Gender trends in match rate to surgical specialties in Canada: A retrospective study from 2003-2022.

BACKGROUND: In Canada, there is a recognized underrepresentation of women in the field of surgery. However, the extent to which this trend applies across various surgical specialties is not well delineated. The aim of this study is to identify existing disparities and trends over time to inform the need for future interventions to make the match process more equitable for applicants. METHODS: Data regarding surgical specialty applicants was extracted from the Canadian Resident Matching Service (CaRMS)'s 2003 to 2022 reports. RESULTS: A total of 9,488 applicants ranked surgical specialties as their first choice from 2003-2022. Increases in the proportion of women applicants comparing periods 2003-2007 to 2018-2022 were significant for cardiac surgery (22% to 43%, p = 0.03), general surgery (46% to 60%, p<0.001), orthopedic surgery (23% to 35%, p<0.001), urology (23% to 38%, p<0.001), and all aggregated surgical specialties ('all surgery') (45% to 55%, p<0.001). An increase in the proportion of women applicants who matched over the same periods was observed for general surgery (+47% to 60%, p<0.001), orthopedic surgery (24% to 35%, p<0.01), urology (21% to 34%, p<0.001), and all surgery (46% to 54%, p<0.001). From 2003-2022, a lower match rate for women compared to men was observed for otolaryngology (0.60 v 0.69, p = 0.008), urology (0.61 v 0.72, p = 0.003), and all surgery (0.71 v 0.73, p = 0.038), while higher match rates were observed for ophthalmology (0.65 v 0.58, p = 0.04). No statistically significant differences in match rate were observed from 2018-2022. CONCLUSIONS: While the proportion of women applicants to surgical specialties in Canada has been increasing, women remain underrepresented in several surgical specialties. This underrepresentation cannot be solely attributed to fewer women applying to these specialties, as women experience lower success rates when matching to specific surgical specialties. Further research is essential to identify and address the underlying causes of these disparities.

Performance evaluation in cataract surgery with an ensemble of 2D-3D convolutional neural networks.

An important part of surgical training in ophthalmology is understanding how to proficiently perform cataract surgery. Operating skill in cataract surgery is typically assessed by real-time or video-based expert review using a rating scale. This is time-consuming, subjective and labour-intensive. A typical trainee graduates with over 100 complete surgeries, each of which requires review by the surgical educators. Due to the consistently repetitive nature of this task, it lends itself well to machine learning-based evaluation. Recent studies utilize deep learning models trained on tool motion trajectories obtained using additional equipment or robotic systems. However, the process of tool recognition by extracting frames from the videos to perform phase recognition followed by skill assessment is exhaustive. This project proposes a deep learning model for skill evaluation using raw surgery videos that is cost-effective and end-to-end trainable. An advanced ensemble of convolutional neural network models is leveraged to model technical skills in cataract surgeries and is evaluated using a large dataset comprising almost 200 surgical trials. The highest accuracy of 0.8494 is observed on the phacoemulsification step data. Our model yielded an average accuracy of 0.8200 and an average AUC score of 0.8800 for all four phase datasets of cataract surgery proving its robustness against different data. The proposed ensemble model with 2D and 3D convolutional neural networks demonstrated a promising result without using tool motion trajectories to evaluate surgery expertise.

Trends in ophthalmology applicants going unmatched in the Canadian Resident Matching Service.

Background: Applicants to ophthalmology have high rates of going unmatched during the CaRMS process, but how this compares to other competitive or surgical specialties remains unclear. Our research aims to examine this phenomenon by identifying trends and comparing match data with other specialties, to identify disparities that may inform the need for future interventions to improve the match process for applicants. Methods: We used a cross-sectional analysis of data provided by CaRMS on the residency match from 2013 to 2022. Results: We obtained data from 608 ophthalmology, 5,153 surgery, and 3,092 top five (most competitive) specialty first choice applicants from 2013-2022. Ophthalmology applicants were more likely to go unmatched (18.9% [120/608]) than applicants to the top five (11.9% [371/3,092]) and surgical (13.5% [702/5,153]) specialties (p<0.001) and were twice as likely to rank no alternate disciplines (31.8%, p < 0.001) over the study period. In the first iteration, when alternate disciplines were ranked, the match rate to alternate disciplines was highest for ophthalmology applicants (0.41, p < 0.001). The majority (57.8%) of unmatched ophthalmology applicants do not participate in the second iteration. Conclusion: Compared to other competitive specialties, first choice ophthalmology applicants were more likely to go unmatched, rank no alternate disciplines, and choose not to participate in the second iteration. Ophthalmology applicant behaviours should be further studied to help explain these study findings.

