysis could inform prognostic and diagnostic decision-making in a clinical setting. The identified pathways provide opportunity for future studies of AMD development and could be valuable in the advancement of novel treatments.
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Affiliation(s)
- Aidan Pucchio
- School of Medicine, Queen’s University, Kingston, ON, Canada
| | - Saffire H Krance
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Daiana R Pur
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Rafael N Miranda
- Toronto Health Economics and Technology Assessment Collaborative, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Tina Felfeli
- Toronto Health Economics and Technology Assessment Collaborative, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
- Correspondence: Tina Felfeli, Department of Ophthalmology and Vision Sciences, University of Toronto, 340 College Street, Suite 400, Toronto, ON, M5T 3A9, Canada, Fax +416-978-4590, Email
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Bassi A, Krance SH, Pucchio A, Pur DR, Miranda RN, Felfeli T. The Application of Artificial Intelligence in the Analysis of Biomarkers for Diagnosis and Management of Uveitis and Uveal Melanoma: A Systematic Review. Clin Ophthalmol 2022; 16:2895-2908. [PMID: 36065357 PMCID: PMC9440710 DOI: 10.2147/opth.s377358] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/16/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aims to identify the available literature describing the utilization of artificial intelligence (AI) as a clinical tool in uveal diseases. Methods A comprehensive literature search was conducted in 5 electronic databases, finding studies relating to AI and uveal diseases. Results After screening 10,258 studies,18 studies met the inclusion criteria. Uveal melanoma (44%) and uveitis (56%) were the two uveal diseases examined. Ten studies (56%) used complex AI, while 13 studies (72%) used regression methods. Lactate dehydrogenase (LDH), found in 50% of studies concerning uveal melanoma, was the only biomarker that overlapped in multiple studies. However, 94% of studies highlighted that the biomarkers of interest were significant. Conclusion This study highlights the value of using complex and simple AI tools as a clinical tool in uveal diseases. Particularly, complex AI methods can be used to weigh the merit of significant biomarkers, such as LDH, in order to create staging tools and predict treatment outcomes.
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Affiliation(s)
- Arshpreet Bassi
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Saffire H Krance
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Aidan Pucchio
- School of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Daiana R Pur
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Rafael N Miranda
- Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada
- The Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Tina Felfeli
- Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada
- The Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Ontario, Canada
- Correspondence: Tina Felfeli, Department of Ophthalmology and Visual Sciences, University of Toronto, 340 College Street, Suite 400, Toronto, ON M5T 3A9, Canada, Fax +416-978-4590, Email
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Cao J, Chang-Kit B, Katsnelson G, Far PM, Uleryk E, Ogunbameru A, Miranda RN, Felfeli T. Protocol for a systematic review and meta-analysis of the diagnostic accuracy of artificial intelligence for grading of ophthalmology imaging modalities. Diagn Progn Res 2022; 6:15. [PMID: 35831880 PMCID: PMC9281030 DOI: 10.1186/s41512-022-00127-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 05/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With the rise of artificial intelligence (AI) in ophthalmology, the need to define its diagnostic accuracy is increasingly important. The review aims to elucidate the diagnostic accuracy of AI algorithms in screening for all ophthalmic conditions in patient care settings that involve digital imaging modalities, using the reference standard of human graders. METHODS This is a systematic review and meta-analysis. A literature search will be conducted on Ovid MEDLINE, Ovid EMBASE, and Wiley Cochrane CENTRAL from January 1, 2000, to December 20, 2021. Studies will be selected via screening the titles and abstracts, followed by full-text screening. Articles that compare the results of AI-graded ophthalmic images with results from human graders as a reference standard will be included; articles that do not will be excluded. The systematic review software DistillerSR will be used to automate part of the screening process as an adjunct to human reviewers. After the full-text screening, data will be extracted from each study via the categories of study characteristics, patient information, AI methods, intervention, and outcomes. Risk of bias will be scored using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) by two trained independent reviewers. Disagreements at any step will be addressed by a third adjudicator. The study results will include summary receiver operating characteristic (sROC) curve plots as well as pooled sensitivity and specificity of artificial intelligence for detection of any ophthalmic conditions based on imaging modalities compared to the reference standard. Statistics will be calculated in the R statistical software. DISCUSSION This study will provide novel insights into the diagnostic accuracy of AI in new domains of ophthalmology that have not been previously studied. The protocol also outlines the use of an AI-based software to assist in article screening, which may serve as a reference for improving the efficiency and accuracy of future large systematic reviews. TRIAL REGISTRATION PROSPERO, CRD42021274441.
