Volume 14 - Issue 3
Periorbital Necrotizing Fasciitis – An Action Plan for Rapid Diagnosis and Management
By IMRAN JIVRAJ, MD, FRCSC
Life-threatening necrotizing fasciitis most commonly affects the limbs, perineum, and abdominal wall; however, it will rarely present in the skin and soft tissue around the eye. Although the mortality rate is lower with periorbital necrotizing fasciitis (PONF) than that associated with other presentations, saving the patient and eye requires prompt identification and treatment, preferably by a multidisciplinary team. This issue of Ophthalmology Rounds presents a case of trauma-induced PONF to illustrate early and effective management.
Volume 14 - Issue 2
Update on Age-Related Macular Degeneration – Part 2: Current and Future Treatment Strategies
By DAVID TRI TA KIM, MD, FRCSC, and ALAN RICHARD BERGER, MD, FRCSC
Age-related macular degeneration (AMD) is a leading cause of vision loss in older patients and in patients in the developed world. The number of patients with this disease is expected to rise as the population ages. The previous issue of Ophthalmology Rounds reviewed the current and future diagnostic options. The current issue outlines the evidence-based therapies for dry and wet AMD and discusses options that are showing promise in clinical study.
Volume 14 - Issue 1
Update on Age-Related Macular Degeneration – Part 1: Current and Future Trends in Diagnosis
By DAVID TRI TA KIM, MD, FRCSC and ALAN RICHARD BERGER, MD, FRCSC
Age-related macular degeneration (AMD) is a leading cause of vision loss in patients aged ≥50 years and especially those living in the developed world. The number of patients with this disease is expected to rise as the population ages.
Volume 13 - Issue 3
Social Determinants of Vision Health: Delivering Ophthalmic Care to Marginalized Populations
By HARLEEN BEDI, MD, FRCSC, MIRRIAM MIKHAIL, HBScC, and MYRNA LICHTER, MD, FRCSC
For the approximately 235,000 Canadians who experience homelessness every year, access to proper eye care is a formidable challenge. This issue of Ophthalmology Rounds is intended to both assess the breadth of the problem of visual disability among the homeless and to develop a framework that can enable equitable and cost-effective delivery of healthcare to our marginalized populations and shelter-dwellers.
Volume 13 - Issue 2
Ultrasound Biomicroscopy – Enduring Clinical Value After a Quarter Century
By CARLA LUTCHMAN, MD, FRCSC, and E. RAND SIMPSON, MD, FRCSC
The technique of ultrasound biomicroscopy (UBM) was described by Pavlin in Ophthalmology Rounds 10 years after the introduction of this important imaging technology. Despite the development of newer imaging technology,
Volume 13 - Issue 1
Refractive Surgery: Today and the Future
By RAYMOND STEIN, MD, FRCSC, and REBECCA STEIN, BSc, MBChB
Technologies and techniques continue to evolve in the correction of myopia, hyperopia, astigmatism, and presbyopia. Patients are increasingly interested in spectacle or contact lens independence. Clinicians need to understand today’s options for vision correction. This issue of Ophthalmology Rounds provides an overview of this exciting area of clinical advancements and research.
Volume 12 - Issue 4
Cataract Surgery in Patients with Disabilities: Key Considerations for Safe and Optimal Outcomes
By HARLEEN BEDI, HBSc, MD, AMANDEEP RAI, MD, FRCSC, and PAUL SANGHERA, MD, FRCSC
Physical or mental disability in a candidate for cataract surgery may represent a particular challenge. This issue of Ophthalmology Rounds aims to describe the preoperative, intraoperative and postoperative considerations to aid the clinician in approaching cataract surgery for patients with disabilities.
Volume 12 - Issue 3
Top 5 Diagnoses Not to Miss in Children
By STEPHANIE N. KLETKE, MD, and MICHAEL J. WAN, MD, FRCSC
This issue of Ophthalmology Rounds focuses on 5 of the most important eye conditions in children that should not be missed. Any clinician who sees children should be familiar with these potentially vision and life-threatening diseases. This article summarizes the clinical presentation, differential diagnosis, assessment, and management of the key pediatric causes of leukocoria, epiphora, ptosis, proptosis, and neurological disease.
Volume 12 - Issue 2
Looking Into Diabetic Retinopathy: Features on Optical Coherence Tomography Angiography
By PAULO RICARDO CHAVES DE OLIVEIRA, MD, ALAN RICHARD BERGER, MD, FRCS, and DAVID ROBERT CHOW, MD, FRCS
With the worsening global pandemic of diabetes, millions more patients are at significant risk of diabetic retinopathy (DR). The development of optical coherence tomography angiography (OCTA) has provided a potentially valuable tool to detect and evaluate retinal disorders, including DR, while avoiding the adverse effects of the more traditional fluorescein angiography.
