Publications by authors named "Davin Johnson"

40 Publications

Does This Patient With Acute Infectious Conjunctivitis Have a Bacterial Infection?: The Rational Clinical Examination Systematic Review.

JAMA 2022 06;327(22):2231-2237

Durham Veterans Affairs Medical Center, Durham, North Carolina.

Importance: Acute infectious conjunctivitis is characterized by ocular redness and discharge, and is a common clinical entity. Evidence-based tools to aid the clinical diagnosis of viral vs bacterial conjunctivitis are lacking and may contribute to overprescribing of topical antibiotics.

Objective: To determine the relative prevalence of viral vs bacterial conjunctivitis in adults and children, and to determine which symptoms or signs are suggestive of a viral vs bacterial etiology.

Data Sources: A MEDLINE search (January 1946-March 2022) yielded 1891 articles. Included articles were rated using a quality score based on a modified Rational Clinical Examination grading system. Methodological quality levels 1 through 4 required a microbiological reference standard for diagnosis, whereas quality level 5 (the lowest quality) used a clinical reference standard for diagnosis.

Study Selection: Consecutive series of patients presenting with acute infectious conjunctivitis and case series of viral or bacterial conjunctivitis alone. Thirty-two studies were included in a meta-analysis to determine prevalence and diagnostic accuracy measures; 27 used a microbiological reference standard for diagnosis and 5 used a clinical reference standard for diagnosis.

Results: In studies involving children (5 studies; 881 patients; mean age, 4.7 years [age range, 1 month-18 years]), the prevalence of bacterial conjunctivitis was higher than viral conjunctivitis (71% vs 16%, respectively, P = .01). In the only study of adults (n = 207 patients; mean age, 25.7 years), the prevalence of viral conjunctivitis was higher than bacterial conjunctivitis (78% vs 16%, respectively, P < .001). For the primary analysis of level 1 (n = 6) and level 2 (n = 5) studies (1725 patients total), the clinical findings that best distinguished a viral etiology for conjunctivitis from a bacterial etiology included pharyngitis (sensitivity range, 0.55-0.58; specificity range, 0.89-0.94; positive likelihood ratio [LR] range, 5.4-9.9), preauricular lymphadenopathy (sensitivity range, 0.17-0.31; specificity range, 0.93-0.94; positive LR range, 2.5-5.6), and contact with another person with red eye (sensitivity, 0.18 [95% CI, 0.14-0.22]; specificity, 0.93 [95% CI, 0.90-0.95]; positive LR, 2.5 [95% CI, 1.6-3.7]). Mucopurulent ocular discharge (sensitivity, 0.76 [95% CI, 0.60-0.87); specificity, 0.66 [95% CI, 0.58-0.73]; positive LR, 2.1 [95% CI, 1.7-2.6]) and otitis media (sensitivity, 0.24 [95% CI, 0.20-0.29]; specificity, 0.91 [95% CI, 0.85-0.94]; positive LR, 2.5 [95% CI, 1.5-4.4]) were associated with the presence of bacterial conjunctivitis.

Conclusions And Relevance: In this review, bacterial conjunctivitis was more common than viral conjunctivitis in children and viral conjunctivitis was more common than bacterial conjunctivitis in adults, although the prevalence estimates were based on limited evidence. Symptoms and signs associated with a higher likelihood of viral conjunctivitis in adults and children included concomitant pharyngitis, an enlarged preauricular node, and contact with another person with red eye, and signs associated with a higher likelihood of bacterial conjunctivitis included the presence of mucopurulent discharge and otitis media, but no single symptom or sign differentiated the 2 conditions with high certainty.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jama.2022.7687DOI Listing
June 2022

Bilateral Peripheral Ulcerative Keratitis Associated with Dupilumab.

Ophthalmology 2022 05;129(5):561

Department of Ophthalmology, Queen's University, Kingston Health Sciences Centre, Kingston, Ontario, Canada.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ophtha.2021.11.002DOI Listing
May 2022

Topical pain control for corneal abrasions: A systematic review and meta-analysis.

Acad Emerg Med 2021 08 5;28(8):890-908. Epub 2021 Mar 5.

Department of Ophthalmology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada.

Objectives: Corneal abrasions are common ophthalmic presentations to emergency departments. Among emergency physicians and ophthalmologists, there are highly variable practice patterns with regard to management of resultant pain and discomfort. The goal of this study was to review and analyze the efficacy and safety of topical pain therapies for corneal abrasions, including topical anesthetics, nonsteroidal anti-inflammatory drugs (NSAIDs), cycloplegics, steroids, pressure patching, and the use of a bandage contact lens (BCL).

