Blind Spot – The Eye Doctor’s Podcast is a podcast directed towards all eye care professionals, including ophthalmologists, optometrists, fellows and residents.  The goal of the show is to challenge eye care specialists to examine their own blind spots in the clinical and surgical management of eye disease.  Each episode features a different guest expert and focuses on a particular clinical diagnosis or surgical challenge in ophthalmology.  It is hosted by Toronto-based ophthalmologist, Zale Mednick.

NEW Episodes:

Episode 10 – Femtosecond Laser Assisted Cataract Surgery (Dr. Eric Donnenfeld) 

Episode 11 – LipiFlow and IPL (Dr. Ashley Brissette) 

Episode 12 – How safe is LASIK? (Dr. Guy Kezirian) 

Episode 13 – Viral Conjunctivitis (Dr. Francis Mah) 

Episode 14 – Flashes and Floaters (Dr. Efrem Mandelcorn) 

Episode 15 – Blepharitis (Dr. Ashley Brissette) 

Episode 16 – Botox and Fillers (Dr. Harmeet Gill) 

Episode 17 – Central Retinal Artery Occlusion (Dr. R. Rishi Gupta) 

Episode 18 – Acetazolamide (Dr. Deborah Friedman) 

Episode 19 – Keratoconus – ‘No Rub, No Cone’ (Dr. Damien Gatinel) 

Episode 20 – Acute Angle Closure Glaucoma (Dr. Ike Ahmed) 

Download the Episodes Here

About your host

Zale Mednick, MD, FRCSC, DABO

Dr. Zale Mednick is an ophthalmologist in Toronto, Canada. He completed his residency training at Queen’s University in Kingston, Ontario and successfully graduated from a fellowship in Cornea, External Disease, and Refractive Surgery at the University of Toronto. He is currently a staff ophthalmologist at North York General Hospital. Zale has been a lead or co-author of multiple peer-reviewed papers in ophthalmology journals including Cornea, JCRS, and AJO.

‍He has also produced the award-winning Preconceived podcast since 2019.

The latest issue of Canadian Eye Care Today is now available. This publication features clinical perspectives and practical information on topics in eye care relevant to today’s clinician. Its peer-reviewed articles focus on the treatment and management of eye disease from a Canadian perspective.

To read the issue now, click here. OR Click on the front cover of the issue below.

The content of this issue includes: Management of recurrent corneal erosions: A stepwise approach Yelin Yang, MD, FRCSC Trocar-based surgical techniques for drainage of management of suprachoroidal hemorrhages David RP Almeida, MD, MBA, PhD
Eric K. Chin, MD Anti-VEGF therapy in pregnancy and breastfeeding Amy Basilious, MD
Rajeev H, Muni, MD, FRCSC
Verena R. Juncal, MD Medical management of glaucoma for the pregnant and breastfeeding patient Gurkaran S. Sarohia, MD
Mathew M. Palakkamanil, MD, FRCSC The evolving role of women in ophthalmology: Can they truly lean in?  Marie-Clause Robert, MD, FRCSC

Read Volume 2, Issue 2

Looking for more? Back issues of Canadian Eye Care Today are available online in open access at canadianeyecaretoday.com.

Description:

This accredited webinar features six case presentations from expert speakers: Dr. James Farmer, Ophthalmologist and Anatomical Pathologist, and Dr. Hamidreza Faragi, Anatomical Pathologist who will discuss interesting and unusual cases in Ocular Pathology. You will have the opportunity to learn about the presentation, diagnosis, and management of these cases.

Learning Objectives:

1. Illustrate the importance of recognizing the unusual presentation of conjunctival tumours and interpreting Pathology results in light of the clinical findings
2. Understand the role of additional tissue sections in Ocular Pathology and including precise clinical information on the surgical pathology requisition to ensure optimal pathologic evaluation
3. Provide adequate tissue samples that are truly representative of the lesion in question.

Download the video here:

Canadian Ophthalmological Society, in co-development with Bausch + Lomb “Shining a light on challenging glaucoma cases – from diagnosis to surgery” Webinar recordings are now available.