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Affiliation(s)
- Jessica Cao
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | | | - Glen Katsnelson
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Adeteju Ogunbameru
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- THETA Collaborative, Toronto General Hospital, University Health Network, Eaton Building, 10th Floor, 200 Elizabeth Street, Toronto, Ontario, ON M5G, Canada
| | - Rafael N Miranda
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- THETA Collaborative, Toronto General Hospital, University Health Network, Eaton Building, 10th Floor, 200 Elizabeth Street, Toronto, Ontario, ON M5G, Canada
| | - Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
- THETA Collaborative, Toronto General Hospital, University Health Network, Eaton Building, 10th Floor, 200 Elizabeth Street, Toronto, Ontario, ON M5G, Canada.
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Abstract
INTRODUCTION There is a notable under-representation of women in leadership positions in ophthalmology despite the increasing number of women as ophthalmologists. Gender inequality in editorial boards of ophthalmology journals has not been investigated on a global scale. This study will aim to evaluate the representation of women as editorial board members in ophthalmology journals across different regions, journal subspecialties and impact factors. METHODS AND ANALYSIS This will be a cross-sectional study describing the gender composition of editorial boards in ophthalmology journals globally. Ulrich's Periodicals Directory and SCImago Journal & Country Rank will be used to comprehensively identify journals indexed with the keyword, 'ophthalmology'. All journals with active websites and lists of editorial boards will be included. Journals will be categorised according to the World Bank's 2021 classification of countries by income and region, and classified into ophthalmology subspecialties based on publication scope. Impact factors will be obtained from Journal Citation Reports. The gender and academic degrees of each editorial board member will be determined based on journal profiles, institutional websites or name query feature on an online interface. The research impact of each editorial board member will be ascertained from the author records on Web of Science. The gender proportion will be presented for all journals combined, and then for journals grouped by regions, subspecialties and impact factors. Editorial board member characteristics including academic degrees and research productivity measures will be compared between men and women. These comparisons will be made using the χ2 test for categorical variables and the independent samples t-test for continuous variables. ETHICS AND DISSEMINATION This study did not require research ethics approval given the use of publicly available data and lack of human subjects. The results will be presented at scientific meetings and published in peer-reviewed journals.
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Affiliation(s)
- Jeff Park
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Yuanxin Xue
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Ryan Xue
- Dr. Norman Bethune Collegiate Institute, Scarborough, Ontario, Canada
| | - Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- The Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Mehraban Far P, Tai F, Ogunbameru A, Pechlivanoglou P, Sander B, Wong DT, Brent MH, Felfeli T. Diagnostic accuracy of teleretinal screening for detection of diabetic retinopathy and age-related macular degeneration: a systematic review and meta-analysis. BMJ Open Ophthalmol 2022; 7:e000915. [PMID: 35237724 PMCID: PMC8845326 DOI: 10.1136/bmjophth-2021-000915] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/07/2022] [Indexed: 11/20/2022] Open
Abstract
Objective To evaluate the diagnostic accuracy of teleretinal screening compared with face-to-face examination for detection of diabetic retinopathy (DR) and age-related macular degeneration (AMD). Methods and analysis This study adhered to the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA). A comprehensive search of OVID MEDLINE, EMBASE and Cochrane CENTRAL was performed from January 2010 to July 2021. QUADAS-2 tool was used to assess methodological quality and applicability of the studies. A bivariate random effects model was used to perform the meta-analysis. Referrable DR was defined as any disease severity equal to or worse than moderate non-proliferative DR or diabetic macular oedema (DMO). Results 28 articles were included. Teleretinal screening achieved a sensitivity of 0.91 (95% CI: 0.82 to 0.96) and specificity of 0.88 (0.74 to 0.95) for any DR (13 studies, n=7207, Grading of Recommendations, Assessment, Development and Evaluation (GRADE) low). Accuracy for referrable DR (10 studies, n=6373, GRADE moderate) was lower with a sensitivity of 0.88 (0.81 to 0.93) and specificity of 0.86 (0.79 to 0.90). After exclusion of ungradable images, the specificity for referrable DR increased to 0.95 (0.90 to 0.98), while the sensitivity remained nearly unchanged at 0.85 (0.76 to 0.91). Teleretinal screening achieved a sensitivity of 0.71 (0.49 to 0.86) and specificity of 0.88 (0.85 to 0.90) for detection of AMD (three studies, n=697, GRADE low). Conclusion Teleretinal screening is highly accurate for detecting any DR and DR warranting referral. Data for AMD screening is promising but warrants further investigation. PROSPERO registration number CRD42020191994.