Methods: The review followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. The protocol was established a priori and published on PROSPERO (CRD42020201288). MEDLINE, EMBASE, CENTRAL, and Web of Science were searched until December 31, 2020. Primary studies comparing topical pain therapies to another therapy or control were included. Primary outcomes included percentage of corneal abrasions healed at 24, 48, and 72 hours, as well as pain control at 24 and 48 hours. Secondary outcomes included use of oral analgesia and incidence of complications. Risk of bias was assessed using validated tools. Quality of evidence was assessed using the GRADE methodology.

Results: Overall, 33 studies (31 randomized controlled trials [RCTs], two cohort studies) comprising 4,167 patients with corneal abrasions were analyzed. Only the data for topical NSAIDs were of adequate evidence from which to draw conclusions; topical NSAIDs demonstrated significantly reduced pain scores at 24 hours (standardized mean differences [SMD] -0.69, 95% CI = -0.98 to -0.41) and 48 hours (SMD = -0.56, 95% CI = -1.02 to -0.10) as well as 53% (95% CI = 34% to 67%) lower oral analgesia use compared to control. Based on available data, topical anesthetics, cycloplegics, patching, and the use of a BCL did not result in any significant difference in pain scores or use of oral analgesia, while no studies examined topical steroids. No interventions resulted in healing delays or significantly higher rates of complications compared to controls.

Conclusions: There was strong evidence to support that topical NSAIDs reduce pain associated with corneal abrasions in the first 48 hours and the need for oral analgesia. The existing evidence was insufficient to support or refute the use of topical anesthetics, cycloplegics, steroids, or BCL for pain control in corneal abrasions. Pressure patching was ineffective at pain reduction and may increase the risk of complications. Delays in healing or other complications were not significantly different between any intervention or control for simple, uncomplicated corneal abrasions; however, larger RCTs are required to identify any differences in rare complications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/acem.14222DOI Listing
August 2021

Distribution and Predictors of Initial Glaucoma Care Among Ophthalmologists and Optometrists: A Population-based Study.

J Glaucoma 2021 06;30(6):e300-e304

Department of Ophthalmology.

Purpose: To evaluate evolution in the distribution of new glaucoma patients between ophthalmologists and optometrists, and to examine factors predicting provider type, in the context of expansion in the scope of optometry practice.

Patients And Methods: A population-based study was undertaken using validated datasets in Ontario, Canada from 2007 to 2018, encompassing time before and after optometry practice scope expansion in 2011. All patients aged 66 and older receiving a glaucoma suspect diagnosis or first-line therapy for glaucoma from ophthalmologists or optometrists were enrolled. Predictors of provider type were evaluated using logistic regression.

Results: From 2007 to 2018, 401,560 patients received initial glaucoma care, including 303,440 by ophthalmologists and 98,120 by optometrists. Population rates of glaucoma suspect diagnosis increased for both providers over the study period. The rate of therapy initiation increased annually among optometrists after 2011, while the rate remained stable over that period among ophthalmologists. By 2018, 88% of patients initiating therapy and 59% of patients first diagnosed as a glaucoma suspect received that care from ophthalmologists. In the final study year, therapy initiations per provider were lower among optometrists (median: 2/provider; interquartile range: 1 to 3) than among ophthalmologists (median: 26.5/provider, interquartile range: 10 to 53). Patients were more likely to receive care from an ophthalmologist than an optometrist if they were older, had higher ocular or systemic comorbidity, or lived in urban settings.

Conclusions: Optometrists have a large and growing role in diagnosing glaucoma suspects; however, despite scope expansion, optometrists play a much smaller role in initiating glaucoma therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/IJG.0000000000001792DOI Listing
June 2021

Predictors of Initial Glaucoma Therapy with Laser Trabeculoplasty versus Medication: A Population-Based Study.

Ophthalmol Glaucoma 2021 Jul-Aug;4(4):358-364. Epub 2020 Dec 21.

Department of Ophthalmology, Queen's University, Kingston, Canada; Department of Ophthalmology, Kingston Health Sciences Centre, Kingston, Canada; ICES, Ontario, Canada. Electronic address:

Purpose: To investigate patient-level factors associated with first-line glaucoma therapy with laser trabeculoplasty (LT) versus topical medication.

Design: Population-based study.

Participants: All patients 66 years of age and older in Ontario, Canada, receiving first-ever therapy for glaucoma with either LT or topical medication between April 1, 2007, and March 31, 2019.