March 30th, 2023 Recording
Presenters:
Dr. Cindy M.L. Hutnik MD, PhD, FRCSC
Professor and Chair,
Department of Ophthalmology
Schulich School of Medicine & Dentistry,
Western University
Ophthalmologist-in-Chief, Ivey Eye Institute
London, Ontario
Dr. Marcelo Nicolela MD, FRCSC
Professor and Head; Chief of Service
Department of Ophthalmology & Visual Sciences
Dalhousie University; NSH – Central Zone
Halifax, Nova Scotia

April 12th, 2023 Recording
Presenters:
Dr. Cindy M.L. Hutnik MD, PhD, FRCSC
Professor and Chair,
Department of Ophthalmology
Schulich School of Medicine & Dentistry, Western University Ophthalmologist-in-Chief, Ivey Eye Institute
London, Ontario
Dr. Jonathan Wong MD, FRCSC
Clinical assistant professor,
Department of Ophthalmology
Cumming School of Medicine,
University of Calgary
Calgary, Alberta

Learning Objectives:

1. Diagnosing and monitoring progression of glaucoma
2. Initiating the most appropriate therapy for your patients
   • Looking at the treatment approach through the glaucoma guidelines
   • Solving the mystery of medication vs SLT vs combination treatment
   • Incorporating Best Practices moving forward

The Shining a light on challenging glaucoma cases – from diagnosis to surgery is a group learning activity (Section 1) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada and approved by the Canadian Ophthalmological Society. You may claim a maximum of 1 hour (credits are automatically calculated).

This webinar has been supported by an educational grant from Bausch + Lomb.

The April 2023 CJO is now available online. Here are some of the highlights: 

2022 Reviewer Acknowledgement: CJO sincerely thanks all of the reviewers who volunteered their valuable time and expertise to the peer review process throughout 2022. Peer review is the cornerstone of scholarly medical publishing, and the CJO would not be where it is today without the contribution of our reviewers.

Resident Perspectives + visual abstract: Our talented team of residents have summarized 5 articles with a focus on what’s most relevant to ophthalmology learners here in Canada and around the globe, including the article featured in our April visual abstract, Improving the patient decision-making experience for cataract surgery during the COVID-19 era.

Original research articles:

·        Late recurrence in birdshot chorioretinopathy

·        Novel classification system for management of rhegmatogenous retinal detachment with minimally invasive detachment surgery

·        Delivering eye care to homeless and marginally housed populations during the COVID-19 pandemic

• Silent sinus syndrome: potentially misleading features that should be recognized

·        Myopic macular pits: a case series with multimodal imaging

·        Success of the Canadian Ophthalmological Society’s first virtual meeting amid COVID-19 pandemic

Research letters, photo essays, and case reports:

·        Increasing equity, diversity, and inclusion in the ophthalmology CaRMS selection process: ACUPO recommendations [research letter]

• Outcomes of giant cell arteritis patients treated with tocilizumab in a single neuro-ophthalmology practice [research letter]
• Effects of the COVID-19 lockdown on Canadian ophthalmologists [research letter]

·        Pigmented floating vitreous cyst [photo essay]

·        Explantation of iris-sutured intraocular lens [case report]

·        Paraproteinemic keratopathy: recognizing the ocular significance [case report]

·        Macular burn secondary to diode laser epilation [correspondence]

Follow the CJO on social media:

Facebook: CanJOphth

Instagram: @cjo_jco

LinkedIn: CJO – JCO

Twitter: @CanJOphth

EXPLORE THE PRACTICE RESOURCE CENTRE – we are pleased to share the new PRC promotional video. In just over two minutes, we highlight the benefits of the site for seasoned practitioners and those just starting their career, how to easily submit ideas and resources, how to create a custom reading list, and much more.

March, 2023

Definition

Corneal neuropathic pain, or corneal neuralgia, may be defined as chronic eye pain lasting more than three months that is not responsive to standard measures, and severe enough to affect daily living. The phenomenon is sometimes described after ocular surgery, including corneal and intraocular, but can occur after any type of eye trauma.

