Skeletal muscle index based on CT at the 12th thoracic spine level can predict osteoporosis and fracture risk: a propensity score-matched cohort study.

Background: Multiple studies have shown that skeletal muscle index (SMI) measured on abdominal computed tomography (CT) is strongly associated with bone mineral density (BMD) and fracture risk as estimated by the fracture risk assessment tool (FRAX). Although some studies have reported that SMI at the level of the 12th thoracic vertebra (T12) measured on chest CT images can be used to diagnose sarcopenia, it is regrettable that no studies have investigated the relationship between SMI at T12 level and BMD or fracture risk. Therefore, we further investigated the relationship between SMI at T12 level and FRAX-estimated BMD and fracture risk in this study. Methods: A total of 349 subjects were included in this study. After 1∶1 propensity score matching (PSM) on height, weight, hypertension, diabetes, hyperlipidemia, hyperuricemia, body mass index (BMI), age, and gender, 162 subjects were finally included. The SMI, BMD, and FRAX score of the 162 participants were obtained. The correlation between SMI and BMD, as well as SMI and FRAX, was assessed using Spearman rank correlation. Additionally, the effectiveness of each index in predicting osteoporosis was evaluated through the receiver operating characteristic (ROC) curve analysis. Results: The BMD of the lumbar spine (L1-4) demonstrated a strong correlation with SMI (r = 0.416, p < 0.001), while the BMD of the femoral neck (FN) also exhibited a correlation with SMI (r = 0.307, p < 0.001). SMI was significantly correlated with FRAX, both without and with BMD at the FN, for major osteoporotic fractures (r = -0.416, p < 0.001, and r = -0.431, p < 0.001, respectively) and hip fractures (r = -0.357, p < 0.001, and r = -0.311, p < 0.001, respectively). Moreover, the SMI of the non-osteoporosis group was significantly higher than that of the osteoporosis group (p < 0.001). SMI effectively predicts osteoporosis, with an area under the curve of 0.834 (95% confidence interval 0.771-0.897, p < 0.001). Conclusion: SMI based on CT images of the 12th thoracic vertebrae can effectively diagnose osteoporosis and predict fracture risk. Therefore, SMI can make secondary use of chest CT to screen people who are prone to osteoporosis and fracture, and carry out timely medical intervention.

Prevalence of self-reported visual impairment among people in Canada with and without diabetes: findings from population-based surveys from 1994 to 2014.

BACKGROUND: Diabetes, a leading cause of visual impairment, is on the rise in Canada. We assessed trends in the prevalence of visual impairment among people in Canada with and without diabetes to inform the development of strategies and policies for the management of visual impairment. METHODS: We analyzed self-reported data from respondents aged 45 years and older in 7 cycles of nationwide surveys (National Population Health Survey and Canadian Community Health Survey) from 1994/95 to 2013/14. The age- and sex-standardized prevalence of visual impairment was calculated. We assessed comparisons by levels of education and income, using sex-standardized prevalence owing to sparse data. RESULTS: Among people in Canada with diabetes, the age- and sex-standardized prevalence of visual impairment was 7.37% (95% confidence interval [CI] 5.31%-9.43%) in 1994/95 and 1996/97 combined, decreasing to 3.03% (95% CI 2.48%-3.57%) in 2013/14, giving a standardized prevalence ratio of 0.41 (95% CI 0.30-0.56) comparing 2013/14 with 1994/95 and 1996/97 combined. Among people in Canada without diabetes, visual impairment prevalence decreased from 3.72% (95% CI 3.31%-4.14%) in 1994/95 and 1996/97 combined to 1.69% (95% CI 1.52%-1.87%) in 2013/14, with a standardized prevalence ratio of 0.45 (95% CI 0.40-0.52). Decreased sex-standardized prevalence of visual impairment was observed among people with high and low education levels and incomes among those with and without diabetes. INTERPRETATION: Visual impairment prevalence was roughly 2 times higher among those with versus without diabetes in all survey years; from 1994 to 2014, visual impairment prevalence decreased among those with and without diabetes irrespective of education and income levels. These results suggest effective collective efforts by clinicians, researchers, the public and government.

Endothelial depletion of Atg7 triggers astrocyte-microvascular disassociation at blood-brain barrier.