Methods: Linked health care databases were used to identify patients receiving first-line glaucoma therapy and to ascertain patient-level factors potentially associated with receipt of LT versus medication. Multivariate logistic regression analyses were undertaken.

Main Outcome Measures: Factors associated with receiving LT versus medications were evaluated using adjusted odds ratios (ORs) for age, gender, previous cataract surgery, previous corneal transplantation, previous retina surgery, level of systemic comorbidity, socioeconomic status (SES), and rural versus urban residence.

Results: In total, 194 759 patients were included. Older patients were less likely to be treated with LT versus medication (≥81 years of age vs. 66-70 years of age: OR, 0.49; 95% confidence interval [CI], 0.48-0.50), whereas women were more likely than men to receive LT (OR, 1.42; 95% CI, 1.39-1.45). Previous ocular surgeries were associated with decreased probability of treatment with LT, including cataract surgery (OR, 0.31; 95% CI, 0.30-0.32), corneal transplantation (OR, 0.39; 95% CI, 0.31-0.49), and retina surgery (OR, 0.46; 95% CI, 0.41-0.51). Patients with high comorbidity were less likely to receive LT (highest vs. lowest level of comorbidity: OR, 0.94; 95% CI, 0.91-0.97). Laser trabeculoplasty use was less likely among patients at higher levels of SES (highest vs. lowest level: OR, 0.86; 95% CI, 0.84-0.89) and from a rural residence (versus urban: OR, 0.92; 95% CI, 0.90-0.95). Increasing utilization of LT over time was noted (for each additional calendar year: OR, 1.05 per year; 95% CI, 1.05-1.05 per year).

Conclusions: Our results identified patient characteristics associated with use of LT as primary therapy for glaucoma, including factors related to patient demographics, ocular history, and comorbidity. Many of these associations are unexpected based on efficacy data or evidence-based guidelines. These results are topical considering growing evidence supporting use of first-line LT.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ogla.2020.11.001DOI Listing
October 2021

Vitritis after Boston Keratoprosthesis Type 1 Implantation.

Ophthalmol Retina 2018 10 3;2(10):1050-1055. Epub 2018 Oct 3.

Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada.

Purpose: To describe the incidence, presentation, and clinical course of vitritis occurring after Boston keratoprosthesis type 1 implantation.

Design: Retrospective chart review.

Participants: Medical records of all patients undergoing type 1 Boston keratoprosthesis implantation over a 4-year period were reviewed.

Methods: Cases of vitreous inflammation were classified as either postoperative (within 1 month after surgery without endophthalmitis), reactive (secondary to ocular surface inflammation), idiopathic, or infectious endophthalmitis. The presenting features and postoperative course of all patients were reviewed.

Main Outcome Measures: Postoperative inflammation.

Results: A total of 110 eyes underwent type 1 Boston keratoprosthesis implantation with a median follow-up of 5.6 years. Overall, there were 21 episodes of vitritis occurring in 17 patients; 6 cases of vitritis were postoperative, whereas 5 were reactive, 7 were idiopathic, and 3 were infectious endophthalmitis. Patients with vitritis sought treatment a median of 10 months after surgery (range, 1 week-7 years). Compared with patients in whom vitritis did not develop, those with vitritis were younger (50.8 years of age vs. 62.2 years of age; P = 0.01), but with a similar prevalence of autoimmune disease (P = 1.00). Eyes with postoperative vitritis had a benign and short course, and were all managed with topical medications. Reactive vitritis occurred in association with infectious keratitis (4 cases) or corneal melting (1 case). Patients with idiopathic vitritis and endophthalmitis demonstrated similar symptoms of pain and severe vision loss. The mean duration of inflammation in patients of idiopathic vitritis was 3.3 months; all patients later demonstrated retroprosthetic membrane, and 2 patients (29%) demonstrated retinal detachment. Three of 7 patients with idiopathic vitritis underwent a vitreous tap, which showed negative results in all cases. The 3 cases of infectious endophthalmitis had a prolonged and severe course, with only 1 eye retaining functional vision.

Conclusions: Patients undergoing type 1 Boston keratoprosthesis implantation are at risk of postoperative vitreous inflammation, which may present in the immediate postoperative period or years later. Cases of idiopathic inflammation may present similarly to infectious endophthalmitis, and a low threshold should be taken for performing vitreous tap and injection of antimicrobials. Caution should be exercised using sub-Tenon corticosteroids, given the high prevalence of glaucoma and possibility of exacerbating fungal infections.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.oret.2018.04.010DOI Listing
October 2018

Brown's syndrome during pregnancy: a case report and review of literature.