Contexte: Les candidats à l'ophtalmologie ont un taux élevé de non-jumelage au cours du processus CaRMS, mais une comparaison avec d'autres spécialités compétitives ou chirurgicales reste à faire. Notre travail a pour but d'examiner ce phénomène en identifiant des tendances et en comparant les données de jumelage avec celles d'autres spécialités, à la recherche de disparités susceptibles d'éclairer le besoin d'interventions futures pour améliorer le processus de jumelage pour les candidats. Méthodes: Nous avons procédé à une analyse transversale des données fournies par CaRMS sur le jumelage des résidents de 2013 à 2022. Résultats: Nous avons obtenu des données sur 608 candidats en ophtalmologie, 5 153 en chirurgie et 3 092 candidats dont le premier choix était l'une des cinq spécialités les plus compétitives de 2013 à 2022. Les candidats en ophtalmologie étaient plus susceptibles de ne pas être jumelés (18,9 % [120/608]) que les candidats aux cinq spécialités les plus compétitives (11,9 % [371/3 092]) et aux spécialités chirurgicales (13,5 % [702/5 153]) (p<0,001), et étaient deux fois plus susceptibles de ne classer aucune autre discipline (31,8 %, p<0,001) au cours de la période d'étude. Lors du premier tour, lorsque des disciplines alternatives ont été classées, le taux de jumelage avec les disciplines alternatives était le plus élevé pour les candidats en ophtalmologie (0,41, p<0,001). La majorité (57,8 %) des candidats non jumelés en ophtalmologie ne participent pas au deuxième tour. Conclusion: Comparativement à d'autres spécialités compétitives, les candidats dont le premier choix étaient l'ophtalmologie étaient plus susceptibles de ne pas être jumelés, de ne pas classer d'autres disciplines et de choisir de ne pas participer au deuxième tour. Les comportements des candidats en ophtalmologie devraient faire l'objet d'études plus approfondies afin d'expliquer nos résultats.

Recent developments and future avenues for human corticospinal neuroimaging.

Non-invasive neuroimaging serves as a valuable tool for investigating the mechanisms within the central nervous system (CNS) related to somatosensory and motor processing, emotions, memory, cognition, and other functions. Despite the extensive use of brain imaging, spinal cord imaging has received relatively less attention, regardless of its potential to study peripheral communications with the brain and the descending corticospinal systems. To comprehensively understand the neural mechanisms underlying human sensory and motor functions, particularly in pathological conditions, simultaneous examination of neuronal activity in both the brain and spinal cord becomes imperative. Although technically demanding in terms of data acquisition and analysis, a growing but limited number of studies have successfully utilized specialized acquisition protocols for corticospinal imaging. These studies have effectively assessed sensorimotor, autonomic, and interneuronal signaling within the spinal cord, revealing interactions with cortical processes in the brain. In this mini-review, we aim to examine the expanding body of literature that employs cutting-edge corticospinal imaging to investigate the flow of sensorimotor information between the brain and spinal cord. Additionally, we will provide a concise overview of recent advancements in functional magnetic resonance imaging (fMRI) techniques. Furthermore, we will discuss potential future perspectives aimed at enhancing our comprehension of large-scale neuronal networks in the CNS and their disruptions in clinical disorders. This collective knowledge will aid in refining combined corticospinal fMRI methodologies, leading to the development of clinically relevant biomarkers for conditions affecting sensorimotor processing in the CNS.

Investigating the associations between lumbar paraspinal muscle health and age, BMI, sex, physical activity, and back pain using an automated computer-vision model: A UK Biobank study.

