Please contact Prem Nichani for a copy of the Abstract as it is not officially accepted by nor published in a scholarly journal. Currently under review at Ophthalmology Retina.

Presentations

1. Popovic MM, Nichani P, Dhoot AS, Pathak A, Muni RH, Kertes PJ. (2021). Treat-and-extend dosing of intravitreal anti-VEGF agents in neovascular age-related macular degeneration: A meta-analysis of 1697 eyes. UofT Department of Ophthalmology & Vision Sciences 62nd Research Day, Toronto, Ontario, Canada (ePoster). View presentation, references, and conflicts of interest here.

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Background: Insurance coverage may reduce cost barriers to obtain vision correction. We determined the frequency and source of prescription eyewear insurance to understand how Canadians finance optical correction.

Methods: Insurance data from Ontario respondents to the Canadian Community Health Survey in 2003, 2005, and 2013/14 was analyzed. Unadjusted proportions and adjusted prevalence ratios (APR) of having insurance were compared.

Results: Insurance covered all or part of the costs of prescription eyewear for 62% of Ontarians in all survey years (n=42,777 in 2003, 41,766 in 2005, and 42,553 in 2013/2014). Among those insured, 84-86% had employer-sponsored coverage, 9-10% from government-sponsorship, and 6-7% via private plans. In 2005 and 2013/14, employer-sponsored coverage remained at 87% for individuals in households with post-secondary graduation, but decreased significantly for those in households without secondary school graduation, from 67.0% (95% confidence interval [CI] 63.2-70.8%, 175,000 individuals) in 2005 to 54.6% (95% CI 50.1-59.2%, 123,500 individuals) in 2013/14. Government-sponsored coverage increased significantly for individuals in households without secondary school graduation, from 29.2% (95% CI 26-33%, 76,400 individuals) in 2005 to 41.7% (95% CI 37-46%, 93,900 individuals) in 2013/14. Ontarians in households without secondary school graduation (versus those with) were less likely to report employer-sponsored coverage (APR 0.79, 95% CI 0.75-0.84), but more likely to have government-sponsored coverage (APR 1.27, 95% CI 1.06-1.53).

Interpretation: 62% of Ontarians had prescription eyewear insurance. The largest source of insurance was employer-sponsored, primarily covering those with higher levels of education. In recent years, government-sponsored insurance increased significantly among less-educated individuals.

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Abstract

Micro-invasive glaucoma surgery (MIGS) is a potentially safer and more efficacious method studied in patients with mild-to-moderate open-angle glaucoma (OAG) requiring less invasive treatment goals; however, the literature on MIGS must be thoroughly evaluated. We conducted a review of MIGS by searching MEDLINE, EMBASE, and Cochrane CENTRAL. Primary efficacy indicators were reductions in intraocular pressure (IOP) and topical medication use postoperatively. While all comparative randomized controlled trials assessing MIGS in English peer-reviewed journals were included, only observational studies with a target follow-up of at least one year and a high priority score were analyzed, resulting in a total of 3476 eyes across 20 trials. The mean age was 69.5 ± 2.9, 53.7% were female, and 77.4% were Caucasian. One study had last follow-up at less than one year, fifteen studies had follow-up extending 1-2 years, and four had longer than two years of follow-up. A pattern of more significant IOP and medication reduction was observed in MIGS patients (n=2170) relative to control (n=1306) interventions. iStent had the most literature supporting its efficacy, followed by Hydrus. The most common adverse events following MIGS implantation included stent obstruction, inflammation, and subsequent surgical intervention. Surgical complication rates and efficacy are favorable following MIGS. This review helps to consolidate the high-quality evidence that exists for various MIGS procedures and to identify gaps where further research is needed.

Keywords: IOP reduction; MIGS; filtration surgery; glaucoma surgery; ocular drainage implant; open-angle glaucoma.