Volume 12 - Issue 1
Staying Plugged in on Lacrimal Occlusive Devices: a Review of Indications and Complications
By CLARA C. CHAN, MD, FRCSC, FACS, and JEFFREY J. HURWITZ, MD, FRCSC
Punctal and canalicular plugs enhance the eye’s tear film by blocking lacrimal drainage. They are used principally in the management of dry eye disease but can be helpful in other conditions that cause eye dryness.
Volume 11 - Issue 8
Getting to the Cause of Unexplained Vision Loss in Children
By MICHAEL J. WAN, MD, FRCSC
Vision loss is a common reason for children to present to both pediatric and comprehensive ophthalmologists. While the majority of cases are due to benign conditions, several blinding and even life-threatening diseases can initially present with unexplained vision loss.
Volume 11 - Issue 7
The Eyebrow: Basic Anatomy and Treatment of Abnormalities
By NAVDEEP NIJHAWAN, MD, FRCSC
Many eye care professionals tend to ignore or have limited understanding of the brow and its function in total ocular health. They see this as mainly a cosmetic concern that is insignificant in the overall ocular health of the individual.
Volume 11 - Issue 6
The Aspheric Cornea, Spherical Aberration, and Intraocular Lenses: Considerations for Surgical Management
By JOHN LLOYD, MD, FRCSC, DABO, REEM ALNABULSI, MD, and MICHAEL WAN, MD
The cornea is the main refractive surface of the eye. The prolate shape of the cornea plays a role in maintaining the optimum total spherical aberration (SA) of the eye by neutralizing the negative SA of the lens. As we age the lenticular SA shifts in the positive direction while the corneal SA remains the same, making the total ocular SA more positive.
Volume 11 - Issue 5
Ophthalmic Imaging in Common Retinal Conditions: Advancing How We See the Eye
By KEYVAN KOUSHAN, MD, FRCSC
In contrast to most organs, the eye can be studied and visualized at different levels. The imaging modalities of the retina and choroid have been expanding steadily, enabling us to learn more about the structure and function of these tissues. These advances in technology have led to better understanding of various retinal diseases.
Volume 11 - Issue 4
Immediately Sequential Bilateral Cataract Surgery (ISBCS): An Increasingly Common Global Practice
By STEVE A. ARSHINOFF, MD, FRCSC
The mid 1990s saw a surge in interest, originating in Canada, the United Kingdom, Finland and Spain, in immediately sequential bilateral cataract surgery (ISBCS). Within 10 years, ISBCS was a topic of common discussion and the practice had become generally
accepted by a significant minority of ophthalmologists in those countries, and was spreading globally.
Volume 11 - Issue 3
Sedation for Ophthalmic Surgeries: Balancing Patient Comfort and Surgical Efficiency
By LAURA NOBLE, BA, RRT, AA, PHILIP S LAU, BSc, RRT, AA, FCSRT, and JEFFREY JAY HURWITZ, MD, FRCSC
Anesthesia for ophthalmic surgery follows many of the rules of other surgical specialties, but also adheres to specific guidelines pertaining to procedures involving the eye and periorbital area.
Volume 11 - Issue 2
Limbal Stem Cell Disease: An Ocular Regenerative Program
By MAURICIO A. PEREZ, MD, CLARA C. CHAN, MD, FRCSC, FACS, and ALLAN R. SLOMOVIC, MD, FRCSC
Limbal stem cells (LSCs) are principally responsible for the 7-day cycle of regeneration of the corneal epithelium. This process can be compromised by congenital, traumatic, or autoimmune factors.
Volume 11 - Issue 1
Update on Vitreomacular Traction and Macular Holes: Current and Emerging Management Options
By JOSHUA S. MANUSOW, MD, and MARK A. MANDELL, MD, FRCSC
Diseases of the vitreomacular interface (VMI) are commonly encountered in clinical practice and include epiretinal membrane, anomalous posterior vitreous detachment, vitreomacular traction, and macular hole.
Volume 10 - Issue 8
Transient Visual Obscurations: Clues to Localization
By JASMINE GOPWANI, MBBS, and EDWARD MARGOLIN, MD, FRCSC
Transient visual obscurations – ie, blurred vision or scotomas lasting <24 hours – are most commonly caused by lesions in the retinocortical component of the visual pathway. Identification of the specific cause of the visual loss can be difficult.