Microvascular basement membrane (BM) plays a pivotal role in the interactions of astrocyte with endothelium to maintain the blood-brain barrier (BBB) homeostasis; however, the significance and precise regulation of the endothelial cell-derived BM component in the BBB remain incompletely understood. Here, we report that conditional knockout of Atg7 in endothelial cells (Atg7-ECKO) leads to astrocyte-microvascular disassociation in the brain. Our results reveal astrocytic endfeet detachment from microvessels and BBB leakage in Atg7-ECKO mice. Furthermore, we find that the absence of endothelial Atg7 downregulates the expression of fibronectin, a major BM component of the BBB, causing significantly reduced coverage of astrocytes along cerebral microvessels. We reveal Atg7 triggers the expression of endothelial fibronectin via regulating PKA activity to affect the phosphorylation of cAMP-responsive element-binding protein. These results suggest that Atg7-regulated endothelial fibronectin production is required for astrocytes adhesion to microvascular wall for maintaining the BBB homeostasis. Thus, endothelial Atg7 plays an essential role in astrocyte-endothelium interactions to maintain the BBB integrity.

Backlog in ophthalmic surgeries associated with the COVID-19 pandemic in Ontario 2020.

OBJECTIVE: To assess the volume of deferred ophthalmic surgeries in Ontario associated with the COVID-19 pandemic from March to December 2020 and suggest strategies and time required to clear the backlog. DESIGN: Cross-sectional study. PARTICIPANTS: Ontarians eligible for the Ontario Health Insurance Plan in 2017-2020. METHODS: Backlog and clearance time for ophthalmic surgeries associated with the COVID-19 pandemic were estimated from time-series forecasting models and queuing theory. RESULTS: From March 16 to December 31, 2020, the estimated ophthalmic surgical backlog needing operating rooms was 92,150 surgeries (95% prediction interval, 71,288-112,841). Roughly 90% of the delayed surgeries were cataract surgeries, and a concerning 4% were retinal detachment surgeries. Nearly half the provincial backlog (48%; 44,542 of 92,150) was in patients from the western health region. In addition, an estimated 23,755 (95% prediction interval, 14,656-32,497) anti-vascular endothelial growth factor injections were missed. Estimated provincial clearance time was 248 weeks (95% CI, 235-260) and 128 weeks (95% CI, 121-134) if 10% and 20% of operating room surgical capacity per week were added, respectively, based on the weekly ophthalmic surgical volume in 2019. CONCLUSIONS: Ontario data demonstrate that the magnitude of the ophthalmic surgical backlog in 2020 alone raises serious concerns for meeting the ophthalmic surgical needs of patients. As the pandemic continues, the accrued backlog size is likely to increase. Planning and actions are needed urgently to better manage the collateral impacts of the pandemic on the ophthalmic surgical backlog.

Use of virtual care in ophthalmology in Ontario, Canada in 2020 during the COVID-19 pandemic.

OBJECTIVE: To investigate the use and trends of virtual care in ophthalmology and examine associated factors in a universal health care system during the COVID-19 pandemic in 2020. DESIGN: Cross-sectional study. PARTICIPANTS: Ontarians eligible for the Ontario Health Insurance Plan. METHODS: We used physician billing data from 2017-2020 to describe the use of virtual versus in-person care. We used logistic regression to examine factors associated with virtual care use. RESULTS: The uptake of ophthalmic virtual visits increased immediately following the government's directive to ramp down clinic activities and institution of a new virtual fee code (17.6%), peaked 2 weeks later (55.8%), and decreased immediately after the directive was lifted (24.2%). In March-December 2020, virtual visits were higher in female (11.6%) versus male (10.3%) patients and in patients <20 years of age (16.4%) and 20-39 years of age (12.3%) versus those aged 40-64 years (10.8%) and 65+ years (10.6%). Patients residing in the poorest/poorer neighbourhoods (10.9%) had similar use as their counterparts (11.1%). Patients with an acute infectious disease (14.2%) or nonurgent diagnosis (16.2%) had the highest use. Those with retinal disease had the lowest use (4.2%). Female ophthalmologists (15.4%) provided virtual care more often than male ophthalmologists (9.9%). Ophthalmologists aged 60-69 years (13.1%) provided virtual care more often than any other age groups (<40 years: 11.3%; 40-49 years: 11.0%; 50-59 years: 10.0%; and 70+ years: 7.7%). Multiple logistic regression models revealed similar results. CONCLUSION: Virtual care in ophthalmology increased significantly during the initial phase of the pandemic and decreased thereafter. There were significant variations in virtual care use by patient and ophthalmologist characteristics.