BACKGROUND CONTEXT: The role of lumbar paraspinal muscle health in back pain (BP) is not straightforward. Challenges in this field have included the lack of tools and large, heterogenous datasets to interrogate the association between muscle health and BP. Computer-vision models have been transformative in this space, enabling the automated quantification of muscle health and the processing of large datasets. PURPOSE: To investigate the associations between lumbar paraspinal muscle health and age, sex, BMI, physical activity, and BP in a large, heterogenous dataset using an automated computer-vision model. DESIGN: Cross-sectional study. PATIENT SAMPLE: Participants from the UK Biobank with abdominal Dixon fat-water MRI (N=9,564) were included (41.8% women, mean [SD] age: 63.5 [7.6] years, BMI: 26.4 [4.1] kg/m2) of whom 6,953 reported no pain, 930 acute BP, and 1,681 chronic BP. OUTCOME MEASURES: Intramuscular fat (IMF) and average cross-sectional area (aCSA) were automatically derived using a computer-vision model for the left and right lumbar multifidus (LM), erector spinae (ES), and psoas major (PM) from the L1 to L5 vertebral levels. METHODS: Two-tailed partial Pearson correlations were generated for each muscle to assess the relationships between the muscle measures (IMF and aCSA) and age (controlling for BMI, sex, and physical activity), BMI (controlling for age, sex, and physical activity), and physical activity (controlling for age, sex, and BMI). One-way ANCOVA was used to identify sex differences in IMF and aCSA for each muscle while controlling for age, BMI, and physical activity. Similarly, one-way ANCOVA was used to identify between-group differences (no pain, acute BP, and chronic BP) for each muscle and along the superior-inferior expanse of the lumbar spine while controlling for age, BMI, sex, and physical activity (α=0.05). RESULTS: Females had higher IMF (LM mean difference [MD]=11.1%, ES MD=10.2%, PM MD=0.3%, p<.001) and lower aCSA (LM MD=47.6 mm2, ES MD=350.0 mm2, PM MD=321.5 mm2, p<.001) for all muscles. Higher age was associated with higher IMF and lower aCSA for all muscles (r≥0.232, p<.001) except for LM and aCSA (r≤0.013, p≥.267). Higher BMI was associated with higher IMF and aCSA for all muscles (r≥0.174, p<.001). Higher physical activity was associated with lower IMF and higher aCSA for all muscles (r≥0.036, p≤.002) except for LM and aCSA (r≤0.010, p≥.405). People with chronic BP had higher IMF and lower aCSA than people with no pain (IMF MD≤1.6%, aCSA MD≤27.4 mm2, p<.001) and higher IMF compared to acute BP (IMF MD≤1.1%, p≤.044). The differences between people with BP and people with no pain were not spatially localized to the inferior lumbar levels but broadly distributed across the lumbar spine. CONCLUSIONS: Paraspinal muscle health is associated with age, BMI, sex, and physical activity with the exception of the association between LM aCSA and age and physical activity. People with BP (chronic>acute) have higher IMF and lower aCSA than people reporting no pain. The differences were not localized but broadly distributed across the lumbar spine. When interpreting measures of paraspinal muscle health in the research or clinical setting, the associations with age, BMI, sex, and physical activity should be considered.

Eight-Year Outcomes of Bilateral Lateral Rectus Recessions versus Unilateral Recession-Resection in Childhood Basic-Type Intermittent Exotropia.

PURPOSE: To report 8-year outcomes from a randomized controlled trial (RCT) comparing bilateral lateral rectus muscle recession (BLRc) with unilateral recession-resection (R&R) for childhood intermittent exotropia (IXT). DESIGN: Eight-year follow-up of RCT cohort. PARTICIPANTS: Of 197 randomized participants, 123 agreed to continue follow-up after the 3-year outcome visit (baseline age, 3-< 11 years; basic-type IXT, 15-40 prism diopters [Δ] by prism and alternate cover test [PACT]; baseline stereoacuity, ≤ 400 arcsec; no prior surgery). METHODS: After the RCT primary outcome at 3 years, annual follow-up from 4 through 8 years with treatment at investigator discretion. MAIN OUTCOME MEASURES: Suboptimal surgical outcome by 8 years after randomization, defined as any of the following at any visit: exotropia of 10 Δ or more by simultaneous prism cover test (SPCT) at distance or near, constant esotropia (ET) of 6 Δ or more by SPCT at distance or near, loss of near stereoacuity by 0.6 log arcsec or more from baseline, or reoperation. Secondary outcomes included (1) reoperation by 8 years and (2) complete or near-complete resolution at 8 years, defined as exodeviation of less than 10 Δ by SPCT and PACT at distance and near and 10 Δ or more reduction from baseline by PACT at distance and near, ET of less than 6 Δ at distance and near, no decrease in stereoacuity by 0.6 log arcsec or more from baseline, and no reoperation or nonsurgical treatment for IXT. RESULTS: The Kaplan-Meier cumulative probability of suboptimal surgical outcome through 8 years was 68% (55 events among 101 at risk) for BLRc and 53% (42 events among 96 at risk) for R&R (difference, 15%; 95% confidence interval [CI], -2% to 32%; P = 0.08). Complete or near-complete resolution at 8 years occurred in 15% (7/46) for BLRc and 37% (16/43) for R&R (difference, -22%; 95% CI, -44% to -0.1%; P = 0.049). The cumulative probability of reoperation was 30% for BLRc and 11% for R&R (difference, 19%; 95% CI, 2%-36%; P = 0.049). CONCLUSIONS: Despite no significant difference for the primary outcome, the 95% CI did not exclude a moderate benefit of R&R, which together with secondary outcomes suggests that unilateral R&R followed by usual care may yield better long-term outcomes than BLRc followed by usual care for basic-type childhood IXT using these surgical doses. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Development of a standardized Canadian undergraduate medical education ophthalmology curriculum.