The condition is not well understood and there is no agreement on the diagnostic criteria, causes, incidence, nor treatment.

Pathophysiology

The V1 ophthalmic division of the trigeminal nerve contains nociceptors that respond to a variety to stimuli, including mechanical force and temperature. When stimulated, a signal transduction is transmitted and processed in the pain regions of the cerebral cortex. It is hypothesized that repeated damage to the cornea and its corresponding neuronal pathway results in a hyper‐inflammatory state, which leads to maladaptive sensitization either peripherally at the cornea or centrally at postsynaptic junctions.

Therefore, it may be useful to assess and manage corneal neuropathic pain as either peripheral or central pain sensitization.

Symptoms

Symptoms include, but are not limited to:

• Chronic, unrelenting eye pain
• Dry eye syndrome without signs, which is non‐responsive to standard treatment
• Light sensitivity, burning, foreign body sensation
• Symptom severity has resulted in suicide

Signs

• “Pain without stain”,
• Punctate keratopathy
• No signs may be present

Associated Conditions

• Central somatic sensitivity syndrome
• Fibromyalgia
• Autoimmune disease
• Chronic migraine and headache
• Persistent Post‐operative Pain Disorders (PPP)

Investigations

• Patients’ response to topical anesthetic may be useful in determining if the corneal neuropathic pain is a central or peripheral cause. A response of decreased pain with local anesthetic is suggestive of peripheral etiology.

In vivo Confocal microscopy

The sub‐basal nerve density has been reported to be significantly reduced in corneal neuropathic pain compared with control subjects. Other features described are activated keratocytes and spindle, lateral and stump microneuromas. However, the significance of these findings is unclear, as similar changes can be observed following uncomplicated PRK and LASIK. Therefore, the current role of confocal microscopy in these patients is unclear, and it is available on a limited basis in Canada mostly at academic centers.

Treatment Goals

• Regenerate corneal nerves and reduce inflammation
• Patients with predominantly peripheral sensitization likely have a better outcome than those with central sensitization
• Maximize ocular surface management as with severe dry eye
• Frequent preservative‐free artificial tears, limited use of topical steroids, night‐ time gels, topical cyclosporine
• Most patients will have had this treatment prior to referral with failure to respond

Additional Treatment Options

• Autologous serum drops
• Amniotic membrane
• Neurostimulation
• Corneal growth factors
• Neuromodulation
• Scleral contact lenses
• Systemic treatment may be necessary such as gabapentin, pregabalin, amitriptyline, and low‐dose naltrexone
• Referral to neuro‐ophthalmologist/neurologist/pain specialist. Resources are available in Canada for additional consultation and management

Outcomes

There is a high degree of variability in patient outcomes, with some patients suffering long‐term disability from the symptoms while others show complete resolution after 1 to 2 years. Information in this regard is anecdotal but it is advisable to take all possible measures to manage the disease, as long standing corneal neuralgia tends to be associated with worse patients outcomes.

References

Aggarwal S, Kheirkhah A, Cavalcanti BM, et al. Autologous Serum Tears for Treatment of Photoallodynia in Patients with Corneal Neuropathy: Efficacy and Evaluation with In Vivo Confocal Microscopy. The Ocular Surface. 2015;13(3):250‐262. doi:10.1016/j.jtos.2015.01.005

Crane AM, Levitt RC, Felix ER, Sarantopoulos KD, McClellan AL, Galor A. Patients with more severe symptoms of neuropathic ocular pain report more frequent and severe chronic overlapping pain conditions and psychiatric disease. British Journal of Ophthalmology. 2017;101(2):227‐231. doi:10.1136/bjophthalmol‐2015‐308214

Galor A, Covington D, Levitt AE, et al. Neuropathic Ocular Pain due to Dry Eye Is Associated With Multiple Comorbid Chronic Pain Syndromes. The Journal of Pain. 2016;17(3):310‐318. doi:10.1016/j.jpain.2015.10.019

Kundu G, Shetty R, D’Souza S, et al. A novel combination of corneal confocal microscopy, clinical features and artificial intelligence for evaluation of ocular surface pain. PLoS One. 2022;17(11):e0277086. doi:10.1371/journal.pone.0277086