Differences in Practice Patterns and Payments for Female and Male Dermatologists: A Canadian Population-Based Study Over 3 Decades.

BACKGROUND: Canada's fee-for-service physician reimbursement system, where a set rate is provided for each service, suggests that a physician sex pay gap should not exist. However, recent evidence has questioned this presumption. OBJECTIVES: To characterize trends in demographics and billing, overall and by sex, for dermatologists compared to other medical and surgical specialty groups in Ontario, Canada. METHODS: Using population-based data, analysis of physician billing and clinical activity from Ontario, Canada, over 27 years (1992-2018) was performed. Multilevel regression models were used to examine unadjusted and adjusted differences in payments between females and males over time, while controlling for age, distinct patients seen, patient visits, and full-time equivalent. RESULTS: A total of 22 389 physicians were included in the analyses, including 381 dermatologists. The proportion of female dermatologists increased from 32% in 1992 to 46% in 2018. Dermatologists' median Ontario Health Insurance Plan (OHIP) payments were $415 340 (IQR: 285 630-566 580) in 1992 compared to $296 750 (IQR: 164 480-493 180) in 2018. Male dermatologists' OHIP payments were 20% more than their female counterparts across the entire study period. After adjusting for practice volumes, there was no significant pay gap amongst female and male dermatologists (P = .42); however, the sex pay gap remained significant for the other specialty groups (P < .001). From 1992 to 2018, dermatologists on average saw 19% fewer distinct patients per year and 15% fewer visits per patient. CONCLUSIONS: The overall sex pay gap within medical dermatology can be attributed to differences in practice patterns, whereas the sex pay gap remained significant in the other specialty groups.

Delayed anti-VEGF injections during the COVID-19 pandemic and changes in visual acuity in patients with three common retinal diseases: A systematic review and meta-analysis.

The COVID-19 pandemic disrupted the regular injections of anti-vascular endothelial growth factor (anti-VEGF) in patients with various retinal diseases globally. It is unclear to what extent delayed anti-VEGF injections have worsened patients' visual acuity. We performed a meta-analysis to assess the impact of delayed anti-VEGF injections on the best-corrected visual acuity (BCVA) in patients with neovascular age-related macular degeneration (nAMD), retinal vein occlusion (RVO), and diabetic macular edema (DME). We searched four computer databases (EMBASE, MEDLINE, Web of Science, Scopus) from inception to January 5, 2022. Data were pooled using the random-effects model. Results were reported by less than 4 months and 4 months or longer for the time period between the first injection during the pandemic and the last pre-pandemic injection. All BCVA measures were converted to the logarithm of the minimum angle of resolution (logMAR) for analyses. Among patients who received injections 4 months or longer apart, the mean difference in BCVA was 0.10 logMAR (or 5 ETDRS letters) (95% confidence interval [CI] 0.06∼0.14) for nAMD patients, 0.01 logMAR (or∼ 1 ETDRS letter) (95% CI -0.25∼0.27) for RVO patients, and 0.03 logMAR (or ∼1 ETDRS letters) (95% CI -0.06∼0.11) for DME patients. These results suggest that patients with nAMD needing scheduled anti-VEGF injections may require priority treatment over those with RVO and DME in the event of disturbed anti-VEGF injections from COVID-19 lockdowns or similar scenarios.

[Research progress on the regulation of mammalian energy metabolism by the circadian clock system and gut microbiota].