Can J Ophthalmol 2018 12 3;53(6):e256-e258. Epub 2018 May 3.

Queen's University, Kingston, Ont.. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcjo.2018.02.007DOI Listing
December 2018

Detection of plastic BBs on CT scanning of the orbit.

Can J Ophthalmol 2018 08 13;53(4):e148-e149. Epub 2017 Dec 13.

Queen's University & Hotel Dieu Hospital, Kingston, Ont.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcjo.2017.10.019DOI Listing
August 2018

Collagen cross-linking as an adjunct for repair of corneal lacerations: a cadaveric study.

Can J Ophthalmol 2017 Oct 18;52(5):508-512. Epub 2017 Mar 18.

Department of Ophthalmology, Queen's University, Kingston, Ont. Electronic address:

Objective: To determine the efficacy of collagen cross-linking (CXL) as an adjunct to suturing in the repair of corneal lacerations.

Methods: A cadaveric study was undertaken in which a linear 5 mm corneal laceration was created in the central cornea of 20 eyes. The eyes were then randomized to receive 1 (n = 8), 2 (n = 8), or 3 (n = 4) standard corneal sutures. The burst pressure of the wound was then measured. All eyes in the 1- and 2-suture group then underwent standard CXL, with burst pressure repeated afterward.

Results: The initial wound burst pressure in the 1-, 2-, and 3-suture groups was 54.9, 74.0, and 201.2 mm Hg, respectively. After CXL, wound burst pressure increased by a mean of 3.2 and 62.3 mm Hg in the 1- and 2-suture groups, respectively. This change was statistically significant in the 2-suture group (p = 0.017). After CXL, the 2-suture group still had a significantly lower burst pressure compared with the 3-suture group (p = 0.011).

Conclusions: The study highlights a potential novel application for CXL to strengthen corneal wounds. Provided that suture density is sufficient to appose the wound edges, CXL may result in short-term wound strengthening. This could potentially allow for decreased corneal suture density and a corresponding decrease in suture-related complications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcjo.2017.01.015DOI Listing
October 2017

Design and Validation of a Training Simulator for Laser Capsulotomy, Peripheral Iridotomy, and Retinopexy.

Ophthalmic Surg Lasers Imaging Retina 2017 01;48(1):56-61

Background And Objectives: Ophthalmology trainees commonly learn laser procedures on live patients. A simulator for learning peripheral iridotomy (PI), posterior capsulotomy, and retinopexy may improve patient outcomes.

Materials And Methods: A model eye with artificial tissues was designed. The tissues reacted to laser similarly to human tissues. Inexperienced (n = 6; first- to third-year residents) and experienced (n = 7; fourth- to fifth-year residents and staff) ophthalmic personal were compared on performance of the above laser procedures.

Results: The inexperienced group required more shots (P = .04) and caused more lens markings (P = .04) during capsulotomy and had more incomplete retinopexy results (P = .04) than the experienced group. The groups did not differ in total shots for PI, average power for retinopexy, or the total time required for any of the procedures.

Conclusion: Our model effectively simulates common ophthalmic laser procedures and is practical for the training of ophthalmology residents. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:56-61.].
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3928/23258160-20161219-08DOI Listing
January 2017

Re: Johnson et al. Drug-prescribing patterns among optometrists and nonophthalmologist physicians at a tertiary care centre in Kingston, Ontario.

Can J Ophthalmol 2016 08;51(4):307-308

Department of Ophthalmology, University of Toronto, Toronto, Ont; Department of Ophthalmology, Kensington Eye Institute, Toronto, Ont.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcjo.2016.07.007DOI Listing
August 2016

Drug-prescribing patterns among optometrists and nonophthalmologist physicians at a tertiary care centre in Kingston, Ontario.

Can J Ophthalmol 2016 Jun;51(3):168-73

Department of Ophthalmology, Queen's University, Kingston, Ont; Department of Ophthalmology, Hotel Dieu and Kingston General Hospitals, Kingston, Ont; Institute for Clinical Evaluative Sciences, Toronto, Ont. Electronic address:

Objective: To report on patterns of optometry prescribing and adherence to prescribing regulations at a tertiary care ophthalmology centre.

Design: Prospective cohort study.

Participants: All new referrals from optometrists and other health care professionals to the emergency eye care service (n = 1965) between July 2011 and June 2012, as well as optometry referrals to 2 subspecialty services (glaucoma [n = 71] and cornea [n = 212]).

