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Ergonomics: Journal Articles & Editorials

  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/
  30. Kitzmann AS, Fethke NB, Baratz KH, Zimmerman MB, Hackbarth DJ, Gehrs KM. A survey study of musculoskeletal disorders among eye care physicians compared with family medicine physicians. Ophthalmology 2012;119(2):213-20. DOI: 10.1016/j.ophtha.2011.06.034. https://pubmed.ncbi.nlm.nih.gov/21925736/
  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/
  32. Sivak-Callcott JA, Diaz SR, Ducatman AM, Rosen CL, Nimbarte AD, Sedgeman JA. A survey study of occupational pain and injury in ophthalmic plastic surgeons. Ophthalmic Plastic & Reconstructive Surgery 2011;27(1):28-32. DOI: 10.1097/IOP.0b013e3181e99cc8. https://pubmed.ncbi.nlm.nih.gov/20859236/
  33. Dhimitri KC, McGwin G Jr., McNeal SF, et al. Symptoms of musculoskeletal disorders in ophthalmologists. American Journal of Ophthalmology 2005;139(1):179-81. DOI: 10.1016/j.ajo.2004.06.091. https://pubmed.ncbi.nlm.nih.gov/15652844/
  34. Piccoli B, Committee IS. A critical appraisal of current knowledge and future directions of ergophthalmology: consensus document of the ICOH Committee on ‘Work and Vision’. Ergonomics 2003;46(4):384-406. DOI: 10.1080/0014013031000067473. https://pubmed.ncbi.nlm.nih.gov/12637175/
  35. Wallace RB, 3rd. The 45 degree tilt: improvement in surgical ergonomics. Journal of Cataract & Refractive Surgery 1999;25(2):174-6. DOI: 10.1016/s0886-3350(99)80122-9. https://pubmed.ncbi.nlm.nih.gov/9951660/
  36. Chatterjee A, Ryan WG, Rosen ES. Back pain in ophthalmologists. Eye (Lond) 1994;8 ( Pt 4):473-4. DOI: 10.1038/eye.1994.112. https://pubmed.ncbi.nlm.nih.gov/7821477/

Can Vitamin D Help with Dry Eyes?

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:

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.

Benign or Malignant? A Introductory Guide to Eyelid Lesions in the Primary Care Setting

Authors and Affiliations:

Mostafa Bondok, MD1; Anne Xuan-Lan Nguyen, MDCM2; Edsel Ing MD, PhD, MBA, MEd, MPH3,2

1: Section of Ophthalmology, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada

2: Department of Ophthalmology and Vision Sciences, University of Toronto Temerty School of Medicine, Toronto, Canada

3: Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Canada

Corresponding Author

Edsel Ing MD PhD FRCSC MEd MPH MIAD MBA

Professor & Chair of the Department of Ophthalmology & Visual Sciences

Chief of Ophthalmology Edmonton Zone

10240 Kingsway Avenue, Royal Alexandra Hospital, Edmonton, Alberta, T5H 3V9

(c): 780-735-8784; (e): [email protected]

Funding Statement: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Declaration of Authors’ Competing Interests: The authors indicate no financial support or conflicts of interest. The authors have no proprietary or commercial interest in any materials discussed in this article. All authors attest that they meet the current ICMJE criteria for authorship.

Eyelid lesions are common in primary care

Most eyelid lesions are benign, but 5-10% of skin cancers are periocular, with 90% being basal cell carcinoma (BCC) and 5% squamous cell carcinoma (SCC) [1]. Risk factors include age, UV exposure, family history, immunosuppression, and fair skin [1]. Sebaceous carcinoma, malignant melanoma and Merkel cell carcinoma are important but less common eyelid malignancies.

Recognition and clinical evaluation of malignant eyelid lesions is crucial

BCC and SCC often affect the lower eyelid or medial canthus due to sun exposure. Evert the eyelids to evaluate the palpebral conjunctiva and fornix and assess for tissue fixation [1]. Features of malignancy include skin ulceration, telangiectasia, loss of eyelashes, distortion of eyelid architecture, and crusting [1,2]. Assess ocular motility, palpate regional lymph nodes, and scan sun-exposed areas on the face and body for other lesions. Unilateral blepharitis, or recurrent chalazia may masquerade as sebaceous carcinoma. The “ABCDE” criteria (Asymmetry, Border irregularity, Colour variation, Diameter >6mm, Evolution) aids in the evaluation of eyelid malignant melanoma.

Refer lesions with malignant features

Malignant lesions can resemble benign ones, making diagnosis challenging [1]. Refer suspicious cases to an oculoplastic surgeon or dermatologist for biopsy [1,2]. Treatment typically involves surgical excision with clear margins via Mohs or frozen section. For inoperable BCC, vismodegib is an option for extensive disease, while imiquimod may treat superficial cases.

