1. Aloqab A, Alturkistany W, Ali HMN. The relationship between surgical loupes usage, workplace ergonomics, and musculoskeletal disorders among Saudi ophthalmologists. Saudi Journal of Ophthalmology. 2024; 3;39(2):166-173. DOI: 10.4103/sjopt.sjopt_276_23. https://pubmed.ncbi.nlm.nih.gov/40642356/
2. Morrison AK, Kumar S, Amin A, Urban M, Kleinman B. An ergonomic risk assessment of ophthalmology residents using the Rapid Entire Body Assessment (REBA) scale. Cureus 2024;16(2):e53698. DOI: 10.7759/cureus.53698. https://pubmed.ncbi.nlm.nih.gov/38455825/
3. Kamei M, Suzuki H, Terayama H, et al. Ergonomic benefit using heads-up display compared to conventional surgical microscope in Japanese ophthalmologists. PLoS One 2024;19(5):e0297461. DOI: 10.1371/journal.pone.0297461. https://pubmed.ncbi.nlm.nih.gov/38776346/
4. Barrios EL, Polcz VE, Hensley SE, et al. A narrative review of ergonomic problems, principles, and potential solutions in surgical operations. Surgery 2023;174(2):214-221. DOI: 10.1016/j.surg.2023.04.003. https://pubmed.ncbi.nlm.nih.gov/37202309/
5. Fouzdar Jain S, Akhter S, Ishihara R, Siddicky S, High R, Suh DW. The prevalence of work-related musculoskeletal disease among pediatric ophthalmologists. Clinical Ophthalmology 2022;16:833-840. DOI: 10.2147/OPTH.S343155. https://pubmed.ncbi.nlm.nih.gov/35330751/
6. Cerier E, Hu A, Goldring A, Rho M, Kulkarni SA. Ergonomics Workshop Improves Musculoskeletal Symptoms in General Surgery Residents. Journal of Surgical Research 2022;280:567-574. DOI: 10.1016/j.jss.2022.06.014.https://pubmed.ncbi.nlm.nih.gov/35787315/ 
7. Albanesi B, Piredda M, Bravi M, et al. Interventions to prevent and reduce work-related musculoskeletal injuries and pain among healthcare professionals. A comprehensive systematic review of the literature. Journal of Safety Research 2022;82:124-143. DOI: 10.1016/j.jsr.2022.05.004. https://pubmed.ncbi.nlm.nih.gov/36031239/
8. Aaron KA, Vaughan J, Gupta R, et al.The risk of ergonomic injury across surgical specialties. PLoS One 2021;16(2):e0244868. DOI: 10.1371/journal.pone.0244868. https://pubmed.ncbi.nlm.nih.gov/33561117/
9. Schechet SA, DeVience E, DeVience S, Shukla S, Kaleem M. Survey of musculoskeletal disorders among US ophthalmologists. Digital Journal of Ophthalmology 2021;26(4):36-45. DOI: 10.5693/djo.01.2020.02.001. https://pubmed.ncbi.nlm.nih.gov/33867881/
10. Koshy K, Syed H, Luckiewicz A, Alsoof D, Koshy G, Harry L. Interventions to improve ergonomics in the operating theatre: A systematic review of ergonomics training and intra-operative microbreaks. Annals of Medicine & Surgery (Lond) 2020;55:135-142. DOI: 10.1016/j.amsu.2020.02.008. https://pubmed.ncbi.nlm.nih.gov/32477512/
11. Betsch D, Gjerde H, Lewis D, Tresidder R, Gupta RR. Ergonomics in the operating room: it doesn’t hurt to think about it, but it may hurt not to! Canadian Journal of Ophthalmology 2020;55(3 Suppl 1):17-21. DOI: 10.1016/j.jcjo.2020.04.004. https://pubmed.ncbi.nlm.nih.gov/32448408/
12. Weng CY, Hariprasad SM, Leiderman YI. Ergonomics in retina. Ophthalmic Surgery, Lasers and Imaging Retina 2019;50(9):537-542. DOI: 10.3928/23258160-20190905-01. https://pubmed.ncbi.nlm.nih.gov/31589750/
13. Epstein S, Tran BN, Capone AC, et al. The current state of surgical ergonomics education in U.S. surgical training: a survey study. Annals of Surgery 2019;269(4):778-784. DOI: 10.1097/SLA.0000000000002592. https://pubmed.ncbi.nlm.nih.gov/29381528/
14. Diaconita V, Uhlman K, Mao A, Mather R. Survey of occupational musculoskeletal pain and injury in Canadian ophthalmology. Canadian Journal of Ophthalmology 2019;54(3):314-322. DOI: 10.1016/j.jcjo.2018.06.021. https://pubmed.ncbi.nlm.nih.gov/31109470/
15. Bonafede L, Kazmierczak L, Siddicky SF, Gunton KB. Ergonomics in strabismus surgery. Current Opinion in Ophthalmology 2019;30(5):331-336. DOI: 10.1097/ICU.0000000000000594. https://pubmed.ncbi.nlm.nih.gov/31313751/
16. Ratzlaff TD, Diesbourg TL, McAllister MJ, von Hacht M, Brissette AR, Bona MD. Evaluating the efficacy of an educational ergonomics module for improving slit lamp positioning in ophthalmology residents. Canadian Journal of Ophthalmology 2019;54(2):159-163. DOI: 10.1016/j.jcjo.2018.05.016. https://pubmed.ncbi.nlm.nih.gov/30975337/
