Ophthalmology as a career choice among medical students: a survey of students at a Canadian medical school.

BACKGROUND: There is a lack of investigations into the factors that lead medical students to pursue increasingly competitive post-graduate training programs. We sought to determine the factors that influence medical students' opinions on ophthalmology as a career and on ophthalmological medical education. METHODS: An anonymous 36-question survey was distributed to all medical students across the four program years at the Schulich School of Medicine and Dentistry as a non-probabilistic convenience sample. Survey results were analyzed using Mann-Whitney U tests to determine significant differences between study sub-populations. Multivariate regression analysis was performed to identify correlates for positive views towards ophthalmology. RESULTS: 81% of questions had a mean positive response amongst the students. Students held negative views regarding the amount of exposure to ophthalmology in medical school. The greatest differences in opinion regarding ophthalmology were seen between those with more exposure and interest in ophthalmology compared to their counterparts with less. Regression analysis identified interest in ophthalmology as a significant correlate to a positive opinion in the field. CONCLUSIONS: Our survey demonstrates that while most students had positive views about ophthalmology, some aspects were viewed negatively. Students felt there was a lack of exposure, both educationally and clinically to ophthalmology, which may contribute to some misconceptions of the field. Early exposure appeared to be critical to forming positive opinions of ophthalmology and could be emphasized in medical education.

Post-operative analysis of pediatric esotropia associated with high hypermetropia.

BACKGROUND: To describe clinical features, evaluation, surgical management and outcomes in children with esotropia associated with high hypermetropia. METHODS: Medical records of healthy children who received strabismus surgery for accommodative esotropia with hypermetropia larger than spherical equivalence of + 4.0 diopters from 2009 to 2015, were reviewed. RESULTS: A total of 47 patients were identified. The average age was 2.9 years old. The average spherical equivalence of cycloplegic refraction was + 6.0 diopters (D). All patients presented with large angle esotropia with spectacle correction. Average age of esotropia onset was 1.3 years. Average time between the onset of esotropia to spectacle correction was 7.2 months. Average duration between onset of constant esotropia to strabismus surgery was 28.1 months. Average duration between spectacle correction to strabismus surgery was 21.8 months. Post-operatively, 74.5% of patients achieved ocular alignment within 10 prism diopters (PD) of orthotropia. Overall, 66.0% patients developed sensory fusion. For patients who achieved surgical success, 71.4% developed sensory fusion, compared at 50.0% for patients who were over- or under-corrected (p = 0.18). For patients who received hyperopic spectacles within 6 months of esotropia onset, 92.3% developed sensory fusion, compared with 54.5% for patients who received hyperopic spectacles at 6 month or later after esotropia onset (p = 0.02). CONCLUSIONS: Strabismus surgery for esotropia with high hypermetropia has high rate of surgical success with low rate of under- or over-correction. There is a trend toward higher rate of sensory fusion for patients with surgical success. Shorter time interval between esotropia onset and receiving hyperopic spectacles is associated with higher rate of sensory fusion development.

Impact of Early Postnatal Weight Gain on Retinopathy of Prematurity in Very Preterm Infants in Southwestern Ontario.

PURPOSE: To examine the relationship between post-natal growth and development of retinopathy of prematurity (ROP) among preterm infants in southwestern Ontario. METHODS: The medical records of 431 preterm infants, born between January 1, 2008, and June 1, 2015, with a gestational age (GA) of less than 31 weeks or birth weight (BW) of less than 1,250 g were reviewed. Information collected included pregnancy and birth history, neonatal characteristics, ROP status, comorbidities, and postnatal weight measurements at specified intervals. Infants diagnosed as having ROP and no ROP were compared. RESULTS: Low weight velocity from day 7 to day 28 (P < .001), high weight velocity from birth to first day of full enteral feeding (FEF) (P < .001), long duration from birth to FEF (P < .001), and long duration from FEF to discharge/transfer (P < .001) were associated with ROP. After controlling for GA and BW, the durations, birth to FEF, and FEF to discharge/transfer remained significant (P < .05). In a multivariable logistic regression analysis adjusting for GA, bronchopulmonary dysplasia, and surgical ligation for patent ductus arteriosus, the only independent risk factor of ROP was duration from FEF to discharge/transfer (P < .05). CONCLUSIONS: Low weight velocity from day 7 to day 28 may be a useful predictor for the development of ROP but is dependent on GA and BW. A delay to reach FEF, which is associated with comorbidities of ROP, appears to be a risk factor for ROP that is independent of GA and BW. [J Pediatr Ophthalmol Strabismus. 2019;56(3):168-172.].