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John Yip, a highly respected leader in ophthalmology and community health, is the CEO of Kensington Health in Toronto, Canada. He accrued his reputation as a leader in previous roles as the Vice-President of Corporate Services for Health Quality Ontario, a managing consultant for GCI, the IT and business consulting services giant, a senior consultant at Pricewaterhousecoopers Consulting, and a consultant at KPMG. John has made significant strides in health, reducing cataract surgery operating room turnover times from 30 minutes down to a mere seven which is integral when such a procedure has a waitlist of over a year amidst a rapidly aging population. His experiences, insights, and achievements are profoundly influential, not just for other current and future CEOs in healthcare but also for any front-line worker who is willing and dedicated to making an impact during this unprecedented COVID-19 pandemic. There is much to learn from John in terms of leading a revolution to transform and innovate within our healthcare system for the better.

This brief COVID-19-focused leadership interview with John can be summarized into the following key points: (1) Rather than looking to ‘innovate’ and radically change healthcare, look at the triumphs and failures of the past. Often, there is much to learn and improve with little to no additional resources in a way that can significantly ameliorate the care we provide; (2) Three qualities every leader should possess are courage, integrity, and selflessness; (3) Introspection is a crucial part of success. Take the time to reflect on the past and present so you can create sustainable goals for the future without burning out; and (4) Believe in yourself and work hard no matter how difficult it may be because it will always get better, no matter what happens.

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Presentations

1. Nichani P, Popovic MM, Muni RH, Mireskandari K, Tehrani NN, Kertes PJ. (2020). Intravitreal injections versus laser photocoagulation for retinopathy of prematurity: A meta-analysis of 3701 eyes. American Academy of Ophthalmology, Las Vegas, NV, United States (ePoster). Spotlighted by OphthalmologyAdvisor.com and PracticeUpdate.com. View ePoster with narration here.
2. Popovic MM, Nichani P, Muni RH, Mireskandari K, Tehrani NN, Kertes PJ. (2020). Intravitreal injections versus laser photocoagulation for retinopathy of prematurity: A meta-analysis of 3701 eyes. European Society of Retina Specialists EURetina, Virtual Meeting (oral). View presentation here.
3. Popovic MM, Nichani P, Muni RH, Mireskandari K, Tehrani NN, Kertes PJ. (2020). Intravitreal injections versus laser photocoagulation for retinopathy of prematurity: A meta-analysis of 3701 eyes. UofT Department of Ophthalmology & Vision Sciences 62nd Research Day, Toronto, ON (oral). Alumni Award for Best Resident Research Presentation. View presentation here.

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Vision problems from giant cell arteritis (GCA) can be difficult to diagnose as patients may present with vision loss in the absence of systemic symptoms, have other comorbidities that affect inflammatory blood markers, or have other ocular diagnoses. We present 3 cases illustrating this point including a patient with advanced glaucoma with worsening vision from posterior ischemic optic neuropathy from GCA, a patient with arteritic anterior ischemic optic neuropathy (AAION) erroneously diagnosed as optic neuritis without elevated inflammatory blood markers due to corticosteroid use, and a patient with AAION and a history of nonarteritic anterior ischemic optic neuropathy in her fellow eye and untreated obstructive sleep apnea. GCA should be kept in the differential diagnosis for patients over 50 years of age even if they carry other ocular diagnoses. Temporal artery biopsy remains the gold standard for GCA diagnosis and is often required in equivocal cases.

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Abstract

Topic: The role of topical nonsteroidal anti-inflammatory drugs (NSAIDs) for the reduction of ocular pain after intravitreal injections (IVIs) has been explored. To provide clarity on the evidence for these agents, the present meta-analysis of randomized controlled trials (RCTs) was undertaken.

1. Popovic MM, Muni RH, Nichani P, Kertes PJ. (Oct 2020). Topical non-steroid anti-inflammatory drugs for pain from intravitreal injections: A meta-analysis. European Society of Retina Specialists EURetina, Virtual Meeting (ePoster). View ePoster here.

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1. Micieli JA, Nichani P. (2020). Granuloma annulare, scalp necrosis, and ischemic optic neuropathy from giant cell arteritis after varicella-zoster virus vaccination. Canadian Ophthalmological Society Annual Meeting & Exhibition, Vancouver, BC (ePoster).

Notes

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