17. Kaup S, Shivalli S, Kulkarni U, Arunachalam C. Ergonomic practices and musculoskeletal disorders among ophthalmologists in India: An online appraisal. European Journal of Ophthalmology 2020;30(1):196-200. DOI: 10.1177/1120672118815107. https://pubmed.ncbi.nlm.nih.gov/30474398/
18. Venkatesh R, Kumar S. Back pain in ophthalmology: National survey of Indian ophthalmologists. Indian Journal of Ophthalmology 2017;65(8):678-682. DOI: 10.4103/ijo.IJO_344_17. https://pubmed.ncbi.nlm.nih.gov/28820152/
19. Shaw C, Bourkiza R, Wickham L, McCarthy I, McKechnie C. Mechanical exposure of ophthalmic surgeons: a quantitative ergonomic evaluation of indirect ophthalmoscopy and slit-lamp biomicroscopy. Canadian Journal of Ophthalmology 2017;52(3):302-307. DOI: 10.1016/j.jcjo.2016.09.011. https://pubmed.ncbi.nlm.nih.gov/28576213/
20. 2Honavar SG. Head up, heels down, posture perfect: Ergonomics for an ophthalmologist. Indian Journal of Ophthalmology 2017;65(8):647-650. DOI: 10.4103/ijo.IJO_711_17. https://pubmed.ncbi.nlm.nih.gov/28820146/
21. Sivak-Callcott JA, Mancinelli CA, Nimbarte AD. Cervical occupational hazards in ophthalmic plastic surgery. Current Opinion in Ophthalmology 2015;26(5):392-8. DOI: 10.1097/ICU.0000000000000182. https://pubmed.ncbi.nlm.nih.gov/26247136/
22. Alrashed WA. Ergonomics and work-related musculoskeletal disorders in ophthalmic practice. Imam Journal of Applied Sciences 2016;1(2):48-63. DOI: 10.4103/ijas.ijas_24_16. https://journals.lww.com/ijas/fulltext/2016/01020/ergonomics_and_work_related_musculoskeletal.2.aspx
23. Hyer JN, Lee RM, Chowdhury HR, Smith HB, Dhital A, Khandwala M. National survey of back & neck pain amongst consultant ophthalmologists in the United Kingdom. International Ophthalmology 2015;35(6):769-775. DOI: 10.1007/s10792-015-0036-z. https://pubmed.ncbi.nlm.nih.gov/25609503/
24. Herzog NV, Beharic RV, Beharic A, Buchmeister B. Ergonomic analysis and simulation in department of ophthalmology. Procedia Manufacturing 2015;3:128-135. DOI: 10.1016/j.promfg.2015.07.117. https://www.researchgate.net/publication/283960343_Ergonomic_Analysis_and_Simulation_in_Department_of_Ophthalmology
25. Fethke NB, Schall MC, Determan EM, Kitzmann AS. Neck and shoulder muscle activity among ophthalmologists during routine clinical examinations. International Journal of Industrial Ergonomics 2015;49:53-59. DOI: 10.1016/j.ergon.2015.06.001. https://www.sciencedirect.com/science/article/abs/pii/S0169814115300019
26. Hedge A, James T. Detrimental Effects of an electronic health records system on musculoskeletal symptoms among health professionals. Proceedings of the Human Factors and Ergonomics Society Annual Meeting 2014;58(1):773-777. DOI: 10.1177/1541931214581141. https://www.researchgate.net/publication/271722221_Detrimental_Effects_of_an_Electronic_Health_Records_System_on_Musculoskeletal_Symptoms_among_Health_Professionals#:~:text=Exposure%20to%20blood%20and%20body,of%20health%20practitioners%20surveyed%20reported
27. Mehta S, Hubbard GB, 3rd. Avoiding neck strain in vitreoretinal surgery: an ergonomic approach to indirect ophthalmoscopy and laser photocoagulation. Retina 2013;33(2):439-41. DOI: 10.1097/IAE.0b013e318276cbca. https://pubmed.ncbi.nlm.nih.gov/23190927/
28. Dorion D, Darveau S. Do micropauses prevent surgeon’s fatigue and loss of accuracy associated with prolonged surgery? An experimental prospective study. Annals of Surgery 2013;257(2):256-9. DOI: 10.1097/SLA.0b013e31825efe87. https://pubmed.ncbi.nlm.nih.gov/22824853/
29. Marx JL. Ergonomics: back to the future. Ophthalmology 2012;119(2):211-2. DOI: 10.1016/j.ophtha.2011.09.001. https://pubmed.ncbi.nlm.nih.gov/22305308/
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31. Theou O, Soon Z, Filek S, et al. Changing the sheets: a new system to reduce strain during patient repositioning. Nursing Research 2011;60(5):302-8. DOI: 10.1097/NNR.0b013e318225b8aa. https://pubmed.ncbi.nlm.nih.gov/21873921/
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Submitted by: Edmond Sandouk