Methods: In our primary analysis, the frequency of prescribing and classes of medications prescribed were reported and compared amongst various referral sources to the emergency eye care service. As a secondary analysis, we reported frequency of prescribing in optometry referrals to 2 subspecialty clinics. Adherence to prescribing guidelines was reported for all optometry referrals.

Results: Of 296 referrals from optometrists to the emergency eye care service, 20 (6.8%) had received a prescription medication; this was significantly less compared to emergency and family physicians (p < 0.001). Topical antibiotics were the most frequently prescribed medication class. The frequency of prescribing by optometrists was 5.2% (11/212) and 4.2% (3/71) for patients referred to the cornea and glaucoma services, respectively. Among those patients referred after being given a prescription for a glaucoma medication by an optometrist, 89% cases (8/9) did not adhere to prescribing regulations.

Conclusions: After the introduction of prescribing privileges, optometrists prescribe a variety of medications in their practices. Current prescribing guidelines are not always followed in practice, suggesting that continued study and collaboration is necessary to create an optimal model of interdisciplinary care that provides access to the highest quality of care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcjo.2016.04.001DOI Listing
June 2016

Value of subjective visual reduction in patients with acute-onset floaters and/or flashes.

Can J Ophthalmol 2015 Aug;50(4):265-8

Department of Ophthalmology, Queen's University and Hotel Dieu Hospital, Kingston, Ont.. Electronic address:

Objective: To quantify the association between subjective visual reduction (SVR) and retinal pathology in patients with acute-onset monocular floaters or flashes, or both.

Design, Setting, And Participants: Prospective cohorts study involving all new patients referred for acute-onset floaters or flashes, or both, to a tertiary care emergency eye clinic in Kingston, Ontario, between July 1, 2011, and June 29, 2012 (n = 333).

Methods: All patients were evaluated for the presence of SVR in a standardized fashion, as well as other known risk factors for retina pathology including a family history of retinal tear or retinal detachment, a personal history of retinal tear or detachment, high myopia, and ocular trauma. Our major outcome was urgent retinal pathology, defined as retina pathology requiring a same-day referral to a retina specialist for evaluation, management, or both.

Results: SVR was strongly associated with retinal pathology (likelihood ratio 7.9, 95% CI 5.2-12.1).

Conclusions: Patients with SVR are at increased risk for urgent retinal pathology and should be triaged for urgent ophthalmologic examination.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcjo.2015.06.001DOI Listing
August 2015

Efficacy of Intravenous Mannitol in the Management of Orbital Compartment Syndrome: A Nonhuman Primate Model.

Ophthalmic Plast Reconstr Surg 2016 May-Jun;32(3):187-90

*Department of Ophthalmology, †Office of the University Veterinarian, Queen's University, Kingston, Ontario, Canada.

Purpose: To report the efficacy of intravenous mannitol in the treatment of orbital compartment syndrome.

Methods: An experimental study was conducted on 4 nonhuman primates (8 orbits). Orbital compartment syndrome was simulated by injecting autologous blood into both orbits of each nonhuman primate until a pressure of 80 mm Hg was reached (time 0). After 10 minutes, nonhuman primates were randomized to receive an infusion of either mannitol or saline, given over 15 minutes. Five minutes after the infusion was complete, lateral canthotomy and cantholysis was performed on both orbits in isolated steps every 5 minutes. During the study protocol, orbital and intraocular pressures were recorded every 5 minutes, with a final set of measurements at 60 minutes. The primary outcome measures were the mean change in pressure from time 0 to 60 minutes, as well as the mean change in pressure during the infusion period.

Results: There was no statistically significant difference in the mean changes in orbital or intraocular pressure from time 0 to 60 minutes of the protocol. However, during the infusion period there was significantly greater decrease in both orbital and intraocular pressure in the mannitol compared with saline group (-34.0 vs. -9.3 mm Hg for orbital pressure [p = 0.03]; -34.8 vs. -9.7 mm Hg for intraocular pressure [p = 0.04]).

Conclusions: While the definitive treatment of orbital compartment syndrome is lateral canthotomy and cantholysis, mannitol results in a rapid and clinically meaningful drop in orbital and intraocular pressure. The authors believe that their data support the routine use of mannitol in orbital compartment syndrome, especially when there is a delay in timely surgical management.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/IOP.0000000000000463DOI Listing
February 2017

Orbital compartment syndrome after head trauma.