Evaluation and surgical outcome of acquired nonaccommodative esotropia among older children.

OBJECTIVE: To describe the presentation, clinical evaluation, work-up, surgical management, and surgical outcomes in children older than 8 years with spontaneous, comitant, acquired nonaccommodative esotropia (ANAET). DESIGN: Retrospective chart review. PARTICIPANTS: Children who underwent bilateral medial rectus recession surgery for ANAET with initial esotropia onset later than 8 years of age. METHODS: The medical records of children older than 8 years presenting with ANAET from 2009 to 2015 were retrospectively reviewed. The clinical presentation, work-up, surgical intervention, preoperative and postoperative deviations, and surgical outcomes were recorded. RESULTS: A total of 7 healthy patients were identified. The average age of onset was 11.9 years. All patients presented with symptoms of diplopia with large-angle esotropia. Most patients had no preceding illness and presented with minimal refractive error. All 7 patients had unremarkable neurological and general pediatric evaluations without findings of acute intracranial pathology on neuroimaging. Bilateral medial recession surgery was performed for all 7 patients with resolution of diplopia and excellent stereopsis postoperatively. CONCLUSIONS: Diplopia is the most common presenting symptom among older children presenting with ANAET. Bilateral medial recession surgery achieved excellent postoperative results with resolution of diplopia and excellent stereopsis.

Evaluation of Canadian undergraduate ophthalmology medical education at Western University.

To assess and evaluate the current level of ophthalmology knowledge and teaching curriculum in undergraduate year 3 (MS-3) at Western University. The Undergraduate Medical Education Curriculum at Western University has instituted additional ophthalmology lecture series to all MS-3 students. A test on basic ophthalmic knowledge was administered to MS-3 students immediately before and after lecture series to evaluate the level of knowledge at baseline and after ophthalmology didactic teaching. An evaluation survey was also given to MS-3 students to assess students' self-perceived level of competency, exposure, and interests in ophthalmology. A total of 134 students attended the ophthalmology lecture series in the study, and 88.1% of students completed the pretest, post-test, and Ophthalmology Education Survey. The average pretest and post-test scores were 40.7% and 75.6% (p < 0.01), respectively. The average rating from MS-3 students for ophthalmology exposure during medical school education was 2.11 (1 = "very minimal" and 5 = "more than adequate"). The average rating for desire for additional didactic ophthalmology lectures was 4.02 (1 = "strongly disagree" and 5 = "strongly agree"). The average rating for interest in ophthalmology was 2.74 (1 = "very little interest" and 5 = "very strong interest"). The additional ophthalmology lecture series had a positive impact on the level of ophthalmic knowledge among MS-3 students, and a strong desire for more ophthalmology teaching during medical school education was identified, as evidenced by the survey undertaken by students after the lectures.

Predictability of horizontal versus vertical muscle surgery outcomes in thyroid eye disease.

Surgical repair of vertical muscles in thyroid eye disease (TED) is believed to yield more unpredictable results than horizontal muscle surgery. The purpose of this study is to determine if the short-term outcomes for strabismus surgery in TED are equally predictable for horizontal and vertical muscle surgery. We retrospectively reviewed the charts of 27 consecutive patients who underwent strabismus surgery for TED from a single surgeon's practice. Eligibility for inclusion in the study included biochemically stable thyroid disease for at least a year and stable orthoptic measurements for at least 6 months prior to surgery. Nine patients had surgery only on vertical rectus muscles, three only on horizontal, and fifteen on both vertical and horizontal rectus muscles. Mean follow-up was 2.4 ± 5.2 months. In primary gaze at 6 m, a mean horizontal deviation of 16.6 ± 22.3 PD, and a mean vertical deviation of 19.7 ± 14.1 PD were measured pre-operatively. Post-operatively, this measured 2.3 ± 8.4 PD horizontally and 2.1 ± 7.8 PD vertically (p = 0.933). There was no statistically significant difference between post-operative horizontal and vertical deviations in elevation, depression, adduction, and abduction. Nine patients required reoperation to attain satisfactory ocular alignment; seven of these cases involved repeat surgery on vertical muscles, while two cases required operation on both horizontal and vertical muscles. Results suggest that surgical outcomes of both horizontal and vertical muscle surgery are equally predictable in stable TED; however, reoperation rates were higher for vertical muscles compared to horizontal muscles.

Has rising pediatric obesity increased the incidence of idiopathic intracranial hypertension in children?