Volume 10 - Issue 7
The Management of Chalazia: Avoiding Bumps in the Road to Recovery
By EDSEL ING, MD, FRCSC
A chalazion is a chronic lipogranuloma of the eyelid, and is one of the most commonly encountered lesions in ophthalmology. As such, all ophthalmologists should be able to appropriately manage or triage chalazia. Many benign and malignant lid lesions may mimic chalazia, most notably basal cell carcinoma and sebaceous carcinoma. Although the care of most chalazia is straightforward, clinicians should remain diligent with management.
Volume 10 - Issue 6
Surgical Correction of Presbyopia: A Focus on New Techniques
By RAYMOND STEIN, MD, FRCSC, and REBECCA STEIN, BSc, MBChB (Candidate)
Surgical correction of presbyopia is an area of intense research and development. Although it would be ideal to prevent or reverse hardening of the crystalline lens, this is not currently a viable therapeutic option. In recent years, many different surgical procedures have been developed to allow near vision.
Volume 10 - Issue 5
Oculofacial Plastic Surgery: Thinking Outside the Socket
By HARMEET S. GILL MD, FACS, FRCSC
The term “oculofacial” represents the expanded scope of practice of oculoplastic surgery that includes surgery of the forehead, midface, and lower face. There is an overlap between the practice focuses of craniofacial plastic surgeons, head and neck surgeons, oral maxillofacial surgeons, and dermatological surgeons in facial surgery.
Volume 10 - Issue 4
Current Management of Macular Edema Associated with Central and Branch Retinal Vein Occlusion
By RADHA P. KOHLY, MD, PhD, FRCSC, and RAJEEV H. MUNI, MD, MSc (CLIN EPI), FRCSC
With an estimated prevalence of 1%–2% in the general population ?40 years of age, retinal vein occlusion (RVO) is an important cause of significantly impaired vision.
Volume 10 - Issue 3
The Anophthalmic Socket: Trends of Surgical Technique and Implant Selection
By TIIU HESS, MD, MICHAEL C.F. WEBB, BADO, BCO, FASO, and JEFFREY JAY HURWITZ, MD, FRCSC
Enucleation and evisceration have long been employed by ophthalmologists to manage ophthalmic conditions such as severe penetrating trauma or blind painful eyes. Debate surrounding both preferred surgical technique and choice of orbital implant in the anophthalmic socket have persisted over many decades, and continues today.
Volume 10 - Issue 2
Fundus Autofluorescence: Should I Be Using it in My Practice?
By AMANDEEP S. RAI, MD, and NUPURA K. BAKSHI, MD, FRCSC
Fundus autofluorescence (FAF) is an emerging technology with several research and clinical applications. FAF imaging has demonstrated utility in diagnosing macular and retinal disease, identifying disease progression, and monitoring response to therapy.
Volume 10 - Issue 1
Femtosecond Laser Cataract Surgery: Improving Precision, Improving Results
By RAYMOND STEIN, MD, FRCSC, and REBECCA STEIN, BSc, MBCHB (CANDIDATE)
Femtosecond cataract surgery is considered to be one of the most significant advances in cataract surgery in 50 years. Laser cataract surgery has shown excellent results for accurate self-sealing corneal incisions, arcuate incisions to reduce astigmatism, highly circular, strong and well-positioned capsulorhexis, and safer and less technically difficult removal of the cataract with almost complete elimination of phacoemulsification.
Volume 9 - Issue 6
Diabetic Retinopathy: Where We Were, Where We Are, and Where We Need to Go
By JOSHUA S. MANUSOW, MD, and DAVID T. WONG, MD, FRCSC
Diabetic retinopathy continues to be a significant cause of vision loss. However, we currently have more treatment options than ever before, such as vascular endothelial growth factor inhibitors, to offer our patients.
Volume 9 - Issue 5
Optic Neuritis – Keys to Differentiating the Typical Presentation from Atypical Causes
By KATHY CAO, MD, FRCSC, MED (Candidate), and EDWARD MARGOLIN, MD, FRCSC
Optic neuritis (ON), an acute inflammatory disorder of the optic nerve, is often the presenting sign of multiple sclerosis (MS). It is most commonly seen in young Caucasian women. The primary objective in the initial patient evaluation is to differentiate typical ON – ie, ON associated with demyelination – from a symptom set that suggests an atypical presentation requiring additional investigations.
Volume 9 - Issue 4
Step by Step: Identifying and Managing Intermediate Uveitis
By CARLA LUTCHMAN, MD, and LARISSA DERZKO-DZULYNSKY, MD, FRCSC
Although uveitis is significantly more common than previously believed, according to a large population-based study, it has been described as the “anatomic diagnosis that causes the most confusion among Ophthalmologists.” This issue of Ophthalmology Rounds reviews the common etiologies of intermediate uveitis, mainly in the adult population, and presents an approach to its diagnosis and stepwise treatment.