Lancet Neurol 2015 Feb;14(2):136-7

Department of Ophthalmology, Queen's University, Kingston, ON, Canada.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S1474-4422(14)70319-9DOI Listing
February 2015

Identifying predictive morphologic features of malignancy in eyelid lesions.

Can Fam Physician 2015 Jan;61(1):e43-9

Objective: To determine features of eyelid lesions most predictive of malignancy, and to design a key to assist general practitioners in the triaging of such lesions.

Design: Prospective observational study.

Setting: Department of Ophthalmology at Queen’s University in Kingston, Ont.

Participants: A total of 199 consecutive periocular lesions requiring biopsy or excision were included.

Main Outcome Measures: First, potential features suggestive of malignancy for eyelid lesions were identified based on a survey sent to Canadian oculoplastic surgeons. The sensitivity, specificity, and odds ratios (ORs) of these features were then determined using 199 consecutive photographed eyelid lesions of patients who presented to the Department of Ophthalmology and underwent biopsy or excision. A triage key was then created based on the features with the highest ORs, and it was pilot-tested by a group of medical students.

Results: Of the 199 lesions included, 161 (80.9%) were benign and 38 (19.1%) were malignant. The 3 features with the highest ORs in predicting malignancy were infiltration (OR = 18.2, P < .01), ulceration (OR = 14.7, P < .01), and loss of eyelashes (OR = 6.0, P < .01). The acronym LUI (loss of eyelashes, ulceration, infiltration) was created to assist in memory recall. After watching a video describing the LUI triage key, the mean total score of a group of medical students for correctly identifying malignant lesions increased from 46% to 70% (P < .001).

Conclusion: Differentiating benign from malignant eyelid lesions can be difficult even for experienced physicians. The LUI triage key provides physicians with an evidence-based, easy-to-remember system for assisting in the triaging of these lesions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4301785PMC
January 2015

Emergency department visits after intravitreal bevacizumab and ranibizumab injections in diabetic patients.

Can J Ophthalmol 2014 Dec;49(6):e146-8

Queen's University, Kingston, Ont.. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcjo.2014.08.018DOI Listing
December 2014

Patterns and causes of epiphora referrals to a tertiary oculoplastic practice.

Can J Ophthalmol 2014 Apr;49(2):180-2

Department of Ophthalmology, Queen's University, Kingston, Ont.. Electronic address:

Objective: To report the causative factors and surgical candidacy of patients referred to an oculoplastic surgery clinic for the complaint of epiphora.

Design: Prospective observational study.

Participants: Consecutive patients (n = 159) referred to a tertiary care oculoplastic surgery clinic over a 12-month period for the complaint of epiphora.

Methods: The causative factor most responsible for tearing was determined based on clinical examination by the principal investigator, who was blinded to referral source. Patients were considered surgical candidates with a diagnosis of significant nasolacrimal duct obstruction, lid malposition, or pump dysfunction. The primary outcome was the percentage of referrals that were surgical candidates, classified by referral source.

Results: The most common cause of tearing was nasolacrimal duct obstruction, occurring in 53 of 159 (33%) patients. The percentage of surgical candidates was highest in referrals from ophthalmologists (82%), followed by optometrists (67%) and family physicians (55%; p = 0.011 for difference between ophthalmologists and family physicians).

Conclusions: Epiphora may be because of a variety of causes, some of which are amendable to surgical treatment. In the absence of an obvious cause, a trial of lubrication by the family physician is warranted before referral being made to an oculoplastic surgeon.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcjo.2013.12.003DOI Listing
April 2014

Orbital compartment syndrome in a burn patient without aggressive fluid resuscitation.

Orbit 2014 Oct 2;33(5):375-7. Epub 2014 Apr 2.

Department of Ophthalmology, Queen's University , Kingston , Ontario.

Introduction: Orbital compartment syndrome may rarely occur in the setting of burns where therapy includes aggressive fluid resuscitation.

Case: We report a case of bilateral orbital compartment syndrome in a 13-year-old male, with superficial facial burns secondary to hydrobromic acid, who did not receive aggressive fluid resuscitation. The patient was treated successfully with bilateral lateral canthotomy and cantholysis.

Comment: Facial burns may lead to orbital compartment syndrome without aggressive fluid resuscitation, likely due to excessive leakage of fluid and protein into the orbit combined with an inflammatory reaction.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/01676830.2014.881400DOI Listing
October 2014

Do findings on routine examination identify patients at risk for primary open-angle glaucoma? The rational clinical examination systematic review.