OBJECTIVE: Idiopathic intracranial hypertension (IIH) in children is an uncommon but significant cause of morbidity, including permanent visual loss. It is important to understand if, like obesity, IIH in children is on the rise and is related to that increase. The aim of this study is to compare the recent incidence rate of pediatric IIH in a tertiary care hospital with earlier data published from that same hospital. DESIGN: Retrospective chart review. PARTICIPANTS: All children aged 2 to 16 years diagnosed with IIH at the IWK Health Centre in Halifax between 1997 and 2007. METHODS: Charts of eligible patients were reviewed to ensure all diagnostic criteria for IIH were met. Incidence and obesity rates were calculated based on data from Statistics Canada. RESULTS: Twelve cases (5 males, 7 females) fulfilling the diagnostic criteria for IIH were identified, for an annual incidence of 0.6 cases per 100,000 children with no sex predilection (p = 0.51). Obesity was noted in 75% of patients examined (9/12). Children older than 12 years were more likely to be obese (6/6, 100%) compared with those younger than 12 years (3/6, 50%). CONCLUSIONS: The calculated incidence is lower than that found in an earlier study for the same geographic region (0.9 cases per 100,000 children) despite increasing obesity rates. This decrease may be a reflection of improved diagnostic techniques or may indicate that factors other than obesity govern IIH predilection in younger children.

Visuomotor control following surgical correction of strabismus in adults.

OBJECTIVE: To determine whether surgery to correct decompensated exotropia in adulthood had an impact on common visually guided manual tasks in the postoperative period. DESIGN: Case report. PARTICIPANTS: Three adult patients with long-standing strabismus. METHODS: Three adult patients took part in a series of preoperative and postoperative binocular and monocular reaching and grasping tasks before and after undergoing strabismus surgery. Tasks were designed to examine normal goal-directed actions (reaching to visual targets, grasping blocks) and to highlight differences between binocular and monocular control of action (grasping visible object in dark environment). RESULTS: A consistent pattern of change was not found in the 6- to 12-month postoperative period with the tasks provided. CONCLUSIONS: Surgery in adulthood to correct strabismus may not have a significant impact on the control of visually guided actions, at least in the first 6 to 12 months after surgery. Possibly, compensatory strategies used throughout their development (e.g., monocular cues) may continue to be used in the initial period postoperative period. More subjects and longer study period are recommended to make a definitive conclusion.

Transient blindness as the primary symptom of acute hyponatremia post surgery.

Hyponatremia is a common electrolyte abnormality among children and adults. Visual disturbance associated with hyponatremia has been described in the past; however, all of these cases presented primarily with other classical signs and symptoms of hyponatremia, such as seizures, gastrointestinal upset, lethargy, or headache. We present a child who developed blindness on post-operative day #6 after resection of a brain tumour. Computed tomography of the head showed no new bleed, mass lesion, edema, or occipital lobe pathology. Laboratory evaluation revealed acute hyponatremia (115 mmol/L). No other obvious symptoms of hyponatremia were present prior to its identification. As her hyponatremia was gradually corrected, her blindness completely resolved. This is the first reported patient with acute hyponatremia to present primarily with blindness; a "precondition" of chronically increased intracranial pressure (first hit) compounded by acute hyponatremia (second hit) may have induced reversible visual loss. Checking electrolytes should be the standard of care for neurosurgical patients with acute visual disturbance or other unexplained symptoms. It is a simple measure that quickly identifies a dangerous but reversible condition.

The effect of oral acetazolamide on weight gain in children.

OBJECTIVE: Oral acetazolamide is a potent medical treatment for pediatric glaucoma, but ophthalmologists may have concerns that it retards weight gain in children and may choose surgical management instead. DESIGN: Retrospective chart review. PARTICIPANTS: Twenty-two well children with glaucoma taking acetazolamide orally for >or=3 months. METHODS: Abnormal weight gain was determined using downward crossing of 2 percentile lines on growth charts and change in z score for weight using a hierarchical linear model. RESULTS: One patient with Sturge-Weber syndrome and growth failure was excluded when growth hormone deficiency was diagnosed. Two patients crossed 2 lines downward; both showed metabolic acidosis. The trend for the 2 reversed after medication was discontinued. The other 20 tracked steadily on growth curves. Eleven patients (11/22, 50%) showed a decline in z score for weight over the follow-up period, and the remainder showed an increase, for an overall estimate of slope in this sample of 0.01, which was not significant (p = 0.8). CONCLUSIONS: Oral acetazolamide may cause poor weight gain in a small subset of children on treatment. Metabolic acidosis may be a mediating factor for growth failure. Our data suggest that acetazolamide does not cause significant weight changes in cases of pediatric glaucoma. Growth parameters should be followed. Growth hormone deficiency should be considered in Sturge-Weber syndrome. Prospective study is needed.