Styes and chalazia are frequent in primary care

Generally, a stye is a painful, red, and pimple-like lesion caused by infection [3], whereas a chalazion is a non-infectious, painless bump on the eyelid [2,4]. Both often resolve with warm compresses (5-10 min, 4-5x/day) and lid massage. Persistent cases (>4-6 weeks) warrant referral to ophthalmology for assessment of comorbid eye conditions (e.g., rosacea keratitis, blepharitis) [4], and possible definitive management with antibiotics, steroids, and/or incision & curettage [3,5]. Good eyelid hygiene, including lid scrubs with baby shampoo, aids prevention [3–5].

Other common benign eyelid lesions include epidermal inclusion cysts, hidrocystomas, seborrheic keratoses and nevi

Cystic, non-ulcerated lesions that transilluminate may be sweat duct cysts (hidrocystomas), while non-transilluminating cysts may be epidermal inclusion cysts. Seborrheic keratoses appear greasy and “stuck on,” with variable pigmentation. Eyelid nevi may have little to no pigmentation, and the presence of protruding hairs is not uncommon.

References

[1]      Cook BE, Bartley GB. Treatment options and future prospects for the management of eyelid malignancies: An evidence-based update. Ophthalmology 2001;108:2088–98. https://doi.org/10.1016/S0161-6420(01)00796-5.

[2]      Bernardini FP. Management of malignant and benign eyelid lesions. Curr Opin Ophthalmol 2006;17:480–4. https://doi.org/10.1097/01.ICU.0000243022.20499.90.

[3]      Lindsley K, Nichols JJ, Dickersin K. Non-surgical interventions for acute internal hordeolum. Cochrane Database of Systematic Reviews 2017;2017. https://doi.org/10.1002/14651858.CD007742.PUB4/MEDIA/CDSR/CD007742/IMAGE_N/NCD007742-AFIG-FIG01.PNG.

[4]      Zhu Y, Zhao H, Huang X, Lin L, Huo Y, Qin Z, et al. Novel treatment of chalazion using light-guided-tip intense pulsed light. Sci Rep 2023;13:1–11. https://doi.org/10.1038/s41598-023-39332-x.

[5]      Ben Simon GJ, Huang L, Nakra T, Schwarcz RM, McCann JD, Goldberg RA. Intralesional Triamcinolone Acetonide Injection for Primary and Recurrent Chalazia: Is It Really Effective? Ophthalmology 2005;112:913–7. https://doi.org/10.1016/J.OPHTHA.2004.11.037.

CJO: April 2025 Issue Highlights

The April 2025 CJO is now available online. Here are some of the highlights: 

Resident Perspectives + visual abstract: Our talented team of residents have summarized 3 articles from this issue with a focus on what’s most relevant to ophthalmology learners here in Canada and around the globe. And our April visual abstract provides a visual summary of an article on the Comparison of venturi and peristaltic based phacoemulsification efficiency in routine femtosecond laser cataract surgery.

Reviews and Original Research Articles:

Research Letters, Photo Essays, Case Reports, and more:

Follow the CJO on social media:

BlueSky: @cjo-jco.bsky.social

Facebook: CanJOphth

Instagram: @cjo_jco

LinkedIn: CJO – JCO

Vol 41, Issue 1: Video Journal of Cataract, Refractive, & Glaucoma Surgery – Innovative Devices From Around The World

The first issue of the Video Journal of Cataract, Refractive, & Glaucoma Surgery is live! They begin their 41st year with the new program entitled: Innovative Devices From Around The World.

To view more, please visit: http://www.vjcrgs.com/ and view the table of contents below!

2025 Volume 41 Issue 1 TOCDownload

Lifestyle Habits in Glaucoma: Practical Advice for Patients and Ophthalmologists

This article was authored by: Dr. Eileen Javidi, MD, Dr. Georges Durr, MD FRCSC and Dr. Younes Agoumi, MD FRCSC. The PRC Committee wish to acknowledge Félix Plamondon from the University of Laval for their initiative and contribution.

Patients suffering from glaucoma often seek advice on lifestyle changes such as exercise, diet, and other habits that may help them preserve their vision alongside conventional treatments. Although new research is emerging and our understanding of the complex pathophysiology of glaucoma is continuously growing, the relationship between lifestyle habits and glaucoma progression remains to be fully elucidated. This page aims to provide a clear and concise summary of the scientific data currently available, offering guidance for ophthalmologists when counseling their patients on lifestyle changes for glaucoma.