OBJECTIVE: To create a standardized undergraduate medicine ophthalmology curriculum for Canadian medical schools. DESIGN: Two-stage modified Delphi technique. PARTICIPANTS: Undergraduate ophthalmology leads at all the medical schools in Canada and 6 nonophthalmologist physicians with medical education expertise. METHODS: In stage 1, a preliminary list of curricular objectives was developed using the 2018 Association of University Professors in Ophthalmology's list of curricular objectives as a foundation. Subsequently, an online survey was sent to 24 individuals (18 ophthalmology undergraduate curriculum leads and 6 non-ophthalmology medical educators) at 17 institutions to evaluate the objectives using a 5-point Likert-type scale. In stage 2, the ophthalmology curriculum leads were invited to participate in a virtual meeting during which the list of curricular objectives was discussed and finalized by consensus. RESULTS: In stage 1, a preliminary list of 76 learning objectives organized into 10 overarching topics was developed. A total of 21 survey responses were received (87.5% response rate), allowing for the creation of a revised list. In stage 2, five participants from four schools met, achieving consensus following one round of feedback. The final undergraduate ophthalmology curriculum contained 10 topics and 75 objectives; it covered common presentations of a variety of acute and chronic eye diseases that were felt to be relevant to a wide medical audience. CONCLUSIONS: The consensus obtained on a comprehensive list of undergraduate medicine ophthalmology curricular objectives identified in this study is the first of its kind in Canada. These objectives can be used by medical schools across Canada to standardize undergraduate ophthalmology teaching.

Gender Representation on North American Ophthalmology Societies' Governance Boards.

Purpose We examined the gender distribution and academic productivity of North American ophthalmology societies' board members. Methods Cross-sectional and retrospective study of board members on American and Canadian ophthalmology societies. In December 2022, data was gathered from society webpages, online archives, and the Scopus database for publication information. Results Of the identified 73 board presidents and 876 other board members, 49 (67.1%) board presidents were men and 24 (32.9%) were women, while 554 (63.2%) other board members were men and 322 (36.8%) were women ( p = 0.53). Overall, board members who were men had significantly higher median h-indexes (men vs. women: 10 [interquartile range [IQR] = 22] vs. 7 [IQR = 12], p = 0.03) and median publication numbers (men vs. women: 23 [IQR = 84] vs. 14 [IQR = 52.3], p = 0.01). However, m-quotients (h-index divided by length of academic career) were not significantly different (men vs. women: 0.46 [IQR = 0.74] vs. 0.50 [IQR = 0.55], p = 0.67). Overall, a significant increase in the proportion of women board presidents comparing periods 1942 to 1961 and 2002 to 2021 was observed for all societies combined (3.1% [2/65] to 23.6% [210/888], p < 0.001). Conclusion The fraction of women on the academic boards in North American ophthalmology societies has increased sevenfold over the past 83 years. The gender composition of ophthalmology society boards is consistent with the gender composition of practicing ophthalmologists in the United States. Women in board or society positions have comparable academic output to men. Existing and new efforts to sustain progress in promoting women's representation and leadership opportunities must continue.

