Visual impairment, employment status, and reduction in income: the Canadian Longitudinal Study on Aging.

OBJECTIVE: To examine the employment status of those with and without visual impairment and eye disease and to examine the association between visual impairment and eye disease and a reduction in income over a 3-year period. DESIGN: Population-based prospective cohort study. PARTICIPANTS: A total of 12,174 nonretired participants aged 45-64 years old in the Canadian Longitudinal Study on Aging. METHODS: Visual impairment was defined if binocular presenting or pinhole-corrected monocular visual acuity in the better eye was worse than 20/40 at baseline. Self-reported diagnoses of age-related macular degeneration (AMD) and glaucoma were collected. Employment status (employed, not employed due to sickness or disability, or unemployed) was based on questions on labour force participation. Income reduction was defined as household income <$50,000 per year at follow-up when household income was ≥$50,000 at baseline. Multinomial and logistic regressions were used to adjust for demographic and health variables. RESULTS: Visual impairment using binocular presenting visual acuity (odds ratio [OR] = 2.09; 95% CI, 1.21-3.62) and pinhole-corrected visual acuity (OR = 2.99; 95% CI, 1.54-5.83) were associated with a higher odds of not being employed due to sickness or disability after adjustment. AMD (OR = 1.82; 95% CI, 1.11-3.01) and glaucoma (OR = 2.05; 95% CI, 1.28-3.28) at baseline were both associated with reductions in income over a 3-year period after adjustment. CONCLUSION: Individuals with visual impairment experienced lower employment, and those with AMD or glaucoma were more likely to have their incomes decline over 3 years. Policies to improve workplace participation by those with vision loss are needed.

Diagnostic Accuracy of Conjunctival Rt-Pcr in Sars-Cov-2: A Systematic Review and Diagnostic Accuracy Meta-Analysis.

PURPOSE: To study the positivity rate of conjunctival realtime polymerase chain reaction (RT-PCR) testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). DESIGN: Systematic review and diagnostic accuracy meta-analysis. METHODS: MEDLINE and EMBASE were queried using medical subject headings terms. Diagnostic accuracy meta-analyses and forest plots were obtained using the RevMan software. RESULTS: After deduplication, appraisal of abstract titles and full-text analysis of 1441 articles, 42 articles with 3351 COVID-19 patients were included in this review. Of these, 412 conjunctival swabs/Schirmer paper strips tested positive for SARS-CoV-2 by RT-PCR. The pooled sensitivity of the RT-PCR tests across the 24 studies with laboratory-confirmed COVID-19 patients was 10.3%. CONCLUSIONS: Only 1 in 10 RT-PCR tests performed on conjunctival swabs were positive for SARS-CoV-2. Although this suggests that SARS-CoV-2 is likely present and detectable in the conjunctiva, this detection method has low diagnostic potential.

Impact of the COVID-19 Pandemic on Mental Health among Patients with Chronic Ocular Conditions.

The COVID-19 pandemic had significant impacts on the mental and visual health of patients. This cross-sectional, survey-based, multicentric study evaluates the state of mental and visual health among patients with chronic ocular diseases such as glaucoma, neovascular age-related macular degeneration, diabetic retinopathy, or chronic uveitis during the lockdown period of the COVID-19 pandemic. Mental health was assessed using three questionnaires: the Patient Health Questionnaire-9 (PHQ-9), the Impact of Event Scale-Revised (IES-R), and the National Eye Institute Visual Function Questionnaire-25 (VFQ-25). A total of 145 patients completed the questionnaires. The PHQ-9 showed that most respondents (n = 89, 61%) had none or minimal depressive symptoms, while 31 (21%) had mild depressive symptoms, 19 (13%) had moderate depressive symptoms, 5 (3%) had moderately severe depressive symptoms, and 1 (1%) had severe depressive symptoms. Regarding stress surrounding the pandemic, the median IES-R showed mild distress in 16 (11%), moderate distress in 7 (5%), and severe distress in 4 (3%). The COVID-19 pandemic lockdowns had a negative impact on patients' mental health with close to 20% of the patients reporting at least moderately depressive symptoms and 19% reporting at least mildly distressful symptoms.

The Mental Health State of Canadian Ophthalmologists during the COVID-19 Pandemic: A Survey-Based Study and Review.