Volume 9 - Issue 3
Differentiating Vitreoretinal Interface Pathology with Spectral-domain Optical Coherence Tomography
By CHRYSSA McALISTER, MD, SHAO-ONN YONG, BSc (Hons), MBBS, MMED, FRCSE, and WAI-CHING LAM, MD, FRCSC
Optical coherence tomography (OCT) is an imaging modality that has revolutionized the way the vitreoretinal interface is visualized. Over the past 2 decades, OCT has highlighted the role of vitreomacular adhesions in the development of many vitreoretinal interface pathologies.
Volume 9 - Issue 2
Diabetic Macular Edema: Current Management and Future Options
By RAJEEV H. MUNI, MD, MSc (Clin Epi), FRCSC, and RADHA P. KOHLY, MD, PhD, FRCSC
Diabetic macular edema (DME) is the leading cause of moderate vision loss in working-aged individuals in developed countries. Strict blood sugar and blood pressure (BP) control remain the most effective interventions to date.
Volume 9 - Issue 1
Corneal Collagen Crosslinking: A Major Breakthrough in the Management of Keratoconus, Pellucid Marginal Degeneration, and
Ectasia after LASIK
By RAYMOND STEIN, MD, FRCSC, and REBECCA STEIN, BSc HONOURS (MEDICINE)
Corneal collagen crosslinking (CXL) is recognized as a major therapeutic advance in the management of ectatic diseases. CXL treatment involves the use of riboflavin drops (vitamin B2) and ultraviolet A (UV-A) light. The primary goal of CXL is to stabilize the corneal curvature and prevent the need for corneal transplantation.
Volume 8 - Issue 6
Corneal Limbal Stem-cell Technology: Expanding the Options for Cell Cultivation and Transplantation
By HALL F. CHEW, MD, FRCSC
Stem-cell technology is an exciting treatment in medicine, wherein ophthalmology is leading the way. With our anatomical and histopathological knowledge, the visibility of the eye allows for ease of assessment of stem-cell treatments compared to other neurological and visceral organs of the human body.
Volume 8 - Issue 5
The Intravitreal Use of Corticosteroids – Balancing Benefit and Risk
By PETER J. KERTES, MD, CM, FRCSC, and ALEJANDRO OLIVER, MD, MSc, FRCSC
The use of intravitreal (IV) corticosteroids was first explored 35 years ago and the enthusiasm for its use has waxed and waned over that time. While IV steroids will likely be supplanted by anti-vascular endothelial growth factor (VEGF) therapies as a primary treatment for retinal vascular diseases such as diabetic macular edema (DME) and retinal venous occlusive disease, the potent and largely unmatched anti-inflammatory properties of steroids will continue to make this a treatment of choice for conditions such as posterior uveitis.
Volume 8 - Issue 4
Pediatric Orbital Tumours – Saving Young Eyes and Young Lives
By ALBERT Y. WU, MD, PhD, ANTHONY C. SO, BSc, and DAN D. DEANGELIS, MD, FRCSC
Although rare, pediatric orbital tumours may be associated with significant morbidity and risk of mortality, thus identifying and properly managing these patients are of utmost priority. This issue of Ophthalmology Rounds reviews the most common orbital tumours of childhood.
Volume 8 - Issue 3
Cases in Visual Electrophysiology: Unique Insight into Sight
By CAROL WESTALL, PhD
Visual electrophysiology provides unique insight into the functional integrity of different levels of the visual pathway and assists in clinical diagnosis. A common referral to pediatric visual electrophysiology is the child who presents with nystagmus. In the presence of a normal-appearing fundus, the nystagmus may relate to a sensory defect in the visual pathways.
Volume 8 - Issue 2
Lacrimal Trauma in the Adult
By JEFFREY JAY HURWITZ, MD, FRCSC
According to the Canadian Ophthalmological Society, at least 100 000 Canadians experience an accidental eye injury annually. Data from the United States Eye Injury Registry indicate that almost one-third (31%) of eye injuries are caused by a blunt object, followed by a sharp object (18%) and motor-vehicle accident (9%).
Volume 8 - Issue 1
Issues in the Management of the Anophthalmic Socket: Clinical, Comfort, and Cosmetic
By MICHAEL C.F. WEBB, BADO, BCO, FASO
Ophthalmologists have many different perspectives on the terms “artificial eye” or “ocular prosthetic”. Indeed, it is not the last resort for enucleation and evisceration and, as the field of ocularistry has advanced, so too has the relationship with ophthalmologists. To fully recognize enucleation and evisceration as a multidisciplinary approach is to offer patients the best option for a truly successful procedure.