Overview

Dry eye disease (DED) is a multifactorial disorder of theocular surface, in which inflammation is a central component of both symptoms and pathogenesis[1].

While vitamin D is recognized for its role in calcium regulation and bone health, it also has immunomodulatory and anti-inflammatory properties that may benefit ocular health[2].

Multiple studies have investigated the impact of systemic vitamin D supplementation on DED. Notably, Bae et al. conducted a randomized controlled trial on patients with DED and vitamin D deficiency. They demonstrated significant improvements in tear break-up time (TBUT), Schirmer’s test and ocular surface disease index (OSDI) scores following vitamin D supplementation[3, 4].

Building on this promising evidence, a recent clinical trial led by Hassanpour et al explored a novel approach: topical vitamin D eye drops[5].

Study Title

Safety and Efficacy of Topical Vitamin D in the Management of Dry Eye Disease Associated With Meibomian Gland Dysfunction: A Placebo-Controlled Double-Blind Randomized Controlled Trial[5].

Q&A: Insights from the Study

Q: What was the rationale for testing topical vitamin D?
A: Given the positive ocular benefits of systemic vitamin D, this study aimed to assess whether topical administration could provide local therapeutic effects in patients with DED associated with meibomian gland dysfunction (MGD).

Q: What was the study design?
A: The study was a double-blind randomized control trial including 56 patients with both DED and MGD. They were randomly assigned to receive either vitamin D eye drops or placebo eye drops, administered in one eye four times daily for 8 weeks.

Q: What were the results?
A: At 8 weeks, the vitamin D group demonstrated statistically significant improvements across all major outcomes compared to the placebo group:

• Corneal fluorescein staining: improved ocular surface integrity
• Dry Eye Questionnaire (DEQ 5): reduced subjective symptoms of dry eyes
• Schirmer test: increased tear production
• TBUT: longer tear film breakup time
• Meibomian gland expressibility score: improved gland function
• OSDI score: reduced severity of DED

Q: Were there any adverse effects?
A: The treatment was well tolerated. There were no statistically significant ocular adverse events compared to the placebo group, and no participants discontinued the study due to side effects.

Q: Are topical vitamin D eye drops commercially available?
A: The eye drops were specifically prepared for research purposes and are not currently available on the market.