The mammalian internal circadian clock system has been evolved to adapt to the diurnal changes in the internal and external environment of the organism to regulate diverse physiological functions, such as the sleep-wake cycle and feeding rhythm, thereby coordinating the rhythmic changes of energy demand and nutrition supply in each diurnal cycle. The circadian clock regulates glucose metabolism, lipid metabolism, and hormones secretion in diverse tissues and organs, including the liver, skeletal muscle, pancreas, heart, and vessels. As a special "organ" of the host, the gut microbiota, together with the intestinal microenvironment (tissues, cells, and metabolites) in a co-evolutionary process, constitutes a micro-ecosystem and plays an important role in the process of nutrient digestion and absorption in the intestine of the host. In recent years, accumulating evidence indicates that the compositions, quantities, colonization, and functional activities of the gut microbiota exhibit significant circadian variations, which are closely related to the changes of various physiological functions under the regulation of host circadian clock system. In addition, several studies have shown that the gut microbiota can produce many important metabolites such as the short-chain fatty acids through the degradation of indigestive dietary fibers. A portion of gut microbiota-derived metabolites can regulate the circadian clock system and metabolism of the host. This article mainly discusses the interaction between the host circadian clock system and the gut microbiota, and highlights its influence on energy metabolism of the host, providing a novel clues and thought for the prevention and treatment of metabolic diseases.

Differences by sex in supply, payments and clinical activity of family physicians in Ontario: a retrospective population-based cohort study.

BACKGROUND: The proportion of women entering medicine has increased in recent years, and understanding the different practice patterns of female and male family physicians (FPs) will provide important information for health workforce planning. We sought to evaluate differences by sex in the supply, payments and clinical activity among FPs in Ontario. METHODS: We conducted a cohort study using claims data from the Ontario Health Insurance Plan. We included all Ontario FPs who submitted claims from 1992 to 2018. We analyzed data using regression analyses for our outcomes of yearly number of FPs, payments, patient visits and distinct patients. RESULTS: The number of practising FPs increased from 10 370 in 1992 to 14 329 in 2018, with an annual increase of 155 female FPs and 13 male FPs. In 2018, male FPs outnumbered female FPs by 1159. Among male FPs, 32.7% worked less than 1 full-time equivalent (FTE) position, 18.1% worked 1 FTE and 49.2% worked more than 1 FTE, with little change over the 27-year study period. Among female FPs, the percentage of those who worked less than 1 FTE position decreased over time (58.6% in 1998 to 48.3% in 2015), those who worked 1 FTE was stable (22.2%-24.3%) and those who worked more than 1 FTE increased (18.7% in 1998 to 28.0% in 2017). Yearly payments were higher for male FPs than female FPs by 40%-60% overall and by 10%-20% in FPs who worked more than 1 FTE. For FPs who worked 1 FTE or less than 1 FTE, both sexes had similar payment amounts (from 2005-2018). For FPs who worked 1 FTE, female FPs were less likely to receive payments from fee-for-service after 2004, and had 550 fewer visits and 121 fewer patients annually than male FPs. INTERPRETATION: In Ontario, there are differences by sex in FP supply, payments, percentages of FTE groups, number of patient visits and number of distinct patients. Health administrators should be mindful of these differences when considering FP workforce plans to ensure a stronger primary health care system, with adequate health care delivery for the population.

Prevalence of diabetic macular edema based on optical coherence tomography in people with diabetes: A systematic review and meta-analysis.

Diabetic macular edema (DME) is a leading cause of vision loss among people with diabetes. Optical coherence tomography (OCT) allows for accurate assessment and early detection of DME. Meta-analyses on DME prevalence diagnosed with OCT are lacking. We performed a meta-analysis to assess the global prevalence of OCT-diagnosed DME. We searched five electronic databases (EMBASE, CINAHL, Web of Science, Scopus, and MEDLINE) on May 29, 2020 and updated the search on March 19 and June 22, 2021. The quality of retrieved studies was evaluated using the Joanna Briggs Institute Checklist for Prevalence Studies. A random-effects model was used to pool prevalence estimates. Countries were classified into low-to-middle-income and high-income countries using World Bank data for subgroup analyses. Seven studies were included in this meta-analysis. The pooled prevalence of DME was 5.47% (95% CI: 3.66%-7.62%) overall, 5.81% (95% CI: 0.07%-18.51%) in low-to-middle-income countries and 5.14% (95% CI: 3.44%-7.15%) in high-income countries. We reported approximately 5.5% of people with diabetes have DME, with a statistically nonsignificantly lower prevalence in high-income countries versus low-to-middle-income countries. Given the global pandemic of diabetes, there is a need to inform physicians and educate people with diabetes regarding early detection and treatment of DME using OCT.

Impact of discontinuing government-funded routine eye exams on new glaucoma diagnoses in Ontario.