JAMA 2013 May;309(19):2035-42

Department of Ophthalmology, Queen’s University, Kingston, Ontario, Canada.

Importance: Glaucoma is the second leading cause of blindness worldwide, and its insidious onset is often associated with diagnostic delay. Since glaucoma progression can often be effectively diminished when treated, identifying individuals at risk for glaucoma could potentially lead to earlier detection and prevent associated vision loss.

Objective: To quantify the diagnostic accuracy of examination findings and relevant risk factors in identifying individuals with primary open-angle glaucoma (POAG), the most common form of glaucoma in North America.

Data Sources: Structured Medline (January 1950-January 2013) search and a hand search of references and citations of retrieved articles yielding 57 articles from 41 studies.

Study Selection: Population-based studies of high-level methods relating relevant examination findings of cup-to-disc ratio (CDR), CDR asymmetry, intraocular pressure (IOP), and demographic risk factors to the presence of POAG.

Results: The summary prevalence of glaucoma in the highest-quality studies was 2.6% (95% CI, 2.1%-3.1%). Among risk factors evaluated, high myopia (≥6 diopters; odds ratio [OR], 5.7; 95% CI, 3.1-11) and family history (OR, 3.3; 95% CI, 2.0-5.6) had the strongest association with glaucoma. Black race (OR, 2.9; 95% CI, 1.4-5.9) and increasing age (especially age >80 years; OR, 2.9; 95% CI, 1.9-4.3) were also associated with an increased risk. As CDR increased, the likelihood for POAG increased with a likelihood ratio (LR) of 14 (95% CI, 5.3-39) for CDR of 0.7 or greater. Increasing CDR asymmetry was also associated with an increased likelihood for POAG (CDR asymmetry ≥0.3; LR, 7.3; 95% CI, 3.3-16). No single threshold for CDR or asymmetry ruled out glaucoma. The presence of a disc hemorrhage (LR, 12; 95% CI, 2.9-48) was highly suggestive of glaucoma, but the absence of a hemorrhage was nondiagnostic (LR, 0.94; 95% CI, 0.83-0.98). At the commonly used cutoff for high IOP (≥22), the LR was 13 (95% CI, 8.2-17), while lower IOP made glaucoma less likely (LR, 0.65; 95% CI, 0.55-0.76). We found no studies of screening examinations performed by generalist physicians in a routine setting.

Conclusions And Relevance: Individual findings of increased CDR, CDR asymmetry, disc hemorrhage, and elevated IOP, as well as demographic risk factors of family history, black race, and advanced age are associated with increased risk for POAG, but their absence does not effectively rule out POAG. The best available data support examination by an ophthalmologist as the most accurate way to detect glaucoma.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jama.2013.5099DOI Listing
May 2013

Orbital metastasis secondary to merkel cell carcinoma: case report and literature review.

Orbit 2013 Aug 10;32(4):263-5. Epub 2013 May 10.

Department of Ophthalmology, Queen's University, Kingston, Ontario.

Introduction: Merkel cell carcinoma is an aggressive malignancy often associated with metastatic spread, but has never been reported to metastasize to the orbit.

Case: An 80 year old male with metastatic Merkel cell carcinoma presented with ptosis and extraocular movement abnormalities, and was found to have a lesion of the orbit consistent with metastatic spread. The lesion responded favorably to radiation therapy.

Comment: Although the orbit is a frequent site of metastatic disease, this is the first reported case of presumed Merkel cell carcinoma metastasizing to the orbit.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/01676830.2013.788671DOI Listing
August 2013

Ocular and systemic safety of bevacizumab and ranibizumab in patients with neovascular age-related macular degeneration.

Curr Opin Ophthalmol 2013 May;24(3):205-12

Department of Ophthalmology, Queen's University Kingston, Ontario, Canada.

Purpose Of Review: This study reviews differences in both ocular and systemic safety between intravitreal bevacizumab and ranibizumab in the setting of neovascular age-related macular degeneration.

Recent Findings: Serious adverse events associated with either bevacizumab or ranibizumab injections are generally rare. However, acute intraocular inflammation (AII) tends to occur more frequently following bevacizumab injection. Systemic absorption of bevacizumab is greater than with ranibizumab, and many studies have shown an increased risk of systemic adverse events in patients receiving bevacizumab compared with those receiving ranibizumab.

Summary: Although rare, adverse events with off-label use of bevacizumab are more common than with ranibizumab. Continued study into long-term safety of the two agents is warranted.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/ICU.0b013e32835f8ec0DOI Listing
May 2013

Rate of serious adverse effects in a series of bevacizumab and ranibizumab injections.