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Affiliation(s)
- Parsa Mehraban Far
- Department of Ophthalmology, Queen's University, Kingston, Ontario, Canada
| | - Felicia Tai
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Adeteju Ogunbameru
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Petros Pechlivanoglou
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Beate Sander
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - David T Wong
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, St. Michael's Hospital, Toronto Unity Health, Toronto, Toronto, Ontario, Canada
| | - Michael H Brent
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Retina Service, Donald K Johnson Eye Institute, University Health Network, Toronto, Ontario, Canada
| | - Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Felfeli T, Austria G, Menalo R, El-Defrawy SR, Vasiliu D, Zanchetta C, Sander B. Temporal trends in ophthalmic surgical demand in a universal healthcare system: an Ontario population-based study of over two decades. BMJ Open Ophthalmol 2022; 7:e000937. [PMID: 35141421 PMCID: PMC8819778 DOI: 10.1136/bmjophth-2021-000937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bansal A, Lee WW, Felfeli T, Muni RH. Physiology of retinal reattachment in humans: Swept source optical coherence tomography imaging data supporting a novel staging system. Data Brief 2021; 39:107539. [PMID: 34825022 PMCID: PMC8605174 DOI: 10.1016/j.dib.2021.107539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/17/2021] [Accepted: 10/28/2021] [Indexed: 11/26/2022] Open
Abstract
This article presents high-resolution swept source optical coherence tomography (SS-OCT) imaging data used to describe the physiology of retinal reattachment in humans. SS-OCT imaging was performed at baseline and every 2 h for the first 6 h and at frequent intervals thereafter up to 6 weeks following the injection of intravitreal gas in eyes undergoing pneumatic retinopexy for rhegmatogenous retinal detachment. Imaging data presented in this article is related to the research paper titled “Real-Time in Vivo Assessment of Retinal Reattachment in Humans using Swept-Source Optical Coherence Tomography” (Bansal et al., 2021). SS-OCT images were assessed longitudinally and used to devise a novel staging system that describes the physiology of retinal reattachment. Multiple examples of each stage and the transition from one stage to the next are provided. SS-OCT images were also assessed to determine the timing associated with each stage, and the anatomic abnormalities, such as outer retinal folds and subretinal fluid blebs that occured as a result of delayed progression through certain stages.
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Affiliation(s)
- Aditya Bansal
- Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, 8th floor, Donnelly Wing, 30 Bond St. Toronto Ontario M5B 1W8, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Wei Wei Lee
- Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, 8th floor, Donnelly Wing, 30 Bond St. Toronto Ontario M5B 1W8, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Tina Felfeli
- Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, 8th floor, Donnelly Wing, 30 Bond St. Toronto Ontario M5B 1W8, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Canada
| | - Rajeev H. Muni
- Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, 8th floor, Donnelly Wing, 30 Bond St. Toronto Ontario M5B 1W8, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
- Kensington Vision and Research Centre, University of Toronto, Canada
- Keenan Research Centre for Biomedical Science/ Li Ka Shing Knowledge Institute, Toronto, Canada
- Corresponding author at: Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, 8th floor, Donnelly Wing, 30 Bond St. Toronto Ontario M5B 1W8, Canada. @RaHMu123
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Arjmand P, Felfeli T, Mandelcorn ED, Mandelcorn MS. Long-Term Safety and Efficacy of Siluron2000 with Pars Plana Vitrectomy in the Treatment of Patients with Severe Vitreoretinopathy and Chronic Macular Holes. Clin Ophthalmol 2021; 15:4373-4379. [PMID: 34754177 PMCID: PMC8572115 DOI: 10.2147/opth.s338269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/15/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE 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. PATIENTS AND METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Parnian Arjmand
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- The Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Efrem D Mandelcorn
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mark S Mandelcorn
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Tai F, Mehraban Far P, Pechlivanoglou P, Ramsay LC, Georgakopoulos JR, Sander B, Derzko-Dzulynsky LA, Felfeli T. Efficacy and Safety of Adalimumab and Infliximab for Noninfectious Uveitis. Ophthalmology 2021; 129:357-359. [PMID: 34634363 DOI: 10.1016/j.ophtha.2021.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/23/2021] [Accepted: 09/28/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Felicia Tai
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Parsa Mehraban Far
- Department of Ophthalmology, Kingston Health Sciences Center, Queen's University, Kingston, Canada
| | - Petros Pechlivanoglou
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Canada; Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Lauren C Ramsay
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | | | - Beate Sander
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Public Health Ontario, Toronto, Canada; ICES, Toronto, Canada
| | - Larissa A Derzko-Dzulynsky
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; Department of Ophthalmology, St. Joseph's Health Centre, Unity Health Toronto, Toronto, Canada; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Tina Felfeli
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada.
