Jason Noble

Central Serous Chorioretinopathy: Update on Pathophysiology and Treatment

Recent technological advances--new pathophysiological insights, new imaging techniques for diagnosis and management, and new treatments--have led to an improved understanding of central serous chorioretinopathy (CSC). The primary role of the choroid has become more widely accepted with widespread use of indocyanine green angiography. Optical coherence tomography (OCT), and particularly enhanced depth imaging OCT, demonstrate a thickened and engorged choroid. Adaptive optics, fundus autofluorescence, multifocal electroretinography, microperimetry, and contrast sensitivity testing reveal that patients with even a mild course suffer previously undetected anatomic and functional loss. Although focal laser and photodynamic therapy are the current standard of care for persistent subretinal fluid in CSC, they are not appropriate in all cases, and the optimal timing of intervention remains unclear.

Intra-arterial thrombolysis for central retinal artery occlusion : a systematic review

Introduction: This review provides an updated analysis of the evidence supporting intra-arterial thrombolysis (IAT) for the treatment of central retinal artery occlusion (CRAO). Methods: A systemic review of the literature indexed by Ovid MEDLINE was performed for the following medical subject headings: central retinal artery occlusion, thrombolysis, intra-arterial, fibrinolysis. Studies were analysed individually and categorised by study type, and extracted data grouped together for statistical analysis. Only studies with five patients or more were included in the review. Results: Twenty-three studies were identified in the original search; eight were selected for the analysis. Of these studies, 158 patients were represented, in which treatment was instituted within an average of 8.4 (SD 4) h of symptom onset. In these patients, visual improvement occurred on average in 93% of patients, with 13% achieving 20/20 or better, 25% achieving 20/40 or better, and 41% achieving 20/200 or better. Complications occurred in 4.5% of cases. Conclusion: IAT may produce superior visual outcomes compared with conventional treatments for CRAO when instituted in certain situations. At the moment, there is insufficient evidence to support the routine use of IAT to treat CRAO. Well-designed prospective, randomised trials remain to be done.

The feminisation of Canadian medicine and its impact upon doctor productivity.

Objective  We examined the differences in work patterns between female and male doctors in Canada to gain insight into the effect of an increased number of female doctors on overall doctor productivity.

Evaluating the cost-effectiveness of anterior uveitis investigation by Canadian ophthalmologists

BACKGROUND To evaluate the cost-effectiveness of anterior uveitis investigation by Canadian ophthalmologists and to assess the role of implementing national clinical guidelines for such investigation. METHODS Based on data extracted from the Canadian National Uveitis Survey (CNUS, 2007 version), the cost of investigating a patient with anterior uveitis, according to current practice patterns of Canadian ophthalmologists, was determined and grouped across 4 clinical scenarios: (i) nongranulomatous anterior uveitis in an adult, (ii) granulomatous anterior uveitis in an adult, (iii) granulomatous anterior uveitis with suspected sarcoidosis in an adult or a child, and (iv) nongranulomatous anterior uveitis in a child. Similarly, the cost of investigating a patient with anterior uveitis as per published evidence-based guidelines was determined and compared with the current practice pattern using a cost-minimization model, sensitivity analyses, and Monte Carlo simulations. RESULTS Ophthalmologists were found to consistently order more tests than recommended by evidence-based guidelines, across each of the scenarios studied (p < 0.05). Overall, complete blood count, erythrocyte sedimentation rate, C-reactive protein, antinuclear antibody, and rheumatoid factor were the most commonly ordered extraneous tests that were not included in the evidence-based guidelines for the routine investigation of anterior uveitis. Also, there were significant differences in the cost of investigating a patient with anterior uveitis when compared with those predicted by adhering to evidence-based clinical practice guidelines. Cost minimization and sensitivity analyses revealed that published guidelines imparted cost savings when compared with current practice patterns across the 4 clinical scenarios studied (p < 0.01). The maximum additional cost was associated with investigating nongranulomatous anterior uveitis in an adult, where a minimal additional cost of

Honorary Coauthorship: Does It Matter?

75 per patient was spent. For granulomatous anterior uveitis in an adult, the additional cost was approximately

Orbital wall infarction in sickle cell disease

40, whereas the additional cost for investigating an adult or a child with suspected sarcoidosis was

Factors influencing career choice in ophthalmology

36. Only

Does sex affect the success rate of Canadian ophthalmology residency applicants

11 of additional cost was spent in the workup of a child with nongranulomatous anterior uveitis. When applied to the Canadian population, adherence to the Clinical Practice Guidelines recommended by the CNUS may result in cost savings of

The red eye

600,000 per year to the Canadian health care system. INTERPRETATION Adherence to the evidence-based Clinical Practice Guidelines recommended by the CNUS may result in significant cost savings, with virtually no loss of sensitivity in the routine investigation of anterior uveitis in Canada.

Examining the pupils.

Objective To examine the perception of honorary coauthorship among medical academics and to determine whether a potential effect of honorary coauthorship exists on patient care. Methods Corresponding authors of every fourth primary research paper published in JAMA, Journal of the American Medical Association (2001−2003), Canadian Medical Association Journal (2001−2003), British Medical Journal (1998−2000), and Lancet (1998−2000) were surveyed electronically. Questions were focused on each authors personal experience and perception of honorary coauthorship. Results Sixty-five percent of corresponding authors responded (127/195). Fifty-five percent of respondents had published more than 50 peer-reviewed journal articles, and 52% had been listed with an honorary coauthor at some point in their career. Eighteen percent of respondents had been required at some point to list authors who had provided data via a commercial relationship. A majority of authors believed that there were potential negative effects of honorary coauthorship for both the authors themselves (73%) and for their coauthors (83%). These negative effects included personal liability for honorary authors (29%) and dilution of relative contribution for their coauthors (54%). Sixty-two percent of respondents said that honorary coauthorship may have a negative effect on patient care; however, only 2% had been involved in a case in which this phenomenon had actually occurred. Conclusion Honorary coauthorship remains prevalent in the medical literature, even among highly published authors, and has the potential to negatively affect patient care. Respondents believed that a number of possible negative consequences of this phenomenon exist for honorary authors, their coauthors, and patients. Efforts to understand the true influence of honorary authorship on patient care may help further curb this practice in the literature.