Levitt, A.E., Galor, A., Weiss, J.S. et al. Chronic dry eye symptoms after LASIK: parallels and lessons to be learned from other persistent post‐operative pain disorders. Mol Pain 11, 21 (2015). https://doi.org/10.1186/s12990‐015‐0020‐7

Moshirfar M, Benstead EE, Sorrentino PM, Tripathy K. Ocular Neuropathic Pain. In: StatPearls. StatPearls Publishing; 2022. Accessed January 21, 2023. http://www.ncbi.nlm.nih.gov/books/NBK542282/

Neuropathic Corneal Pain ‐ ClinicalKey. 2023.https://www.clinicalkey.com/#!/content/playContent/1‐s2.0‐S0161642017306127

Ocular Neuropathic Pain ‐ EyeWiki. https://eyewiki.aao.org/Ocular_Neuropathic_Pain

Pakravan M, Roshani M, Yazdani S, Faramazi A, Yaseri M. Pregabalin and Gabapentin for Post‐Photorefractive Keratectomy Pain: A Randomized Controlled Trial. European Journal of Ophthalmology. 2012;22(7_suppl):106‐113. doi:10.5301/ejo.5000143

Rosenthal P, Borsook D. Ocular neuropathic pain. Br J Ophthalmol. 2016;100(1):128‐134. doi:10.1136/bjophthalmol‐2014‐306280

The latest issue of Canadian Eye Care Today for 2023 is now available for your reading pleasure. This publication examines issues and topics that are relevant to today’s clinician in the treatment and management of eye disease from a Canadian perspective.

To read this publication now, please click here.

OR

Click on the front cover of the issue below.

Some of the content you will find in this issue:

An Approach to Optic Neuropathies
Vivek R. Patel, MD
Strategies for the Management of Ocular Surface Disease in Glaucoma
William M. Trask, MD
Adam Muzychuk, MD FRCSC
Genetics of retinal degeneration in 2023
Elise Heon, MD, FRCSC
Ajoy Vincent MBBS, MS, FRCSC
Alaa Tayyib MD
Keratoconus Management: Navigating Patient Options
Amir R. Vosoughi, MD
Guillermo Rocha, MD, FRCSC, FACS
From Social Media to Peer Review: How Can we Evaluate Medical Content for Misinformation and Bias?
Chryssa McAlister, MD, MHSc, FRCSC
Hannah Chiu MD, FRCSC
Amin Hatamnejad BSc

Please feel free to forward the publication link to your peers!

As a team of ophthalmologists, ophthalmology residents, and medical students at the University of Calgary, we are dedicated to exploring and developing simulation-based learning endeavours and 3D printing innovations in surgical ophthalmology.

Check out the latest simulation walkthrough videos below:

The EyeSi Simulator Walkthrough

In this project, we provide walkthrough videos of the levels of the VR Magic EyeSi® Surgical simulator. A staple in many ophthalmology training programs, the EyeSi® system provides virtual modules to practice surgical skills in cataract surgery. However, there are no specific walkthroughs and tips provided by the simulator in completing each individual level. Hence our library of over 100 videos on Youtube® include individualized advice and narration on video walkthroughs on how we approached each level, and our final scoring as well. We hope these videos help ophthalmology residents in completing all the levels in the EyeSi® cataract simulator, that will translate directly into real-life operating room success!

EyeSi Vitreoretinal Simulator Walkthrough

In this project, we provide walkthrough videos of the levels of the VR Magic EyeSi® Surgical simulator for the Vitreoretinal module. A staple in many ophthalmology training programs, the EyeSi® system provides virtual modules to practice surgical skills in cataract surgery and vitreoretinal surgery. However, there are no specific walkthroughs and tips provided by the simulator in completing each individual level. Hence our library of over 100 videos on Youtube® include individualized advice and narration on video walkthroughs on how we approached each level, and our final scoring as well.

Read more here to learn about the Clinical Ophthalmologists and the Design Teams involved in this innovative project.