Conclusion

Topical vitamin D appears to be a safe and promising option for the treatment of DED associated with MGD. This study highlights the need for further research and development of vitamin D-based ocular therapies.

References

1.           Clayton, J.A., Dry Eye. N Engl J Med, 2018. 378(23): p. 2212-2223.

2.           Sassi, F., C. Tamone, and P. D’Amelio, Vitamin D: Nutrient, Hormone, and Immunomodulator. Nutrients, 2018. 10(11).

3.           Bae, S.H., et al., Vitamin D Supplementation for Patients with Dry Eye Syndrome Refractory to Conventional Treatment. Sci Rep, 2016. 6: p. 33083.

4.           Rolando, M. and S. Barabino, Dry Eye Disease: What Is the Role of Vitamin D? Int J Mol Sci, 2023. 24(2).

5.           Hassanpour, K., et al., Safety and Efficacy of Topical Vitamin D in the Management of Dry Eye Disease Associated With Meibomian Gland Dysfunction: A Placebo-Controlled Double-Blind Randomized Controlled Trial. Cornea, 2024. 43(5): p. 552-563.

Submitted by: Felix Plamondon

The European Society of Cataract and Refractive Surgeons invites professionals around the world to participate to their 43^rd congress. The event will include many learning activities such as the main symposia, instructional courses, wetlabs, video sessions, posters and oral presentations.

Date: September 12th to 16th 2025.

Location: Bella Center Copenhagen, Center Boulevard, 2300 Copenhagen S

Important information: 

Date: Thursday July 31st, 2025

Time: 5:00 PM, ET

Title: Fuchs Endothelial Corneal Dystrophy (FECD) and Descemet’s Stripping Only (DSO): Novel Insights into Corneal Endothelial Cellular Migration

Speaker: Dr. Stephen Ong Tone

Zoom Link to Register: CLICK HERE

After registering, you will receive a confirmation email containing information about joining the webinar.

After this webinar, participants will be able to:

• To review Descemet’s Stripping Only as a surgical technique for FECD;
• To explore intracellular and extracellular regulators of corneal endothelial cellular migration in FECD;
• To explore intracellular and extracellular regulators of corneal endothelial cellular migration in FECD.

The VPP Grand Rounds Local and Visiting Professor Program is a self-approved group learning activity (Section 1) as defined by the Maintenance of Certification program of The Royal College of Physicians and Surgeons of Canada. You will be able to claim 1 credit for this round.

Scientific Planning Committee

Dr. Parnian Arjmand – Chair
I have a relationship with a for-profit and/or non-profit organization to diclose:

• Any direct financial payments, including receipt of honoraria: COS
• Membership on advisory boards or speakers’ bureaus: Roche, Bayer, Apobiologix

Dr. Vlad Diaconita – Member
I have a relationship with a for-profit and/or non-profit organization to disclose:

• Any direct financial payments, including receipt of honoraria: Voiant LLC Consultant
• Membership on advisory boards or speakers’ bureaus: Biogen, Roche

Dr. Bryon McKay – Member
I do not have a relationship with a for-profit and/or non-profit organization to disclose.

Dr. Miral Mehta-Shounak – Member
I do not have a relationship with a for-profit and/or non-profit organization to disclose.

The 2025 COS Annual Meeting was held from June 19th to 22nd, 2025 in the beautiful Vancouver, British Columbia. This meeting boasted an outstanding international and Canadian faculty presenting the latest in ophthalmic research and practice. The COS Annual Meeting and Exhibition included invited lectures, scientific papers, wet labs and workshops, as well as networking opportunities and an extensive exhibition of ophthalmic equipment and services.

If you registered for the Annual Meeting but did not get a chance to check out the ePoster station, you’re in luck! Our ePosters are still available for viewing. Here is how to access the platform:

• Go to: https://cos.multiregistration.com/autologin/COS2025
• Enter the email address you used when you registered for the COS 2025 Annual Meeting
• Check your inbox (or spam folder) for an email with direct access to the link. You will then have access to the 2025 COS Annual Meeting Gallery Platform.

Learning from ePosters may be claimed as Education content review (reading), under Section 2 of the MOC Program as defined by the RCPSC. You may claim 0.5 credits per hour.