Spontaneous Late Visual Recovery in Pediatric Central Retinal Artery Occlusion: A Case Report and Literature Review.

The authors report a rare case of pediatric central retinal artery occlusion (CRAO) and spontaneous late recovery, with associated literature review. A retrospective review of patient medical records and literature search of four relevant databases was conducted. A 7-year-old girl with sudden, painless loss of vision in her right eye was referred to the authors' center where she was found to have a CRAO with hand motion visual acuity. One month later, the patient developed multiple retinal hemorrhages throughout the fundus. Despite undergoing extensive investigations, a cause for her condition was not determined. Seventeen months after the original event, the patient regained a visual acuity of 20/40. A CRAO in the pediatric population is relatively rare and requires extensive investigation into the potential cause. Compared to adult CRAO, presentation in the pediatric age group should warrant a high index of suspicion and extensive work-up to treat any underlying systemic conditions and possibly prevent involvement of the other eye. [J Pediatr Ophthalmol Strabismus. 2023;60(6):e70-e74.].

Systematic review of simulation-based education in strabismus assessment and management.

BACKGROUND: Strabismus is a dynamic condition for which simulation-based training is valuable, given the variable complexity and relatively reduced exposure compared with other ophthalmic presentations. This study assessed the performance of simulation models available for medical training in the assessment and management of strabismus. METHODS: A systematic review of relevant peer-reviewed academic databases was conducted, without publication date restrictions. English-language publications evaluating the performance of simulation models for education on strabismus were included. Risk of bias was assessed using the Cochrane RoB-2 tool and CLARITY Risk of Bias Instrument for Cross-Sectional Surveys of Attitudes and Practices. Validity of evidence was evaluated using the Kirkpatrick framework. RESULTS: Of the total 3,298 citations exported for title and abstract screening, 54 advanced to full-text screening, and 7 were included in final review. Model types were either dry (2), wet (4), or virtual reality (1). All models were deemed to be successful, but few standardized parameters were specified. Costs of models ranged from a few dollars (ball and wood), to moderate (non-cadaveric), to costly (virtual reality). All studies scored a moderate or high risk of bias, and the majority (4/7) of studies scored level 1 on the Kirkpatrick scale. CONCLUSIONS: Research on simulation for strabismus assessment and management is limited and varied for model fidelity and testing audiences. All models were deemed individually successful compared to non-simulation-based teaching methodologies, although no direct comparisons were made. The limited evidence available suggests that low-fidelity and low-cost models can be used for trainees without sacrificing educational quality.

Evaluation of commitment to equity, diversity, and inclusion on Canadian ophthalmology residency program websites.

OBJECTIVE: Program websites play a crucial role in providing information to prospective residency applicants. This research assesses the extent to which Canadian ophthalmology residency programs demonstrate their commitment to equity, diversity, and inclusion (EDI) through their websites and identifies areas for potential improvement. METHODS: A cross-sectional analysis of websites affiliated with 15 accredited Canadian ophthalmology residency training programs was performed. A score was assigned based on 16 EDI elements derived from recent literature. The relationship between program website EDI elements with language, geography, and regional population diversity was explored. RESULTS: Of the 15 Canadian ophthalmology residency programs, 12 (80%) met at least 1 of 16 EDI elements, with a mean program score of 2.4 (SD = 1.92). The program that attained the highest score met 7 of 16 EDI elements. Anglophone programs had a higher mean score (2.92; SD = 1.78) when compared with their Francophone counterparts (0.33; SD = 0.58; p = 0.023). No significant difference was found between programs in western, central, and eastern Canada (p = 0.86). The regional minorities proportion associated with each program was not found to influence scores (p = 0.088). CONCLUSIONS: EDI elements were seldom addressed on Canadian ophthalmology residency program affiliated websites. We propose recommendations in 4 domains: showcasing team diversity, clear discourse in recruitment, inclusive resources, and program organization. Improving EDI visibility on program websites through revisions of existing websites or through creation of new promotional websites may foster recruitment of a diverse resident body.

Missed appointments in a tertiary academic pediatric ophthalmology and adult strabismus service: cross-sectional study and literature review.