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Felfeli T, Ximenes R, Naimark DMJ, Hooper PL, Campbell RJ, El-Defrawy SR, Sander B. The ophthalmic surgical backlog associated with the COVID-19 pandemic: a population-based and microsimulation modelling study. CMAJ Open 2021; 9:E1063-E1072. [PMID: 34815262 PMCID: PMC8612655 DOI: 10.9778/cmajo.20210145] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Jurisdictions worldwide ramped down ophthalmic surgeries to mitigate the effects of COVID-19, creating a global surgical backlog. We sought to predict the long-term impact of COVID-19 on the timely delivery of non-emergent ophthalmology sub-specialty surgical care in Ontario. METHODS This is a microsimulation modelling study. We used provincial population-based administrative data from the Wait Time Information System database in Ontario for January 2019 to May 2021 and facility-level data for March 2018 to May 2021 to estimate the backlog size and wait times associated with the COVID-19 pandemic. For the postpandemic recovery phase, we estimated the resources required to clear the backlog of patients accumulated on the wait-list during the pandemic. Outcomes were accrued over a time horizon of 3 years. RESULTS A total of 56 923 patients were on the wait-list in the province of Ontario awaiting non-emergency ophthalmic surgery as of Mar. 15, 2020. The number of non-emergency surgeries performed in the province decreased by 97% in May 2020 and by 80% in May 2021 compared with the same months in 2019. By 2 years and 3 years since the start of the pandemic, the overall estimated number of patients awaiting surgery grew by 129% and 150%, respectively. The estimated mean wait time for patients for all subspecialty surgeries increased to 282 (standard deviation [SD] 91) days in March 2023 compared with 94 (SD 97) days in 2019. The provincial monthly additional resources required to clear the backlog by March 2023 was estimated to be a 34% escalation from the prepandemic volumes (4626 additional surgeries). INTERPRETATION The estimates from this microsimulation modelling study suggest that the magnitude of the ophthalmic surgical backlog from the COVID-19 pandemic has important implications for the recovery phase. This model can be adapted to other jurisdictions to assist with recovery planning for vision-saving surgeries.
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Affiliation(s)
- Tina Felfeli
- Department of Ophthalmology and Vision Sciences (Felfeli), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Ximenes), University Health Network; Sunnybrook Health Sciences Centre (Naimark), Toronto, Ont.; Ivey Eye Institute (Hooper), Western University, London, Ont.; Department of Ophthalmology (Campbell), Queen's University, Kingston, Ont.; Kensington Vision and Research Centre (El-Defrawy), Kensington Eye Institute, and Institute of Health Policy, Management and Evaluation (Sander), University of Toronto, Toronto, Ont.