OBJECTIVE: In 2004, government-funded routine eye exams were discontinued for individuals aged 20-64 years in Ontario. We assessed whether this policy change reduced the rate of new glaucoma diagnoses. DESIGN: Cohort-based time-series analysis. PARTICIPANTS: Ontarians aged 20+ years in 2000-2014. METHODS: Province-wide physician billing data were analyzed using segmented regression analysis. New glaucoma diagnoses were defined as the first glaucoma diagnostic billing code submitted by an ophthalmologist or optometrist among Ontarians who did not visit an ophthalmologist or an optometrist in the year prior to the study year. RESULTS: Post- versus pre-2004, the rate of new glaucoma billings was reduced in all age groups: -2.7‰ (p < 0.0001) in the age group 20-39 years, -8.2‰ (p < 0.0001) in the age group 40-64 years (p < 0.0001), and -2.1‰ (p = 0.0003) in the age group 65+ years. This corresponds to a decreased number of individuals with a new glaucoma billing after 2004 versus before 2004: -8,800 (p < 0.001) in the age group 20-39 years, -32,234 (p < 0.0001) in the age group 40-64 years, and -3,255 (p = 0.0012) in the age group 65+ years. Reduced rates of new glaucoma diagnostic billings were seen in males, females and rural and urban residents among policy-affected and policy-unaffected age groups. Ontarians living in the wealthiest neighbourhood areas also had a significantly reduced rate after versus before 2004: -2.7‰ (p < 0.0001) for the age group 20-39 years, -9.0‰ (p < 0.0001) for the age group 40-64 years, and -2.3‰ (p < 0.001) for the age group 65+ years. CONCLUSIONS: Discontinuation of government-funding for routine eye exams was associated with a significantly reduced rate of new glaucoma diagnostic billings irrespective of sociodemographics. More research is needed to understand the reduced glaucoma billings in unaffected seniors and those living in the wealthiest neighbourhood areas.

Trends in payments among male and female ophthalmologists in Ontario from 1992 to 2018.

OBJECTIVE: To examine sex differences in Ontario Health Insurance Plan (OHIP) payments from 1992 to 2018. DESIGN: Population-based observational study. PARTICIPANTS: Ophthalmologists submitting claims to OHIP from 1992 to 2018. METHODS: Physician billing data over 27 years (1992-2018) were analyzed for yearly number of ophthalmologists, OHIP payments, distinct patients, and patient visits. RESULTS: Yearly median OHIP payments to female ophthalmologists were less than to male ophthalmologists with a gap ratio of 0.55 in 1992 to 0.73 in 2018. Stratifying by full-time equivalent (FTE), there was little difference in median payments between males and females for 1 FTE. Median female-to-male payments ratio varied from 0.80 to 1.16 for <1 FTE and 1.14 to 0.84 for >1 FTE from 1992 to 2018. Among female ophthalmologists, 72.7% and 52.9% were <1 FTE and 11.4% and 19.2% were >1 FTE in 1992 and 2018, respectively. In comparison, for male ophthalmologists, 35.7% and 45.6% were <1 FTE and 43.4% and 45.6% were >1 FTE in 1992 and 2018, respectively. Overall, male ophthalmologists had more patients and patient visits than female ophthalmologists, but there was little difference between male and female ophthalmologists for 1 and >1 FTE. The results for <1 FTE varied by year. CONCLUSIONS: Overall, female ophthalmologists have lower OHIP payments compared with males, but there was little difference for those stratified to 1 FTE. This overall payments difference by sex is largely explained by the higher proportion of <1 FTE females, lower proportion of >1 FTE females, and higher payments for >1 FTE males.

The Effect of Government-Uninsured Optometric Services on the Use of Primary Care Providers.