The coronavirus disease 2019 (COVID-19) pandemic disrupted the practice of medicine, causing stress and uncertainty among ophthalmologists. This cross-sectional, survey-based study of Canadian Ophthalmological Society members (n = 1152) aims to report on Canadian ophthalmologists' mental health during the COVID-19 pandemic. Four questionnaires were administered between December 2020 and May 2021: the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), the 7-item Insomnia Severity Index (ISI), and the Impact of Event Scale-Revised (IES-R). From all of the responses, 60/85 answers were deemed complete and were included. The median age was 50-59 years and 53% were women. On PHQ-9, most respondents had no or minimal depressive symptoms (n = 38, 63%), while 12% (n = 7) had moderately severe depressive symptoms and 12% (n = 7) reported impaired daily functioning and/or thoughts of suicide or self-harm. On the GAD-7 scale, 65% (n = 39) had no significant anxiety, while 13% (n = 8) had moderate to severe anxiety. Most respondents did not have clinically significant insomnia (n = 41, 68%). Finally, 16 respondents (27%) had an IES-R score ≥24 suggesting possible post-traumatic stress disorder. No significant differences were found based on demographics. During the COVID-19 pandemic, up to 40% of respondents experienced varying degrees of depression, anxiety, insomnia, and distress from the event. In 12%, there were concerns for impaired daily functioning and/or suicidal thoughts.

Recurrent and De Novo Toxoplasmosis Retinochoroiditis following Coronavirus Disease 2019 Infection or Vaccination.

This study reports three cases of toxoplasmosis retinochoroiditis following coronavirus disease 2019 (COVID-19) infection or vaccination from the national Canadian COVID-19 Eye Registry between December 2020 and September 2021. A 56-year-old male presented 15 days after a positive COVID-19 test with toxoplasmosis retinochoroiditis. He later relapsed 8 days following a first Pfizer-BioNTech vaccine dose. Two patients presented with toxoplasmosis retinochoroiditis following COVID-19 vaccination: A 58-year-old female presenting 4 days following a first Pfizer-BioNTech vaccine dose with anterior uveitis and a posterior pole lesion discovered 3 months later and a 39-year-old female presenting 17 days after a first Moderna vaccine dose. Resolution was achieved with oral clindamycin, oral trimethoprim/sulfamethoxazole, and topical prednisolone acetate 1%. Patients were offered prophylactic trimethoprim/sulfamethoxazole for subsequent doses without relapse. Following COVID-19 infection or vaccination, patients may be at risk for toxoplasmosis retinochoroiditis. Prophylactic antibiotics for future doses may be offered to patients with known ocular toxoplasmosis to prevent recurrence.

Incidence of visual impairment in Canada: the Canadian Longitudinal Study on Aging.

OBJECTIVE: Determine the 3-year incidence of visual impairment (VI) in Canada and its risk factors. DESIGN: Prospective 3-year cohort study PARTICIPANTS: Data from 23 973 adults taking part in the Canadian Longitudinal Study on Aging Comprehensive Cohort baseline and 3-year follow-up exams were included. METHODS: Inclusion criteria were 45 to 85 years of age, community-dwelling, and living near one of the 11 data collection sites across 7 Canadian provinces. Presenting binocular visual acuity was measured using the Early Treatment of Diabetic Retinopathy study chart. Incidence of VI was defined as the development at follow-up of visual acuity worse than 20/40 in those with acuity better than or equal to 20/40 at baseline. RESULTS: 3.88% (95% confidence interval [CI] 3.61-4.17) of Canadian adults developed VI over a 3-year period. There was a high degree of variability in the incidence between Canadian provinces with a low of 1.42% in Manitoba and a high of 7.33% in Nova Scotia. Uncorrected refractive error was the leading cause. Risk factors for incident VI included older age (odds ratio [OR] = 1.07, 95% CI 1.06-1.07), Black race (OR = 2.64, 95% CI 1.36-5.14), lower household income (OR = 1.73 for those making less than $20,000 per year, 95% CI 1.24-2.40), current smoker (OR = 1.78, 95% CI 1.37-2.32), and province. CONCLUSION: The incidence of visual impairment is common in older Canadian adults, varies markedly between provinces, and is largely owing to treatable causes. Risk factors for VI suggest subgroups that may benefit from interventions to improve access to eye care.

Visual Impairment, Eye Disease, and 3-Year Cognitive Decline: The Canadian Longitudinal Study on Aging.