| | - Raphael Ximenes
- Department of Ophthalmology and Vision Sciences (Felfeli), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Ximenes), University Health Network; Sunnybrook Health Sciences Centre (Naimark), Toronto, Ont.; Ivey Eye Institute (Hooper), Western University, London, Ont.; Department of Ophthalmology (Campbell), Queen's University, Kingston, Ont.; Kensington Vision and Research Centre (El-Defrawy), Kensington Eye Institute, and Institute of Health Policy, Management and Evaluation (Sander), University of Toronto, Toronto, Ont
| | - David M J Naimark
- Department of Ophthalmology and Vision Sciences (Felfeli), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Ximenes), University Health Network; Sunnybrook Health Sciences Centre (Naimark), Toronto, Ont.; Ivey Eye Institute (Hooper), Western University, London, Ont.; Department of Ophthalmology (Campbell), Queen's University, Kingston, Ont.; Kensington Vision and Research Centre (El-Defrawy), Kensington Eye Institute, and Institute of Health Policy, Management and Evaluation (Sander), University of Toronto, Toronto, Ont
| | - Philip L Hooper
- Department of Ophthalmology and Vision Sciences (Felfeli), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Ximenes), University Health Network; Sunnybrook Health Sciences Centre (Naimark), Toronto, Ont.; Ivey Eye Institute (Hooper), Western University, London, Ont.; Department of Ophthalmology (Campbell), Queen's University, Kingston, Ont.; Kensington Vision and Research Centre (El-Defrawy), Kensington Eye Institute, and Institute of Health Policy, Management and Evaluation (Sander), University of Toronto, Toronto, Ont
| | - Robert J Campbell
- Department of Ophthalmology and Vision Sciences (Felfeli), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Ximenes), University Health Network; Sunnybrook Health Sciences Centre (Naimark), Toronto, Ont.; Ivey Eye Institute (Hooper), Western University, London, Ont.; Department of Ophthalmology (Campbell), Queen's University, Kingston, Ont.; Kensington Vision and Research Centre (El-Defrawy), Kensington Eye Institute, and Institute of Health Policy, Management and Evaluation (Sander), University of Toronto, Toronto, Ont
| | - Sherif R El-Defrawy
- Department of Ophthalmology and Vision Sciences (Felfeli), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Ximenes), University Health Network; Sunnybrook Health Sciences Centre (Naimark), Toronto, Ont.; Ivey Eye Institute (Hooper), Western University, London, Ont.; Department of Ophthalmology (Campbell), Queen's University, Kingston, Ont.; Kensington Vision and Research Centre (El-Defrawy), Kensington Eye Institute, and Institute of Health Policy, Management and Evaluation (Sander), University of Toronto, Toronto, Ont
| | - Beate Sander
- Department of Ophthalmology and Vision Sciences (Felfeli), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Ximenes), University Health Network; Sunnybrook Health Sciences Centre (Naimark), Toronto, Ont.; Ivey Eye Institute (Hooper), Western University, London, Ont.; Department of Ophthalmology (Campbell), Queen's University, Kingston, Ont.; Kensington Vision and Research Centre (El-Defrawy), Kensington Eye Institute, and Institute of Health Policy, Management and Evaluation (Sander), University of Toronto, Toronto, Ont
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42
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Arjmand P, Felfeli T, Mandelcorn ED. Combined Pars Plana Vitrectomy and Segmental Scleral Buckle for Rhegmatogenous Retinal Detachment with Inferior Retinal Breaks. Clin Ophthalmol 2021; 15:3515-3519. [PMID: 34434043 PMCID: PMC8380623 DOI: 10.2147/opth.s321371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/06/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To describe a variation of the traditional segmental scleral buckle (SB) without an encircling band combined with 23-gauge pars plana vitrectomy (PPV) for the management of rhegmatogenous retinal detachment (RRD) with inferior retinal breaks. Patients and Methods This is a single-center, retrospective, consecutive review of all RRDs with inferior retinal breaks that were treated with PPV and segmental SB without an encircling band between May 2019 and February 2020. Results A total of 12 eyes of 12 patients were included in the study. All patients had at least 1 inferior retinal break and more than 2 clock hours of retinal detachment. Eight eyes had RRD with macular involvement at presentation. Seven eyes had a persistent RRD following previous pneumatic retinopexy (C3F8). All eyes were treated by PPV combined with a segmental #510 sponge without an encircling band. Surgery anatomical success was 100%. Mean logMAR visual acuity was 1 (SD 0.6; 20/160) and 0.5 (SD 0.4; 20/60) at 3 months and last follow-ups, respectively. No scleral buckle-related complications were noted over the 4.1 (SD 0.8) month follow-up period. Conclusion The combined segmental buckling technique is a safe and effective adjunct to PPV in treatment of inferior RRD.