Volume 7 - Issue 6
Advances in Low Vision Rehabilitation
By SAMUEL N. MARKOWITZ, MD, FRCSC
Clinically, low vision (LV) is defined as an untreatable impairment that limits pertinent activities of daily living (ADL), and is one of the 10 most prevalent causes of disability. Given current demographic changes, most cases of LV are caused by age-related eye diseases, particularly, age-related macular degeneration (AMD).
Volume 7 - Issue 5
Update on Age-Related Macular Degeneration
By EFREM MANDELCORN MD, FRCSC, and MARK MANDELCORN MD, FRCSC
In developed countries, age-related macular degeneration (AMD) is the leading cause of irreversible legal blindness in adults ≥65 years of age. Considering the current increase in life expectancy and the projected increase in the average age of the population, AMD is likely to become a major public health concern in the future.
Volume 7 - Issue 4
A Review of Diabetic Retinopathy
By DANIEL WEISBROD, MD, FRCSC, and CAROL SCHWARTZ, MD, FRCSC
Diabetes mellitus is the leading cause of blindness in adults <75 years old, and without proper screening, patients can have significant retinopathy before visual loss even occurs. Primary interventions such as control of glycemia, blood pressure, and lipids can have a major impact on the development and progression of diabetic retinopathy.
Volume 7 - Issue 3
The Management of Orbital Tumours
By EDSEL B. ING, MD, FRCSC, and KHALED E. ABUHALEEQA, MD, FRCSC
Orbital tumours are rare, but they have the potential to debilitate vision and become life threatening. Given the serious consequences, all ophthalmologists should be able to recognize and appropriately triage patients with orbital disease.
Volume 7 - Issue 2
Update on Endothelial Keratoplasty
By JOSEPH J.K. MA, MD, FRCSC, PATRICK Y.H. WONG, BSEE, and SILVIA ODORCIC, BA
New surgical techniques in endothelial keratoplasty (EK) have provided promising alternatives to the traditional “gold standard” treatment for endothelial dysfunction, penetrating keratoplasty (PKP). Compared with PKP, EK techniques allow for faster visual rehabilitation, a more predictable change in refractive power, a decrease in surgicallyinduced astigmatism, and a lower incidence of graft rejection.
Volume 7 - Issue 1
Squamous Neoplasia of the Conjunctiva:
The New TNM Classification by the American Joint Committee on Cancer (AJCC)
By HUGH D. MCGOWAN, MD, FRCSC
Recently, the American Joint Committee on Cancer (AJCC) and the International Union Against Cancer (IUCC) developed an update for the tumour, node, metastasis (TNM) classification of conjunctival intraepithelial neoplasia (CIN), carcinoma in situ (Cis), and squamous cell carcinoma (SCC).
Volume 6 - Issue 6
Aspects of Pediatric Oculoplastics Trauma: Floor Fracture and Canalicular Lacerations
By KIM JEBODHSINGH, MBBS, and DAN D. DEANGELIS, MD, FRCSC
The management of orbital trauma utilizes different approaches to achieve the same final goal: the restoration of normal orbital and craniofacial anatomy and the return of function. Orbital floor fractures and canalicular lacerations in the pediatric age group require special considerations in diagnosis, management, and treatment.
Volume 6 - Issue 5
Pupillary anatomy, physiology, and related disorders
By EDWARD MARGOLIN, MD, FRCSC, and CLARA C. CHAN, MD
Knowledge of pupillary anatomy and physiology is essential for any practicing ophthalmologist. This knowledge provides a wealth of information about visual pathways that can guide clinicians in differentiating relatively minor conditions from life-threatening illnesses.
Volume 6 - Issue 4
The Kenyan National Retinoblastoma Strategy: Building Local Capacity in the Diagnosis and Management of Pediatric Eye Cancer in Kenya
By HELEN DIMARAS, PhD, ABBY WHITE, and BRENDA GALLIE, MD
Death from a delayed diagnosis of retinoblastoma is almost unheard of in developed countries, where 97% of patients are cured and the main focus of treatment is on preserving vision. The high cure rate achieved in resource-rich countries can be equally achieved in Kenya with minimal financial input, by building local capacity for improved diagnosis and management of retinoblastoma.
Volume 6 - Issue 3
Optic Nerve: Anatomy, Function, andCommon Disorders
By EDWARD A. MARGOLIN, MD, FRCSC , and RAJESHVAR K. SHARDA, MD
Optic nerve diseases and disorders affect millions of people worldwide. These small nerves act as cables to form the essential link connecting the eye to the brain. At any point along this trajectory, damage to these nerves will result in visual impairment; further, due to the crossing over of nerve fibres at the optic chiasm, various distinct patterns of visual loss can occur.