PURPOSE: To examine the longitudinal association between vision-related variables and the 3-year change in cognitive test scores in a community-dwelling sample of adults and to explore whether sex, education, or hearing loss act as effect modifiers. METHODS: Data came from two waves of a 3-year population-based prospective cohort study (Canadian Longitudinal Study on Aging), which consisted of 30,097 randomly selected people aged 45-85 years from 7 Canadian provinces. Visual impairment (VI) was defined as binocular presenting visual acuity worse than 20/40. Participants were asked if they had ever had a diagnosis of age-related macular degeneration (AMD), glaucoma, or cataract. Cognitive change over 3 years was examined by calculating the difference between baseline and follow-up scores for the Rey Auditory Verbal Learning Test (RAVLT) and the RAVLT delayed test (memory tests), the Controlled Oral Word Association Test (COWAT) and the Animal Naming Test (ANT) (verbal fluency tests), and the Mental Alternation Test (MAT) (processing speed test). Multiple linear regression was used. RESULTS: VI, AMD, and cataract were not associated with 3-year changes on any of the 5 cognitive tests after adjusting for age, sex, ethnicity, education, income, smoking, diabetes, stroke, heart disease, and province. A report of glaucoma was associated with greater declines in MAT scores (ß = -0.60, 95% CI -1.03, -0.18). No effect modification was detected. CONCLUSIONS: Glaucoma was associated with worsening processing speed. Further research to confirm this finding and to understand the possible reason is necessary.

A rare presentation of Klebsiella pneumoniae endogenous panophthalmitis with optic neuritis and orbital cellulitis from a urinary tract infection.

This case illustrates the rare presentation of endogenous Klebsiella pneumoniae endophthalmitis with concomitant orbital cellulitis from an acute pyelonephritis. A 59-year-old Caucasian female with type 2 diabetes mellitus was transferred from a regional hospital with decreased visual acuity, periorbital edema, photophobia, proptosis and pain of the right eye, as well as suprapubic discomfort. Initial ocular examination and B-scan ultrasonography were consistent with endophthalmitis and orbital cellulitis which lead to a vitreous tap and intravitreal antibiotics injection and systemic antibiotherapy. Vitreous and blood cultures confirmed Klebsiella pneumoniae as the causative organism. An orbital MRI showed a panophthalmitis with optic neuritis and further imaging confirmed a concomitant pyelonephritis secondary to a septic nephrolithiasis. The patient was given treatment with high-does intravenous antibiotics, oral and topical corticotherapy, and an early core pars plana vitrectomy (PPV), performed 5 days after presentation with repeat injections of antibiotics and dexamethasone. Unfortunately, two weeks following PPV, despite an initial stable postoperative course, the patient deteriorated and presented with purulent discharge from one of the vitrectomy port incision site. An emergency evisceration was performed in order to control the infection, revealing a large subretinal abscess and necrosed sclerotic tissue around the prior vitrectomy incision sites. Conclusion: This is the first case report of Klebsiella pneumoniae endophthalmitis or panophthalmitis presenting with orbital cellulitis and optic neuritis from an urinary tract infection. Prognosis is poor despite treatment including early vitrectomy.

Fine Particulate Matter and Age-Related Eye Disease: The Canadian Longitudinal Study on Aging.

Purpose: To determine the relationship between fine particulate matter (PM2.5) and ocular outcomes such as visual impairment and age-related eye disease. Methods: Baseline data were used from the Canadian Longitudinal Study on Aging. The Comprehensive Cohort consisted of 30,097 adults ages 45 to 85 years. Annual mean PM2.5 levels (µg/m3) for each participant's postal code were estimated from satellite data. Ozone, sulfur dioxide, and nitrogen dioxide levels were also estimated. Binocular presenting visual acuity was measured using a visual acuity chart. Intraocular pressure (IOP) was measured in millimeters of mercury using the Reichart Ocular Response Analyzer. Participants were asked about a diagnosis of glaucoma, macular degeneration, or cataract. Logistic and linear regression models were used. Results: The overall mean PM2.5 level was 6.5 µg/m3 (SD = 1.8). In the single pollutant models, increased PM2.5 levels (per interquartile range) were associated with visual impairment (odds ratio [OR] = 1.12; 95% confidence interval [CI], 1.02-1.24), glaucoma (OR = 1.14; 95% CI, 1.01-1.29), and visually impairing age-related macular degeneration (OR = 1.52; 95% CI, 1.10-2.09) after adjustment for sociodemographics and disease. PM2.5 had a borderline adjusted association with cataract (OR = 1.06; 95% CI, 0.99-1.14). In the multi-pollutant models, increased PM2.5 was associated with glaucoma and IOP only after adjustment for sociodemographics and disease (OR = 1.24; 95% CI, 1.05-1.46 and ß = 0.24; 95% CI, 0.12-0.37). Conclusions: Increased PM2.5 is associated with glaucoma and IOP. These associations should be confirmed using longitudinal data and potential mechanisms should be explored. If confirmed, this work may have relevance for revision of World Health Organization thresholds to protect human health.