PURPOSE: To investigate the rate of missed appointments in a Canadian academic hospital-based pediatric ophthalmology and adult strabismus practice and the demographic and clinical factors associated with missed appointments. METHODS: This cross-sectional study included all consecutive patients seen from June 1, 2018, to May 31, 2019. Multivariable logistic regression model assessed associations between clinical and demographic variables with no-show status. A literature review on evidence-based interventions to reduce no-show appointments in ophthalmology was performed. RESULTS: Of 3,922 visits, 718 (18.3%) were no-shows. Characteristics associated with no-shows included new patient (OR = 1.4; 95% CI, 1.1-1.7 [P = 0.001]), age 4-12 years (OR = 1.6; 95% CI, 1.1-2.3 [P = 0.011]) or age 13-18 years (OR = 1.8; 95% CI, 1.2-2.7 [P = 0.007]) compared with age 19+ years, history of previous no-shows (OR = 2.2; 95% CI, 1.8-2.7 [P = 0.001]), referrals from nurse practitioners (OR = 1.8; 95% CI, 1.0-3.2 [P = 0.037]), nonsurgical diagnoses such as retinopathy of prematurity (OR = 3.2; 95% CI, 1.8-5.6 [P < 0.001]), and winter season (OR = 1.4; 95% CI, 1.2-1.7 [P < 0.001]). CONCLUSIONS: Missed appointments in our pediatric ophthalmology and strabismus academic center are more likely new patient referrals, prior no-shows, referrals from nurse practitioners, and nonsurgical diagnoses. These findings may facilitate targeted strategies to help improve utilization of healthcare resources.

The Role of Interferon-α in Neurodegenerative Diseases: A Systematic Review.

BACKGROUND: Neurodegenerative diseases (NDs) impose significant financial and healthcare burden on populations all over the world. The prevalence and incidence of NDs have been observed to increase dramatically with age. Hence, the number of reported cases is projected to increase in the future, as life spans continues to rise. Despite this, there is limited effective treatment against most NDs. Interferons (IFNs), a family of cytokines, have been suggested as a promising therapeutic target for NDs, particularly IFN-α, which governs various pathological pathways in different NDs. OBJECTIVE: This systematic review aimed to critically appraise the currently available literature on the pathological role of IFN-α in neurodegeneration/NDs. METHODS: Three databases, Scopus, PubMed, and Ovid Medline, were utilized for the literature search. RESULTS: A total of 77 journal articles were selected for critical evaluation, based on the inclusion and exclusion criteria. The studies selected and elucidated in this current systematic review have showed that IFN-α may play a deleterious role in neurodegenerative diseases through its strong association with the inflammatory processes resulting in mainly neurocognitive impairments. IFN-α may be displaying its neurotoxic function via various mechanisms such as abnormal calcium mineralization, activation of STAT1-dependent mechanisms, and increased quinolinic acid production. CONCLUSION: The exact role IFN-α in these neurodegenerative diseases have yet to be determine due to a lack in more recent evidence, thereby creating a variability in the role of IFN-α. Future investigations should thus be conducted, so that the role played by IFN-α in neurodegenerative diseases could be delineated.

Self-reported physical function is strongly related to pain behavior and pain interference and weakly related to physical capacity in people with chronic low back pain.

BACKGROUND: Inclusion of self-reported and capacity-based measures may help to further elucidate the interactive link between how people think and move. OBJECTIVE: To characterize the relationship between self-reported factors of physical function and pain with objective physical capacity measures. DESIGN: Cross-sectional study of 328 adults with chronic low back pain (CLBP). METHOD: Spearman correlations assessed the relationship between pairs of measures. Multiple linear regression models assessed the association between self-reported measures of physical function and the grouping of physical capacity measures. Self-reported measures included Roland Morris Disability Questionnaire (RMDQ), PROMIS Physical Function, Pain Behavior, and Pain Interference; Fear-Avoidance Beliefs Questionnaire (FABQ), Pain Catastrophizing Scale (PCS), and Chronic Pain Acceptance Questionnaire (CPAQ). Capacity measures included walking speed and endurance, lower extremity functional strength, lumbopelvic range of motion, and trunk endurance. RESULTS: PROMIS Physical Function was directly and weakly correlated with walking speed (ρ = 0.26, 2-min walk) and inversely and weakly correlated with lower extremity strength (ρ = -0.29, 5x sit-to-stand). RMDQ was not correlated with any of the capacity-based measures. PROMIS Physical Function was inversely and moderately correlated with Pain Interference (ρ = -0.48) and Pain Behavior (ρ = -0.43), PCS (ρ = -0.36), and FABQ (ρ = -0.31). The RMDQ was strongly correlated with PROMIS Physical Function (ρ = -0.56), Pain Behavior (ρ = 0.51) and Pain Interference (ρ = 0.49); and moderately correlated with PCS (ρ = 0.37) and FABQ (ρ = 0.33). PROMIS Physical Function and RMDQ were not correlated with CPAQ. Lower scores on PROMIS Physical Function were weakly associated with lower measures of lower extremity strength (-0.30, 95% CI: -0.51 to -0.09, p = 0.005). Higher scores on RMDQ were also weakly associated with lower measures of lower extremity strength (0.26, 95% CI: 0.11 to 0.41, p = 0.001). CONCLUSIONS: A strong association emerged between self-reported limitations in physical function, pain behavior, and pain interference. A weak association emerged between self-reported physical function and lower extremity strength.