INTRODUCTION: Eye care in many countries is provided by optometrists, ophthalmologists, primary care providers (PCPs, including family physicians and pediatricians) and emergency department (ED) physicians. In the province of Prince Edward Island (PEI), Canada, optometric services are not government-insured, while services provided by other eye care providers are government-insured. Clinics of optometrists, PCPs and ED physicians are widely distributed across the island. Clinics of ophthalmologists however are concentrated in the capital city Charlottetown. PURPOSE: To investigate if more patients visited government-insured PCPs and EDs for eye care when local optometric services are government-uninsured and government-insured ophthalmologists are potentially distant. METHODS: From PEI physician billing database, we identified all patients with an ocular diagnosis from 2010-2012 using International Classification of Diseases, 9th Revision (ICD-9) codes. The utilization of government-insured PCPs and EDs in five geographical regions was assessed utilizing patients' residential postal code. Of the five regions, Prince was the region farthest from the capital Charlottetown. RESULTS: Compared to utilization of government-insured PCPs for ocular diagnoses in Charlottetown (13.5% in 2010, 95% confidence interval [CI] 12.9-14.0%), the utilization in Prince (22.4% in 2010, 95% CI 21.7-23.1%) was nearly double (p<0.05). The utilization of ED physicians for ocular diagnoses was similarly double in Prince (8.8%, 95% CI 8.3-9.3%) versus Charlottetown (4.1%, 95% CI 3.8-4.5%). The utilization of ophthalmologists however was significantly lower in Prince (43%, 95% CI 41.4-42.9%) versus Charlottetown (56.3%, 95% CI 55.6-57.1%). Similar trends remained throughout 2010-2012. CONCLUSION: When optometric services are government-uninsured and government-insured ophthalmologist services are geographically distant, ocular patients utilized PCPs and ED physicians more frequently. Due to different levels of training and available equipment for eye examinations among PCPs, ED physicians and optometrists, the quality of eye care and cost-effectiveness of increased use of PCPs and ED physicians for ocular management warrant further investigation. TRIAL REGISTRATION: Not applicable.

Frequency and source of prescription eyewear insurance coverage in Ontario: a repeated population-based cross-sectional study using survey data.

BACKGROUND: Insurance coverage may reduce cost barriers to obtain vision correction. Our aim was to determine the frequency and source of prescription eyewear insurance to understand how Canadians finance optical correction. METHODS: We conducted a repeated population-based cross-sectional study using 2003, 2005 and 2013-2014 Canadian Community Health Survey data from respondents aged 12 years or older from Ontario, Canada. In this group, the cost of prescription eyewear is not covered by the government unless one is registered with a social assistance program or belongs to a specific population. We determined the frequency and source of insurance coverage for prescription eyewear in proportions. We used survey weights provided by Statistics Canada in all analyses to account for sample selection, a complex survey, and adjustments for seasonal effect, poststratification, nonresponse and calibration. We compared unadjusted proportions and adjusted prevalence ratios (PRs) of having insurance. RESULTS: Insurance covered all or part of the costs of prescription eyewear for 62% of Ontarians in all 3 survey years. Of those insured, 84.1%-86.0% had employer-sponsored coverage, 9.0%-10.3% had government-sponsored coverage, and 5.7%-6.8% had private plans. Employer-sponsored coverage remained constant for those in households with postsecondary graduation but decreased significantly for those in households with less than secondary school graduation, from 67.0% (95% confidence interval [CI] 63.2%-70.8%) (n = 175 000) in 2005 to 54.6% (95% CI 50.1%-59.2%) (n = 123 500) in 2013-2014. Government-sponsored coverage increased significantly for those in households with less than secondary school graduation, from 29.2% (95% CI 25.5%-32.9%) (n = 76 400) in 2005 to 41.7% (95% CI 37.2%-46.1%) (n = 93 900) in 2013-2014. In 2013-2014, Ontarians in households with less than secondary school graduation were less likely than those with secondary school graduation to report employer-sponsored coverage (adjusted PR 0.79, 95% CI 0.75-0.84) but were more likely to have government-sponsored coverage (adjusted PR 1.27, 95% CI 1.06-1.53). INTERPRETATION: Sixty-two percent of Ontarians had prescription eyewear insurance in 2003, 2005 and 2013-2014; the largest source of insurance was employers, primarily covering those with higher education levels, whereas government-sponsored insurance increased significantly among those with lower education levels. Further research is needed to elucidate barriers to obtaining prescription eyewear and the degree to which affordability impairs access to vision correction.

Ophthalmology-focused publications and findings on COVID-19: A systematic review.