Vision, Eye Disease, and the Onset of Balance Problems: The Canadian Longitudinal Study on Aging.

PURPOSE: To understand the relationship between visual impairment, self-reported eye disease, and the onset of balance problems. DESIGN: Population-based prospective cohort study. METHODS: Baseline and 3-year follow-up data were used from the Canadian Longitudinal Study on Aging. The Comprehensive Cohort included 30,097 adults aged 45 to 85 years recruited from 11 sites across 7 provinces. Balance was measured using the 1-leg balance test. Those who could not stand on 1 leg for at least 60 seconds failed the balance test. Presenting visual acuity was measured using the Early Treatment of Diabetic Retinopathy Study chart. Participants were asked about a previous diagnosis of cataract, macular degeneration, or glaucoma. Logistic regression was used. RESULTS: Of the 12,158 people who could stand for 60 seconds on 1 leg at baseline, 18% were unable to do the same 3 years later. For each line worse of visual acuity, there was a 15% higher odds of failing the balance test at follow-up (odds ratio [OR] = 1.15, 95% confidence interval [CI] 1.10, 1.20) after adjustment. Those with a report of a former (OR = 1.59, 95% CI 1.17, 2.16) or current cataract (OR = 1.31, 95% CI 1.01, 1.68) were more likely to fail the test at follow-up. Age-related macular degeneration and glaucoma were not associated with failure on the balance test. CONCLUSION: These data provide longitudinal evidence that vision loss increases the odds of balance problems over a 3-year period. Efforts to prevent avoidable vision loss are needed, as are efforts to improve the balance of visually impaired people.

Visual Impairment, Eye Disease, and the 3-year Incidence of Depressive Symptoms: The Canadian Longitudinal Study on Aging.

PURPOSE: Our goal was to explore the longitudinal association between vision-related variables and incident depressive symptoms in a community-dwelling sample of older adults and to examine whether sex, education, or hearing loss act as effect modifiers. METHODS: A 3-year prospective cohort study was performed using data from the Canadian Longitudinal Study on Aging consisting of 30,097 individuals aged 45-85 years. Visual acuity was evaluated with habitual distance correction using an illuminated Early Treatment of Diabetic Retinopathy Study chart. Visual impairment was defined as binocular presenting visual acuity worse than 20/40. Incident depressive symptoms was defined using a cut-off score of 10 or greater on the Center for Epidemiologic Studies Depression scale. Participants were asked if they had ever had a physician diagnosis of age-related macular degeneration (AMD), glaucoma, or cataract. Multivariable Poisson regression was used. RESULTS: Of 22,558 participants without depressive symptoms at baseline, 7.7% developed depressive symptoms within 3 years. Cataract was associated with incident depressive symptoms (relative risk = 1.20, 95% confidence interval 1.05, 1.37) after adjusting for age, sex, income, education, partner status, smoking, level of comorbidity, hearing loss, and province. Visual impairment, AMD, and glaucoma were not associated with incident depressive symptoms. No effect modification was detected. CONCLUSIONS: Our longitudinal data confirm that the risk of depressive symptoms is higher in those who report ever having a cataract. Further research should confirm this and interventions should be considered.

Endogenous Tuberculous Endophthalmitis and Panophthalmitis: A Systematic Review of Case Reports and Case Series.