Volume 6 - Issue 2
Update on Retinitis Pigmentosa
By TRACEY WONG, MBChB , FRANZCO, and MICHAEL H. BRENT, MD, FRCSC
Retinitis pigmentosa (RP) is a group of hereditary diseases in which progressive photoreceptor degeneration results in increasing visual dysfunction. Worldwide, the prevalence is approximately 1 in 4000. Inheritance patterns include: autosomal dominant (30%-40%), autosomal recessive (50%-60%), and X-linked (5%-15%). Patients may also present as isolated cases without known affected family members.
Volume 6 - Issue 1
A Practical Approach to the Management of Eyelid Tumours
By JEFFREY JAY HURWITZ, MD, FRCSC
In the July/August 2005 edition of Ophthalmology Rounds (Volume 2, Issue 4) Dr. David Howarth, a pathologist at Mount Sinai Hospital and the University
of Toronto, outlined a pragmatic approach to understanding the pathology of benign and malignant eyelid tumours.
Volume 5 - Issue 6
Adult Strabismus Part 2: Therapeutic Options
By STEPHEN P. KRAFT, MD, FRCSC
The last issue of Ophthalmology Rounds presented the prevalent misconceptions and realities associated with adult strabismus. It discussed why adult strabismus is a disabling condition in most patients and explained why treatment for adults with eye muscle conditions should be considered restorative or reconstructive and not cosmetic.
Volume 5 - Issue 5
Adult Strabismus Part 1: Myths and Reality
By STEPHEN P. KRAFT, MD, FRCSC
References to adult strabismus go back to ancient times. Egyptian statues dating from 2750 BCE and 1850 BCE reveal pharaohs with horizontal strabismus,1 while Egyptian papyri from the 18th century BCE describe a misaligned eye and an eye with amblyopia. Despite the long-documented history of adult eye muscle disorders and their treatment, several misconceptions are still prevalent among eyecare professionals.
Volume 5 - Issue 4
An Update on Advanced Intraocular Lens (IOL) Technology: Monofocal IOLs
By BASEER U. KHAN, MD, FRCS(C)
The past two decades have witnessed incredible advancements in the technologies and therefore, the subsequent outcomes of cataract surgery. The first 10 years saw the near universal acceptance of phacoemulsification as the standard of care in cataract extraction, while the past decade has seen a plethora of advances in IOL technologies. Although originally proposed by Sir Harold Ridley in 1955, the IOL was not widely accepted until the mid-
Volume 5 - Issue 3
By MARK BONA, MD, and AGNES WONG, MD, PhD, FRCSC
Pregnancy is associated with changes to multiple organ systems, including the visual system. The effects of pregnancy on vision can be divided into 3 broad categories.
Volume 5 - Issue 2
Update on the Management of Age-related Macular Degeneration (AMD): Part II – Atrophic “Dry” AMD
By LUIS G. RIVEROS, MD, and MICHAEL H. BRENT, MD, FRCSC
This issue of Ophthalmology Rounds presents Part II of an update on the management of AMD. This article discusses the epidemiology and genetic aspects of the disease and presents the relevant outcomes of clinical trials involving the atrophic or dry form of AMD.
Volume 5 - Issue 1
Update on the Management of Age-related Macular Degeneration (AMD): Part I – Neovascular AMD
By MICHAEL H. BRENT, MD, FRCSC
Age-related macular degeneration (AMD) continues to be the leading cause of severe vision loss in North America and the developed world. Approximately 17,000 new cases of neovascular AMD and 180,000 cases of geographic atrophy (dry) AMD occur in Canada each year.
Volume 4 - Issue 6
Advances in Corneal Transplantation
By DAVID S. ROOTMAN, MD, FRCSC
It has been 101 years since Dr. Eduard Zirm performed the first successful penetrating keratoplasty (PKP). He operated on the eyes of an itinerant farm worker who had been blinded by alkali.
Volume 4 - Issue 5
The Management of an Ectropion and an Entropion for the Comprehensive Ophthalmologist
By JEFFREY J. HURWITZ, MD, FRCSC
An ectropion (where the eyelid margin rolls outward) and an entropion (where the eyelid margin rolls inward) can affect both the upper and the lower eyelid. In the lower lid, the etiology can be cicatricial but, more often, it is due to aging and relaxational changes within the supporting structures of the lower eyelid.