PURPOSE: To summarize COVID-19 research endeavors by ophthalmologists/researchers in terms of publication numbers, journals and author countries, and to detail key findings. METHODS: The LitCovid database was systematically reviewed for ophthalmology-focused COVID-19 articles. The quality of the evidence was assessed for articles investigating conjunctivitis in COVID-19 patients. RESULTS: There were 21,364 articles in LitCovid on June 12, 2020, of which 215 (1%) were ophthalmology-focused. Of articles on COVID-19 transmission, 3.3% were ophthalmology-focused. Ophthalmology-focused articles were published in 68 journals and originated from 25 countries. The top five countries publishing ophthalmology-focused articles (China, India, United States of America, Italy, and United Kingdom) produced 145/215 (67%) articles. A total of 16 case reports/series from eight countries reported that conjunctivitis can be the initial or the only symptom of COVID-19 infection. Conjunctivitis may occur in the middle phase of COVID-19 illness. A total of 10 hospital-based cross-sectional studies reported that between 0% and 31.6% of COVID-19 patients have conjunctivitis or other ocular conditions, with a pooled prevalence of 5.5% reported in a meta-analysis. Viral RNA was detected in conjunctival swabs of patients with and without ocular manifestations, after resolution of conjunctivitis, after nasopharyngeal swabs turned negative and in retina of deceased COVID-19 patients. CONCLUSION: Within 3 months of declaring the COVID-19 pandemic, 215 ophthalmology-focused articles were published in PubMed, concentrating on disease manifestations and transmission. The reported presence of conjunctivitis or other ocular conditions in COVID-19 patients is varied. Clinicians should be alert for ocular involvement in COVID-19 infections and possible ocular transmission even in patients without ocular symptoms.

Cost-related nonadherence with glaucoma medications in Ontario.

OBJECTIVE: To determine the proportion of glaucoma patients in Ontario aged 25-64 who lack insurance coverage for glaucoma medications and to assess the frequency of cost-related nonadherence to glaucoma medications. DESIGN: Cross-sectional study. PARTICIPANTS: Glaucoma patients on medication from 2 glaucoma clinics in Toronto, Ontario. METHODS: 100 consecutive glaucoma patients aged 25-64 (not entitled to provincial drug benefit) and 100 consecutive glaucoma patients aged 65+ (entitled to provincial drug benefit), all on topical glaucoma therapy, completed a standardized questionnaire. Questions included insurance coverage for glaucoma medications, cost concerns when paying for glaucoma medications, cost-related nonadherence, and sociodemographics. RESULTS: 25.8% of those aged 25-64 express concerns about the cost of their glaucoma medications compared to 7.1% of those aged 65+ (p < 0.001). Patients aged 25-64 were also significantly more likely to report at least one form of cost-related nonadherence (15.5% vs 2.0%, p = 0.001) and significantly more likely to report missing eye drops in a given week than patients aged 65+ (32.0% vs 16.7%, p = 0.01). 17% (95% confidence interval 11%-26%) of patients aged 25-64 self-reported having no insurance coverage for their glaucoma medications. Of those with coverage, the most common source of insurance was employer-sponsored (68.6%) with 44% requiring a copayment. The average copayment was $18 (range $2-$250) for those aged 25-64 compared with $5 in the 65+ group (range $0.62-$100). CONCLUSIONS: 17% of glaucoma patients aged 25-64 do not have coverage for their drops. One in four expressed concerns about the cost of their glaucoma medications, and 15.5% reported cost-related nonadherence.

Cataract prevalence following a nationwide policy to shorten wait time for cataract surgery.

Background: Cataract is an age-related eye disease. Visual impairment from cataract can be restored by cataract surgery. In 2004 the Canadian federal government invested in a multibillion dollar wait time strategy to shorten the wait time for cataract surgery, a government-insured health service in all Canadian jurisdictions. We assessed if this nationwide policy reduced the number of Canadians waiting for cataract surgery as more individuals with cataract were free of cataract following the rapidly conducted surgery. Methods: In this cross-sectional study we analyzed data from randomly selected individuals aged ≥ 45 years responding to the Canadian Community Health Survey (CCHS) in 2000/2001, 2003, 2005, and the CCHS Healthy Aging in 2008/2009. Information on cataract was obtained from self-reported questionnaire. The age- and sex-standardized prevalence of cataract was calculated for comparisons. Results: Cataract was reported by 0.93 million Canadians in 2000/2001, 0.99 million in 2003, 1.10 million in 2005, and 1.34 million in 2008/2009. This corresponds to an age- and sex-standardized prevalence of 8.9% in 2000/2001, 9.0% in 2003, 9.5% in 2005, and 10.2% (P <0.05) in 2008/2009. The increase in age- and sex-standardized prevalence was greater in individuals without secondary school graduation than those with secondary school graduation or higher (4.3% versus 1.3%, P < 0.05) and was seen in all Canadian provinces. The largest increase was documented in a province (Saskatchewan, from 9.8% in 2000/2001 to 12.6% in 2008/2009, P < 0.05) with the longest median wait times for cataract surgery (118 days in 2008) and the lowest number of ophthalmologists per 100 000 population (1.96 versus 3.35 national average). Conclusions: The age- and sex-standardized prevalence of cataract increased 4‒5 years after the multibil- lion-dollar wait time strategy was launched in 2004. A lower threshold to diagnose cataract may be one potential reason for this finding. Further research is needed to understand the true reasons for the increase.

