Chryssa McAlister

Noninsured services provided with insured cataract surgery in Canada: ensuring transparent and fair treatment for patients

Cataract surgery is the most commonly performed medically necessary procedure in Canada, and the costs are covered under provincial and territorial health insurance plans. Patients who require this surgery are frequently offered one or more of a number of optional services related to refractive

Anterior capsular snap: New sign of zonular dehiscence and instability

UNLABELLED We describe the case of a 95-year-old woman with dense nuclear sclerotic cataracts and pseudoexfoliation glaucoma. Preoperative phacodonesis was noted on slitlamp biomicroscopy. During surgery, a localized anterior capsule dehiscence occurred with visible snapping of the anterior capsule over the capsulorhexis edge. This preferential anterior zonular dehiscence occurred during the lateral separation of 2 hemisegments of nucleus; the nuclear fragments protected the equatorial and posterior zonular fibers, avoiding zonular dialysis. The case was completed without incident after recognition and management of the zonular instability. The anterior capsular snap is a new sign of intraoperative anterior zonular dehiscence. FINANCIAL DISCLOSURE Neither author has a financial or proprietary interest in any material or method mentioned.

Patient bias toward lasers: Hidden vulnerability in the widespread adoption of femtosecond laser-assisted cataract surgery.

recent study by Makhotkina et al. reported lower success rates for piggyback IOL insertion, with complete symptom resolution in 6 (67%) of 9 eyes and partial resolution in 7 (78%) of 9 eyes. Placement of an IOL in the ciliary sulcus is still the most effective technique as all reported cases have had complete symptom resolution. However, in-the-bag exchange carries a decreased risk for pigment dispersion, iris chafing, and uveitis–glaucoma–hyphema syndrome as well as superior long-term centration. Therefore, in-the-bag exchange may represent a practical surgical alternative.

An ophthalmology code of ethics in Canada: enhancing our practice patterns.

Medical codes of ethics are social contracts between physicians and the public that describe ethical values and standards of care to which we hold all members of our profession. These codes of conduct reflect the virtuous and trustworthy character that society expects from physicians. Codes of ethics also help guide physicians facing challenging situations through a framework of fundamental principles and values of medical ethics. The Canadian Medical Association code of ethics (CMA code), first published in 1868, is a robust and well-established ethical guide to help all practicing Canadian physicians. However, Canadian eye physicians and surgeons may face several unique ethical challenges not addressed in the CMA code due to evolving research, abundant innovative technology, and changing practice patterns in ophthalmology. In 2014, the Eye Physicians and Surgeons of Ontario (EPSO) recognized an opportunity to develop an ophthalmology code of ethics (EPSO code) to help our membership better address challenging eye care scenarios, such as the combining of insured and noninsured services, mandatory reporting of visual acuity and field defects, and supporting patients with current or potential visual impairment and blindness. The concept of a specialty-specific code of ethics is not novel in medicine or in ophthalmology. Codes have been established in orthopaedics, surgery, psychiatry, emergency medicine, and others. The International Academy of Ophthalmology published a “Code of Ophthalmology Ethics” in 1978. In 1977, the American Academy of Ophthalmology (AAO) began developing a code of ethics (AAO code). At the time, reports of unethical practice in the United States prompted the inclusion of sanctions to those who did not follow the “rules” of the code, which remain enforceable by the AAO ethics committee today. Similarly, recent anecdotes of practice patterns of some Canadian ophthalmologists echo concerns voiced in the past, with talk of fee splitting, unethical charges to patients, and deficient informed consent. From a public perspective, these allegations may bring into question the integrity of our profession and threaten physician self-regulation. Self-regulation is a privilege not held in all medical jurisdictions. Physicians in the United Kingdom lost selfregulation in 2009 due to the General Medical Council’s inability to address scandals involving “bad apple” doctors. Self-regulation in Canada is left to the provincial medical colleges and requires a clear understanding of accepted ethical standards of practice in each specialty.

The Halifax Explosion of 1917: The oculist experience

BACKGROUND Despite its prominence in Canadian history, there are few publications about the Halifax Explosion of 1917 that deal with the care of victims with eye injuries. METHODS Archived documents relating to the nature and treatment of eye injuries sustained during the Halifax Explosion were reviewed at the Public Archives of Nova Scotia and the Maritime Museum of the Atlantic. A review of current literature was performed. RESULTS Detailed accounts regarding the personal and surgical experience of 2 ophthalmologists, G.H. Cox and F.T. Tooke, were found. Several unpublished government and personal documents on eye injuries sustained during the Halifax Explosion are filed at the Public Archives of Nova Scotia. Twelve ophthalmologists treated 592 people with eye injuries and performed 249 enucleations. Sixteen people had double enucleations. Most of the eye injuries were caused by shards of shattered glass. Sympathetic ophthalmia was the feared complication for penetrating eye injuries and a common indication for enucleation in 1917. A Blind Relief Fund was established to help treat, rehabilitate, and compensate the visually impaired. INTERPRETATION Many of the eye injuries sustained during the Halifax Explosion were due to flying shards of glass. Details of their treatment provide insight into a unique and devastating event in Canadian medical history and demonstrate how eye injuries were managed in 1917.