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Affiliation(s)
- Parnian Arjmand
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Efrem D Mandelcorn
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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43
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Buys YM, Canizares M, Felfeli T, Jin YP. Trends in payments among male and female ophthalmologists in Ontario from 1992 to 2018. Can J Ophthalmol 2021; 57:47-57. [PMID: 34450046 DOI: 10.1016/j.jcjo.2021.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine sex differences in Ontario Health Insurance Plan (OHIP) payments from 1992 to 2018. DESIGN Population-based observational study. PARTICIPANTS Ophthalmologists submitting claims to OHIP from 1992 to 2018. METHODS Physician billing data over 27 years (1992-2018) were analyzed for yearly number of ophthalmologists, OHIP payments, distinct patients, and patient visits. RESULTS Yearly median OHIP payments to female ophthalmologists were less than to male ophthalmologists with a gap ratio of 0.55 in 1992 to 0.73 in 2018. Stratifying by full-time equivalent (FTE), there was little difference in median payments between males and females for 1 FTE. Median female-to-male payments ratio varied from 0.80 to 1.16 for <1 FTE and 1.14 to 0.84 for >1 FTE from 1992 to 2018. Among female ophthalmologists, 72.7% and 52.9% were <1 FTE and 11.4% and 19.2% were >1 FTE in 1992 and 2018, respectively. In comparison, for male ophthalmologists, 35.7% and 45.6% were <1 FTE and 43.4% and 45.6% were >1 FTE in 1992 and 2018, respectively. Overall, male ophthalmologists had more patients and patient visits than female ophthalmologists, but there was little difference between male and female ophthalmologists for 1 and >1 FTE. The results for <1 FTE varied by year. CONCLUSIONS Overall, female ophthalmologists have lower OHIP payments compared with males, but there was little difference for those stratified to 1 FTE. This overall payments difference by sex is largely explained by the higher proportion of <1 FTE females, lower proportion of >1 FTE females, and higher payments for >1 FTE males.
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Affiliation(s)
- Yvonne M Buys
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.
| | - Mayilee Canizares
- Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ont
| | - Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont; Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Ya-Ping Jin
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont; Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
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44
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Georgakopoulos JR, Felfeli T, Drucker AM, Jo CE, Piguet V, Yeung J. Two-year efficacy, safety, and drug survival of dupilumab for atopic dermatitis: A real-world Canadian multicenter retrospective study. JAAD Int 2021; 4:67-69. [PMID: 34409396 PMCID: PMC8362263 DOI: 10.1016/j.jdin.2021.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Jorge R Georgakopoulos
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Aaron M Drucker
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Women's College Hospital, Toronto, Ontario, Canada
| | - Christine E Jo
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Vincent Piguet
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Women's College Hospital, Toronto, Ontario, Canada
| | - Jensen Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Women's College Hospital, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Probity Medical Research Inc, Waterloo, Ontario, Canada
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45
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Felfeli T, Canizares M, Jin YP, Buys YM. Pay Gap among Female and Male Ophthalmologists Compared with Other Specialties. Ophthalmology 2021; 129:111-113. [PMID: 34271073 DOI: 10.1016/j.ophtha.2021.06.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; ICES.
| | - Mayilee Canizares
- Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Ya-Ping Jin
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; ICES
| | - Yvonne M Buys
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada.
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46
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Bansal A, Lee WW, Felfeli T, Muni RH. Real-Time In Vivo Assessment of Retinal Reattachment in Humans Using Swept-Source Optical Coherence Tomography. Am J Ophthalmol 2021; 227:265-274. [PMID: 33626363 DOI: 10.1016/j.ajo.2021.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To assess the in vivo physiology of retinal reattachment in humans using swept-source optical coherence tomography (SS-OCT) in real time. DESIGN Prospective case series. METHODS Fifteen consecutive patients with fovea-involving rhegmatogenous retinal detachment were undergoing pneumatic retinopexy. SS-OCT was performed at presentation and frequent intervals immediately after pneumatic retinopexy. The primary outcome was longitudinal assessment of early postoperative SS-OCT to establish stages of reattachment. RESULTS Most patients (93.3%, 14/15) achieved successful reattachment at the median follow-up duration of 13 weeks (interquartile range 7.5-18.0). Reattachment occurred in 5 specific stages: 1) redistribution of fluid and approach of the neurosensory retina toward the retinal pigment epithelium occurred in 100% (15/15); 2) reduction in cystoid macular edema and improvement of outer retinal corrugations was achieved in 100% (15/15); 3) initial contact of the neurosensory retina to the retinal pigment epithelium occurred completely in 66.7% (10/15); 4) deturgescence of the inner and outer segments of the photoreceptors occurred in 66.7% (10/15); and 5) recovery of photoreceptor integrity occurred in 3 specific substages: 5A) external limiting membrane recovery (10/15, 66.6%); 5B) ellipsoid zone recovery (9/15, 60%); and 5C) interdigitation zone/foveal bulge recovery (3/15, 20%). Twenty percent (3/15) had delayed progression through stage 2, characterized by formation of outer retinal folds. Similarly, 33.3% (5/15) developed residual subfoveal fluid blebs (delayed progression to stage 3). CONCLUSIONS This study characterizes the in vivo physiology of retinal reattachment in humans using high-resolution SS-OCT that occurs in 5 specific stages. Delayed progression through certain stages was characterized by postoperative anatomic abnormalities. Am J Ophthalmol 2021;221:•••-•••. © 2021 Elsevier Inc. All rights reserved.