Volume 4 - Issue 4
Thyroid Orbitopathy: What the General Ophthalmologist Should Know
By NANCY TUCKER, MD
Thyroid orbitopathy can be a devastating illness for the thousands of patients who develop this condition each year. The frustration for both patients and physicians relates to battling a disease that presently has few good treatment options and about which much remains unknown. However, there have been some advances over the past decade in both understanding its pathophysiology and in the treatment options for this illness.
Volume 4 - Issue 3
Update on the Diagnosis and Management of Retinopathy of Prematurity
By NASRIN NAJM-TEHRANI, MB, BCh, MSc, FRCS ED (Ophth)
Retinopathy of prematurity (ROP) is a disease affecting the immature retina. Infants born at low gestational age (GA) and low birth weight (BW) are at the highest risk for developing this disease. Although most cases of ROP regress spontaneously as the infant matures, a small, but significant number develop severe ROP that can lead to cicatricial changes in the retina, tractional retinal detachment, and eventual blindness.
Volume 4 - Issue 2
Update on Nonpenetrating Glaucoma Surgery
By BASEER U. KHAN, MD, and IKE K. AHMED, MD
Over the last 30 years, trabeculectomy has been the standard of care for surgically-managed glaucoma. Several refinements in surgical technique and postoperative care (eg, the use of antimetabolites, argon suture lysis, and releasable sutures) have improved the success rates for trabeculectomy, but complications continue to occur at significant rates.
Volume 4 - Issue 1
The Management of Macular Holes
By DAVID T. WONG, MD, FRCSC
Macular holes are full-thickness retinal tissue defects centered at the fovea. They were first described by Knapp in 1869 in a case of ocular trauma. For the next 100 years, there were further descriptions of macular holes and theories expounded on the cause for the problem, but no therapy was devised.
Volume 3 - Issue 6
Ocular Oncology: Intraocular Metastatic Tumours
By SOHEL SOMANI , MD
The most common form of intraocular malignancy encountered by an ophthalmologist is metastatic disease, with the most common sources being breast and lung cancer. Most metastatic disease involves the posterior choroid, and can be multifocal and/or bilateral.
Volume 3 - Issue 5
By NURHAN TORUN, MD, FRCSC
Ophthalmologists occasionally encounter patients who complain that they are not able to see well, yet they have relatively intact visual acuities and fields and an unremarkable examination. Such a scenario may be due to a disorder affecting higher cortical centers involved in the processing of visual information.
Volume 3 - Issue 4
A Practical Approach to Understanding the Pathology of Eyelid Tumours
By DAVID HOWARTH , MD
“Know thy enemy: know thyself” paraphrases Sun Tzu in The Art of War, an ancient treatise on the practice of warfare and the sociopolitical implications
of war. Sun Tzu was an Oriental general retained by a Chinese king to help establish an army.
Volume 3 - Issue 3
By ALLAN R. SLOMOVIC , MA, MD, FRCS, MICHAEL HYAMS , MD, RUTH LAPID, MD
Ocular allergic disease is a common and potentially serious problem for the comprehensive ophthalmologist. The spectrum of disease ranges from minor ocular allergy to severe and chronic sight-threatening conditions that have a major impact on quality of life. Ocular allergic disease affects approximately 20% of the population.
Volume 3 - Issue 2
The Complications of Blepharoplasty Surgery – Part 2
By JAMES OESTREICHER, MD, FRCSC
Part 1 of this comprehensive presentation by Dr. James Oestreicher, a leading Canadian Oculoplastic Surgeon, was featured in the January/February issue of Ophthalmology Rounds; Part 2 is presented in this issue.
Volume 3 - Issue 1
The Complications of Blepharoplasty Surgery – Part 1
Cosmetic surgery is becoming much more of a consideration for a greater number of people. Women and men, regardless of age, occupation, or socio-economic level, are interested in maintaining a youthful persona and optimizing their appearance. The incidence of cosmetic eyelid operations is increasing exponentially, being performed by many different specialties. However, when complications occur, it is the ophthalmologist who is called upon for help.
Volume 2 - Issue 10
The Diagnosis and Management of Epiphora when the Lacrimal Drainage Pathways are Patent
By JEFFREY JAY HURWITZ, MD, FRCSC
When a patient presents with symptoms of tearing, the diagnosis that usually springs to mind is that of a blocked tearduct. However, most patients with symptoms of tearing do not have blocked tearducts and the etiology is something else.
Volume 2 - Issue 9
Advances in Refractive Surgery
By RAYMOND M. STE I N, MD, FRCSC
In recent years, refractive surgery has undergone significant technological advances that have led to enhanced safety, predictability, and patient satisfaction. In the past, the goal was to achieve an uncorrected visual acuity that was similar to the best-corrected acuity with contact lenses or
Volume 2 - Issue 8
A Genetic View of Corneal Dystrophies
By ELISE HÉON MD, FRCSC
Corneal dystrophies refer to a group of corneal diseases that are genetically determined. These diseases have been traditionally classified and described according to the layer of cornea involved and the pathological changes observed, respectively. It is now known that this classification does not reflect the underlying pathobiology or genetic defects involved.