Port-wine vascular malformations and glaucoma risk in Sturge-Weber syndrome.

PURPOSE: Treatment of the capillary vascular malformation (port-wine stain) in Sturge-Weber syndrome with the use of a laser is helpful cosmetically. However, concerns have been raised that laser obliteration of port-wine stains may result in ocular hypertension. The aim of this study was to review clinical features and management of ocular complications of SWS and assess the effects of dermatological laser treatment on the incidence of glaucoma or ocular hypertension. METHODS: This retrospective cohort study was conducted in an institutional setting. All patients had involvement of the face. Patients who underwent skin laser to the port-wine vascular malformation were analyzed further. Ocular involvement, glaucoma, and skin laser treatment and the relationship to ocular hypertension/glaucoma were observed. RESULTS: Forty-one Sturge-Weber syndrome patients with port-wine vascular malformation were analyzed. Glaucoma was observed in 24 patients (58.5%) at mean age of 2.9 years (range, 0.0-16.5). Of these, 18 (75.0%) were treated with medical therapy, and 10 (41.7%) required trabeculectomy, with 2 of these requiring Seton implant. Of the 41 patients, 28 (68.3%) underwent laser to face/forehead. Mean age of laser commencement was 5 years (range, 0.4-16.5). Thirteen did not undergo laser treatment. Fourteen of the 28 and 10 of the 13 developed ocular hypertension/glaucoma. CONCLUSIONS: This retrospective review did not find evidence to suggest that laser treatment of port-wine vascular malformations causes glaucoma or that it can worsen a preexisting ocular hypertension or glaucoma. Statistical analysis was inconclusive.

Late-onset bleb infections: prevalence and risk factors.

OBJECTIVE: The purpose of this study was to determine the rate and course of blebitis/late endophthalmitis 5-10 years post-filtration surgery and to evaluate risk factors. DESIGN: Retrospective chart review. PARTICIPANTS: Three hundred fifty consecutive patients undergoing filtration surgery from January 1, 1996, to December 31, 2001, by a single surgeon. Five hundred twenty-one surgeries were evaluated. METHODS: Data recorded included patient demographics, systemic disease(s), glaucoma type, left or right eye, date of surgery, last follow-up date, surgical procedure details, postoperative antimetabolite injections, bleb manipulations, bleb leaks and treatment, date of infection, type of infection, pre- and postinfection visual acuity, intraocular pressure (preinfection, during, and postinfection), treatment, and functionality of the bleb after infection. Statistical analysis used for assessment of risk factors included Fisher's exact test and the Student's t test analysis. RESULTS: There were a total of 5 bleb-related infections (0.96%), 4 blebitis and 1 endophthalmitis, occurring at a mean of 31.3 months after surgery. Three occurred in blacks and 2 in Caucasians. The mean age at surgery for the infected group was 53.5 years compared with 64.7 years for those with no infection. Mitomycin C was used in 4 of the 5 cases compared with in 52% of controls. Four underwent suture lysis. Bleb leaks occurred in 4 cases. The bleb remained functional and vision unchanged in the 4 blebitis cases; however, the endophthalmitis case lost vision and had uncontrolled pressure following the infection. CONCLUSIONS: We report a 0.96% bleb infection rate with a 5.3-year mean follow-up. Bleb leak, black race, and bleb manipulation were risk factors for infection.

Nanophthalmos: ultrasound biomicroscopy and Pentacam assessment of angle structures before and after cataract surgery.

We report a case of nanophthalmos with intractable secondary glaucoma. Bilateral cataract extraction with intraocular lens implantation was used as definitive treatment for the chronic angle-closure glaucoma. The changes in angle and ciliary body anatomy were well documented with preoperative and postoperative Pentacam assessment (Oculus Optikgeräte GmbH) and ultrasound biomicroscopy (Paradigm Medical Industries) images. We believe these are the first diagnostic and prognostic images of this kind in a nanophthalmic eye.

Anterior megalophthalmos in a family with 3 female siblings.

This report describes different modes of management in 3 sisters with anterior megalophthalmos. We report our management of the anterior megalophthalmos and a new technique of anterior chamber intraocular lens implantation, which was used in 1 case.