PURPOSE: To systematically review the characteristics of patients with endogenous tuberculous (TB) endophthalmitis and panophthalmitis in an effort to help clinicians with diagnosis and treatment. PATIENTS AND METHODS: We conducted a systematic literature search in MEDLINE/PubMed, EMBASE and Web of Science from inception to August 2020. References and abstracts were screened independently by two authors. Included studies were case reports and case series reporting endogenous TB endophthalmitis and panophthalmitis secondary to Mycobacterium tuberculosis complex (MTBC). Available-case analysis was employed to handle missing data. RESULTS: A total of 1343 articles were found using the search strategy. Following abstract screening, 51 articles were selected for full text-review, from which 26 were deemed eligible for inclusion in the study. Forty-four cases from 26 articles were included in the quantitative analysis. The median age of presentation was 29.5 (range: 1 to 81), and 11/44 patients (25.0%) were pediatric. Immunosuppression was seen in 9/36 cases (25.0%). Most patients (24/38, 63.2%) had no prior history of tuberculosis. Systemic symptoms were absent in half of the patients (16/32, 50.0%). Visual acuity was poor, with 23/27 cases (85.2%) being 20/200 or worse at presentation. Poor organ and visual outcomes were reported: 36/43 cases (83.7%) resulted in enucleation/evisceration or exenteration. Intraocular tumors were suspected in 5/34 cases (14.7%). Pulmonary tuberculosis was seen in 15/35 cases (42.8%), and miliary tuberculosis was seen in 7/35 cases (20.0%). The earliest source of TB diagnosis was through histopathologic specimen after eye removal in 32/44 cases (72.7%), vitreous specimen in 6/44 cases (13.6%) and aqueous specimen in 3/44 cases (6.8%). CONCLUSION: TB endophthalmitis is a rare and sight-threatening manifestation of ocular tuberculosis. It can occur in apparently healthy individuals and can mimic intraocular tumors and other infectious etiologies. Diagnosis remains a significant challenge, which, often delayed, leads to profound visual loss. Early detection and treatment of intraocular tuberculosis may be associated with better ocular and systemic outcomes.

Interaction between postmenopausal hormone therapy and diabetes on cataract.

OBJECTIVE: We investigated whether postmenopausal hormone therapy (HT) use interacts with diabetes, a risk factor for several age-related eye diseases. METHODS: A cross-sectional analysis of women involved in the Canadian Longitudinal Study on Aging was performed. The random sample comprised of 15,320 community-dwelling women between ages 45 and 85 years old sampled from areas adjacent to 11 data collection centers across Canada. Information on menopausal status and HT were collected by self-report. Data on diabetes and eye disease were obtained by self-report of a physician diagnosis. Multivariable logistic regression was used. RESULTS: After adjusting for demographic, lifestyle, and health variables, a multiplicative interaction was identified such that HT use for 10 years or more was associated with a much higher odds of a report of cataract in women with type 2 diabetes (odds ratio = 2.44, 95% confidence interval 1.49, 3.99) but not in long-term HT users with no diabetes (odds ratio = 1.03, 95% confidence interval 0.87, 1.21) (interaction term P value = 0.013). HT use was not associated with glaucoma or macular degeneration. CONCLUSIONS: Long-term HT use and type 2 diabetes interact in their relationship with cataract. This novel finding should be confirmed. If confirmed, women with type 2 diabetes should be informed that long-term HT use increases their risk of cataract. : Video Summary:http://links.lww.com/MENO/A519.

Video Summary:http://links.lww.com/MENO/A519.

Ocular syphilis: case series (2000-2015) from 2 tertiary care centres in Montreal, Canada.

OBJECTIVE: To describe the demographics, clinical presentation, proportion of co-infection with human immunodeficiency virus (HIV), and treatment of patients with ocular syphilis seen at the ophthalmology department of 2 tertiary centres in Montreal, Canada. DESIGN: Retrospective case series. PARTICIPANTS AND METHODS: A total of 169 eyes of 115 patients, seen between 2000 and 2015, with a positive syphilis treponemal serology and a likely syphilis-related ophthalmologic diagnosis. Subgroup analysis was performed between HIV-infected and HIV-uninfected patients. RESULTS: Mean age of onset was 55 years, and 79% were male. Mean presenting logMAR visual acuity was 0.7. HIV status was available for 66%, of whom 49% were HIV-infected. The anatomical ocular diagnoses included isolated anterior uveitis (18%) and posterior segment involvement (42%). Both eyes were affected in 47%. Lumbar puncture (LP) was performed in 55%, of whom 22% had a positive cerebrospinal fluid (CSF) Venereal Disease Research Laboratory (VDRL) test. Antibiotherapy, consisting of intravenous penicillin alone or in addition to intramuscular benzathine penicillin, was administered in 65 patients (69%). Treatment allowed a visual improvement of -0.23 logMAR. HIV-infected patients were younger men (p < 0.01) and had more abnormal CSF analysis (p = 0.02), but there were no statistically significant differences in the anatomical location of ocular inflammation or visual function improvement. CONCLUSIONS: Given its varied presentations, syphilis must always be part of the differential diagnosis of intraocular inflammation. HIV testing and an LP are required in the evaluation of ocular syphilis, which should be treated as neurosyphilis with the appropriate regimen.