Postural Changes and the Trans-Lamina Cribrosa Pressure Difference: A Pilot Study in Neurosurgical Patients without Glaucoma.

PURPOSE: To evaluate the effect of changes in position in the trans-lamina cribrosa pressure difference (TLCPD) by simultaneously measuring and comparing intracranial pressure (ICP) with intraocular pressure (IOP) in seated and supine positions. DESIGN: Prospective cohort study. PARTICIPANTS: Patients admitted to the neurosurgery unit at Toronto Western Hospital with an external ventricular drain placed for ICP monitoring. Exclusion criteria were any ophthalmic surgical procedures within the preceding 6 months, history of glaucoma, and corneal abnormalities affecting IOP measurement. METHODS: Intraocular pressure and ICP were recorded simultaneously in both the supine and seated positions with the order of positions randomized. Measurements were made 10 minutes after assuming each position. The TLCPD (IOP minus ICP) was calculated for the sitting and supine positions. The paired t test was used to assess significance of differences. MAIN OUTCOME MEASURE: The TLCPD. RESULTS: Twenty patients were included in the study. The average age was 54±17 years. Results were similar for left and right eyes. Data are shown for right eyes only. Mean sitting and supine IOPs were 15.3±3.5 mmHg and 15.9±3.7 mmHg, respectively (P = 0.32). Mean sitting and supine ICPs were 12.5±6.8 mmHg and 12.8±5.1 mmHg, respectively (P = 0.66). Mean TLCPD was 3.1±6.0 mmHg in the sitting position and 3.1±7.0 mmHg in the supine position (P = 1.00). Supine TLCPD increased in 10 patients (50%), decreased in 8 patients (40%), and was unchanged in 2 patients (10%). CONCLUSIONS: In this pilot study of 20 neurosurgical patients without glaucoma, posture-induced TLCPD changes were variable.

The cost of publishing in an indexed ophthalmology journal in 2019.

OBJECTIVE: To determine the proportion of indexed ophthalmology journals with article processing charges (APCs) and potential factors associated with APCs. DESIGN: Cross-sectional study. PARTICIPANTS: Web of Science-indexed Ophthalmology journals in 2019. METHODS: Indexed ophthalmology journal web sites were reviewed to obtain information on APCs, impact factor (IF), publication mode, publisher type, journal affiliation, waiver discount, and continent of origin. For data unavailable on the web site, the journal was contacted. Journal publication mode was categorized into subscription, fully open access, and hybrid (open access and subscription combined). Linear regression analysis was used to evaluate the association between APCs and the above variables. MAIN OUTCOME MEASURE: Proportion of ophthalmology journals with APCs. RESULTS: 59 indexed ophthalmology journals were identified; 3 (5.1%) subscription only, 10 (16.9%) open access, and 46 (78.0%) hybrid. Overall 52/59 (88.1%) journals had APCs; 10 of 59 journals (16.9%) required APCs for publication (7 fully open access and 3 hybrid journals), whereas 42/59 (71.2%, all hybrid journals) had optional APCs for open access. The 7/59 journals (11.9%) without APCs included 100% (3/3) of the subscription-only journals, 30% (3/10) of the open access, and 2% (1/46) of the hybrid journals. The mean cost for journals with APCs was US$2854 ± 708.9 (range US$490-5000). Higher IF, publication mode, and commercial publishers were associated with higher APCs. CONCLUSIONS: 16.9% of indexed ophthalmology journals in 2019 required APCs, and additional 71.2% hybrid journals had APCs for the option of open access. Independent predictors of APCs were IF and publication mode.