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Felfeli T, Murtaza F, Abueh B, Mandelcorn MS, Wong DD, Mandelcorn ED. Clinical Significance of Macula-Off Rhegmatogenous Retinal Detachment Preoperative Features on Optical Coherence Tomography. Ophthalmic Surg Lasers Imaging Retina 2021; 52:S23-S29. [PMID: 34310238 DOI: 10.3928/23258160-20210518-05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate the clinical significance of preoperative spectral-domain optical coherence tomography (OCT) features and their association with postoperative outcomes in eyes with primary macula-off rhegmatogenous retinal detachment (RRD). PATIENTS AND METHODS This is a retrospective case series of all consecutive cases undergoing repair of primary macula-off RRD at two tertiary care academic centers between January 2018 to January 2021. RESULTS Among 406 eyes, baseline visual acuity (β = 0.184, P = .001) and time to surgery (β = 0.009, P = .033) were predictive of postoperative visual acuity at 1-year follow-up after adjusting for age, sex and lens status, as well as presence of preoperative features on OCT such as outer retinal corrugations and height of the retinal detachment. CONCLUSION Baseline visual acuity and time to surgical repair are the best predictors of vision outcomes following macula-off RRD repair. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:S23-S29.].
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van der Merwe P, Felfeli T, Mandelcorn ED. A Practical Approach to Slit-Lamp Smartphone Photography. Can J Ophthalmol 2021; 57:e75-e76. [PMID: 34171269 DOI: 10.1016/j.jcjo.2021.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/17/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Pieter van der Merwe
- Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, Ont
| | - Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Efrem D Mandelcorn
- Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, Ont.; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont..
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Steffen J, van der Merwe P, Felfeli T, Mandelcorn ED. Assistant-controlled directional chandelier. Can J Ophthalmol 2021; 57:e79-e80. [PMID: 34119466 DOI: 10.1016/j.jcjo.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 05/13/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Jonel Steffen
- Division of Ophthalmology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Pieter van der Merwe
- Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, Ont
| | - Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.; The Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Efrem D Mandelcorn
- Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, Ont.; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont..
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50
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Affiliation(s)
- Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Kensington Vision and Research Centre, Kensington Eye Institute, University of Toronto, Toronto, Ontario, Canada
| | - Samantha B Kasloff
- J.C. Wilt Infectious Diseases Research Centre, Public Health Agency of Canada Ontario Manitoba Saskatchewan Regional Office, Winnipeg, Manitoba, Canada.,Canadian Science Centre for Human and Animal Health, Winnipeg, Manitoba, Canada
| | - Jay Krishnan
- J.C. Wilt Infectious Diseases Research Centre, Public Health Agency of Canada Ontario Manitoba Saskatchewan Regional Office, Winnipeg, Manitoba, Canada.,Canadian Science Centre for Human and Animal Health, Winnipeg, Manitoba, Canada
| | - Sherif R El-Defrawy
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Kensington Vision and Research Centre, Kensington Eye Institute, University of Toronto, Toronto, Ontario, Canada
| | - Tony Mazzulli
- Department of Microbiology, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario Laboratory, Toronto, Ontario, Canada
| | - Todd A Cutts
- J.C. Wilt Infectious Diseases Research Centre, Public Health Agency of Canada Ontario Manitoba Saskatchewan Regional Office, Winnipeg, Manitoba, Canada.,Canadian Science Centre for Human and Animal Health, Winnipeg, Manitoba, Canada
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