Utilization and barriers to eye care following school-wide pediatric vision screening.

OBJECTIVE: In August 2018, Ontario introduced the Child Visual Health and Vision Screening Protocol outlining school-based senior kindergarten (aged 4-6 years) vision screening. We determine the prevalence of children at risk based on screening in an Ontario community and follow up to determine resource utilization after screening. METHODS: Vision screening data (HOTV, Randot, Autorefractor) from 41 schools (1127 children) were collected for the 2018-2019 and 2019-2020 school years. Phone follow-up was conducted 1-1.5 years after screening to determine whether an optometry visit occurred, if glasses were prescribed, and potential barriers to accessing eye care. Independent t tests were used to compare time to follow-up between groups, and χ2 testing was used for associations between material and social deprivation. RESULTS: Overall screening resulted in a 32.2% referral rate within our region. Of the referred children who responded, the rate of seeking out eye care was 69.9% (n = 64), and 65.2% of these visits were prompted specifically by vision screening, and 34.4% of referred children respondents were prescribed glasses. There was a significant relationship between receiving a referral and living in a more materially deprived (p = 0.001) and a more socially deprived area (p = 0.006). The most frequently reported barriers were related to insufficient insurance coverage for eye care or glasses, COVID-19-related difficulties, and scheduling conflicts. CONCLUSION: Our vision screening program identified and referred more than one third of children screened for follow-up eye examinations, with children in more deprived neighbourhoods being more frequently referred. Around two thirds of referred children sought care, and one third were prescribed glasses in the follow-up sample.

Use of Machine Learning to Assess Cataract Surgery Skill Level With Tool Detection.

Purpose: To develop a method for objective analysis of the reproducible steps in routine cataract surgery. Design: Prospective study; machine learning. Participants: Deidentified faculty and trainee surgical videos. Methods: Consecutive cataract surgeries performed by a faculty or trainee surgeon in an ophthalmology residency program over 6 months were collected and labeled according to degrees of difficulty. An existing image classification network, ResNet 152, was fine-tuned for tool detection in cataract surgery to allow for automatic identification of each unique surgical instrument. Individual microscope video frame windows were subsequently encoded as a vector. The relation between vector encodings and perceived skill using k-fold user-out cross-validation was examined. Algorithms were evaluated using area under the receiver operating characteristic curve (AUC) and the classification accuracy. Main Outcome Measures: Accuracy of tool detection and skill assessment. Results: In total, 391 consecutive cataract procedures with 209 routine cases were used. Our model achieved an AUC ranging from 0.933 to 0.998 for tool detection. For skill classification, AUC was 0.550 (95% confidence interval [CI], 0.547-0.553) with an accuracy of 54.3% (95% CI, 53.9%-54.7%) for a single snippet, AUC was 0.570 (0.565-0.575) with an accuracy of 57.8% (56.8%-58.7%) for a single surgery, and AUC was 0.692 (0.659-0.758) with an accuracy of 63.3% (56.8%-69.8%) for a single user given all their trials. Conclusions: Our research shows that machine learning can accurately and independently identify distinct cataract surgery tools in videos, which is crucial for comparing the use of the tool in a step. However, it is more challenging for machine learning to accurately differentiate overall and specific step skill to assess the level of training or expertise. Financial Disclosures: The author(s) have no proprietary or commercial interest in any materials discussed in this article.