Volume 2 - Issue 7
Pterygium – An Update on Current Concepts and Treatment Modalities
By SAO BING LEE, MD, and ALLAN SLOMOVIC, MD
A pterygium is a relatively common eye disorder that predominates in warm, dry areas north and south of the equator. Although excision with conjunctival grafting is currently the gold standard of treatment, new treatments have been described, some of which have the potential to cause ocular surface complications.
Volume 2 - Issue 6
Ocular Oncology: Malignant Melanoma of the Conjunctiva
By HUGH D. McGOWAN, M.D.
Malignant melanoma of the conjunctiva/cornea is a rare malignancy of conjunctival melanocytes, in which management may ultimately affect survival.
Distinguishing malignant melanoma of the conjunctiva from other melanocytic tumours of the conjunctiva is based on certain clinical features of the tumour.
Volume 2 - Issue 5
Surgical Management of Coexisting Cataract and Glaucoma
By YVONNE M. BUYS, MD, FRCSC
Glaucoma and cataracts are both diseases associated with aging and, as a result, it is not unusual to find both conditions coexisting in the same patient. In the past, however, combined surgery was not a popular procedure since the individual surgeries have conflicting endpoints, namely satisfactory wound closure in cataract surgery and the maintenance of a filtering wound in glaucoma surgery.
Volume 2 - Issue 4
Phacoemulsification Techniques and Innovations
By ROSA BRAGA-MELE, M.Ed, MD, FRCSC
Cataract surgery and phacoemulsification techniques have advanced dramatically over the past 10 years. The trend has been towards less traumatic surgery by using ultrasound-assisted phacoaspiration instead of vacuum-assisted phacoemulsification.
Volume 2 - Issue 3
Ophthalmic Pathology: Pigmented Conjunctival Lesions
By YENI H. YÜCEL, MD, PhD, FRCPC
The richness and diversity of ophthalmic pathology has served as a platform for the clinical practice of ophthalmology. Its application to ophthalmology has had a phenomenal impact on our understanding of the natural history of eye disease and the response of tissues to treatment modalities. Furthermore, ophthalmic pathology, as a discipline concerned with how and why ocular cells break away from normal physiological roles and relationships, remains at the interface between experimental and clinical ophthalmology.
Volume 2 - Issue 2
Age-related Macular Degeneration
By MICHAEL H. BRENT, M.D.
Age-related macular degeneration (AMD) is the leading cause of irreversible severe vision loss in North America and developed countries throughout the world. AMD patients, 55 years of age and older, often present to the office with a variety of visual symptoms. A targeted diagnostic approach can help determine and stage the disease process. Results from recent clinical trials and emerging technology are changing the way AMD is managed.
Volume 2 - Issue 1
By CHARLES J. PAVLIN, MD
Ultrasound is an indispensable tool in medical imaging and plays an important role in ophthalmologic diagnoses. Conventional B-scan examination produces 2-dimensional cross-sectional views of the eye and orbit. This method of imaging is the most important examination technique for intraocular lesions, particularly in the presence of anterior segment opacities.
Volume 1 - Issue 3
Cosmetic Eyelid and Eyebrow Surgery
By DAN D. DEANGELIS MD, FRCS(C)
The art of ophthalmic plastic and reconstructive surgery has evolved considerably over the last few decades. Procedures that were previously the domain of the plastic surgeon have been incorporated into the practices of comprehensive ophthalmologists, ophthalmic plastic surgeons, and other subspecialty trained physicians.
Volume 1 - Issue 2
By SAMUEL N. MARKOWITZ, MD, FRCS (C)
The practice and teaching of low vision rehabilitation (LVR) in all university-based ophthalmology programs is mandated by The Royal College of Physicians and Surgeons of Canada for the purposes of accreditation. Although formal training is acquired by most, and in spite of an ever-increasing need for practitioners of LVR, few ophthalmologists across the country (and, in fact, across North America) offer low vision (LV) services to their patients.
Volume 1 - Issue 1
By JEFFREY JAY HURWITZ, MD
Patients with symptoms associated with the lacrimal system commonlypresent to their physician’s office. The anatomical and physiological integrity
of the lacrimal drainage pathways are important components of the properfunctioning eye and periocular structures. This inaugural issue of Ophthalmology Rounds will focus on three cases that emphasize important issues related to the lacrimal drainage system.