Can J Ophthalmol 2012 Jun;47(3):275-9

Department of Ophthalmology, Queen's University, Kingston, Ont.

Objective: To compare the rate of serious ocular and systemic adverse effects of intravitreal bevacizumab and ranibizumab in the treatment of a variety of eye diseases.

Design: Retrospective chart review.

Participants: Consecutive series of intravitreal injections of bevacizumab (n = 693) and ranibizumab (n = 891).

Methods: Medical records of all patients receiving injections in the series were retrieved. We considered the rate of both serious ocular adverse effects (e.g., acute intraocular inflammation, infectious endophthalmitis, retinal detachment, vitreous hemorrhage) and of arterial thromboembolic events that occurred within 1 month of injection.

Results: Subjects who received bevacizumab were 12 times more likely to develop severe intraocular inflammation following each injection than were those who received ranibizumab (OR = 11.71; 95% CI 1.5-93). The 1 case of acute intraocular inflammation following ranibizumab injection was mild and not associated with vision loss. No other serious ocular complications were noted. A trend was also noted toward an increased risk for arterial thromboembolic events in patients receiving bevacizumab, although the confidence interval was wide (OR = 4.26; 95% CI 0.44-41).

Conclusions: Significant concern still exists regarding the safety of off-label use of intravitreal bevacizumab. Patients receiving bevacizumab should be counselled regarding a possible increased risk for serious adverse events.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcjo.2012.03.026DOI Listing
June 2012

Anaesthetic plus dilating gel improves pupil dilation for cataract surgery.

Can J Ophthalmol 2012 Apr 14;47(2):145-9. Epub 2012 Mar 14.

Department of Ophthalmology, Queen's University. Kingston, Ontario, Canada.

Objective: To evaluate the efficacy of a combination anaesthetic plus dilating gel (ADG) on pupil dilation (PD) and corneal anaesthesia (KA) compared to traditional preoperative pharmacotherapy for cataract surgery.

Design: Prospective, noninferiority study.

Methods: We studied 20 consenting adults who experienced unilateral cataracts and underwent routine cataract surgery, receiving the traditional preoperative pharmacologic regimen in the operated eye (control eye): diclofenac 0.1%, gentamicin 0.3%, cyclopentolate 1%, phenylephrine 2.5%, and tropicamide 1% 60 and 20 minutes prior to surgery. They then received tetracaine 0.5% and povidone-iodine 5% 10 minutes prior to surgery; and were given tetracaine 0.5%, povidone-iodine 5%, and lidocaine 2% gel 1 minute prior to surgery. Epinephrine 0.1%, 1 cc per 500 mL bag of balanced saline salt solution was administered during surgery. The nonoperated eye (study eye) received tetracaine 0.5%, povidone-iodine 5%, and 0.35 cc ADG gel (phenylephrine 10%, tropicamide 1%, diclofenac 0.1%, and lidocaine 2%) 60 and 10 minutes prior to surgery. PD and KA were measured at baseline, at 30 minutes, and at 5 minutes prior to surgery, and at 5 minutes after surgery.

Results: There was no difference in PD (p = 0.2634) or KA (p = 0.6058) between the study eyes and the control eyes at baseline. Preoperatively, greater mydriasis was achieved in the study eye (7.95 ± 0.91 mm vs 7.17 ± 1.25 mm; p < 0.0001). There was no significant difference in preoperative KA between the study and control eyes (1.5 ± 2.2 mm vs 1.4 ± 2.1 mm; p = 0.77).

Conclusions: The combination ADG for preoperative preparation of cataract patients achieves at least equivalent dilation and corneal anaesthesia as the current preoperative pharmacologic regimen.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcjo.2012.01.007DOI Listing
April 2012

Acute-onset floaters and flashes.

CMAJ 2012 Mar 28;184(4):431. Epub 2011 Nov 28.

Department of Ophthalmology, Queen's University, Kingston, Ont.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1503/cmaj.110686DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3291672PMC
March 2012

Ophthaproblem. Can you identify this condition? Idiopathic intracranial hypertension.

Can Fam Physician 2011 Aug;57(8):901, 906

Department of Ophthalmology at Queen’s University in Kingston, Ont.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3155444PMC
August 2011

Ophthaproblem. Can you identify this condition? Horner syndrome.

Can Fam Physician 2010 May;56(5):439, 443

Queen's University, Kingston, Ont.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2868614PMC
May 2010
-->