Exercise

Physical activity may be associated with slower rates of visual field loss in patients with glaucoma.1 Aerobic exercise, beyond its benefits for cardiovascular health, has also been shown to reduce IOP significantly. This effect is greater in previously sedentary people than in those who are already physically active.2 When a regular exercise regimen is adopted by previously sedentary individuals, IOP reduction may be sustained for longer periods of time (several weeks).3

Other studies have shown that strength training may increase IOP, particularly when holding one’s breath (Valsalva maneuver) while performing a weight-lifting exercise.4 On the other hand, some studies have found that resistance training may slightly decrease IOP in the minutes that follow the exercise.5 Since extensive research is still lacking, it may be safer to counsel patients to limit their resistance training to low or moderate intensities, to make sure to breathe out during the exercise and to avoid weigh- lifting altogether in moderate to advanced glaucoma.

Yoga, when practiced vigilantly through exercises involving relaxation and breathing techniques and while making sure to keep the head above the heart, appears to be safe and may even reduce IOP.6 However, glaucoma patients must be strongly advised to avoid handstands and head-down positions, as these are known to acutely increase IOP, up to doubling it.7,8

Sleep

IOP is higher during sleep and in the supine position, increasing to a greater extent in patients with glaucoma and more advanced disease.9 It is also higher in lateral decubitus in the dependent eye,10 and when sleeping face down with contact with a pillow.11 These effects may be mitigated by avoiding sleeping face down or on the side, and by adding a wedge pillow to elevate the head by 30 degrees.12

Diet and Supplements

Coffee increases IOP immediately after consumption,13 but the data on its long-term impact on IOP and risk of glaucoma remains conflicting. Caffeine consumption may be associated with an increased risk of developing glaucoma in individuals with family history of glaucoma, but no association has been found in those without family history.14 It seems reasonable for most patients to consume moderate amounts of caffeine, but greater intakes should be discouraged, particularly in those with high IOP, severe glaucoma and a positive family history.15

Ginkgo biloba extract has gained attention for its potential antioxidant and neuroprotective effects, and benefits on blood circulation. However, current data is inconclusive regarding effects on IOP and visual field progression in glaucoma.16

Smoking

A large retrospective study has shown that being a current or past smoker is associated with elevated IOP. This association is even greater in glaucoma patients.17

Marijuana

Marijuana has been discussed as a potential alternative treatment for glaucoma, as it reduces IOP for three to four hours following its consumption by inhalation. However, maintaining adequate IOP control using marijuana would require near-continuous use; therefore, using marijuana for controlling glaucoma is highly ill-advised given its numerous cognitive, respiratory, and other adverse effects such as impairment in functioning.18

Meditation

Mindfulness meditation has been found to lower IOP and can be used as adjuvant treatment to medical therapy for IOP control in glaucoma.19-21

References

1.         Lee MJ, Wang JX, Friedman DS, Boland MV, De Moraes CG, Ramulu PY. Greater Physical Activity Is Associated with Slower Visual Field Loss in Glaucoma. Ophthalmology. Jul 2019;126(7):958-964. doi:10.1016/j.ophtha.2018.10.012

2.         Roddy G, Curnier D, Ellemberg D. Reductions in Intraocular Pressure After Acute Aerobic Exercise: A Meta-Analysis. Clin J Sport Med. Sep 2014;24(5):364-372.

3.         Passo MS, Goldberg L, Elliot DL, Van Buskirk EM. Exercise training reduces intraocular pressure among subjects suspected of having glaucoma. Arch Ophthalmol. Aug 1991;109(8):1096-8. doi:10.1001/archopht.1991.01080080056027

4.         Vieira GM, Oliveira HB, de Andrade DT, Bottaro M, Ritch R. Intraocular pressure variation during weight lifting. Arch Ophthalmol. Sep 2006;124(9):1251-4. doi:10.1001/archopht.124.9.1251

5.         Chromiak JA, Abadie BR, Braswell RA, Koh YS, Chilek DR. Resistance training exercises acutely reduce intraocular pressure in physically active men and women. J Strength Cond Res. Nov 2003;17(4):715-720.

6.         Chetry D, Singh J, Chhetri A, Katiyar VK, Singh DS. Effect of yoga on intra-ocular pressure in patients with glaucoma: A systematic review and meta-analysis. Indian J Ophthalmol. May 2023;71(5):1757-+. doi:10.4103/ijo.IJO_2054_22

7.         Baskaran M, Raman K, Ramani KK, Roy J, Vijaya L, Badrinath SS. Intraocular pressure changes and ocular biometry during Sirsasana (headstand posture) in yoga practitioners. Ophthalmology. Aug 2006;113(8):1327-1332. doi:10.1016/j.ophtha.2006.02.063

8.         Jasien JV, De Moraes GV, Ritch R. Rise of Intraocular Pressure in Subjects With and Without Glaucoma during Four Common Yoga Positions. Invest Ophth Vis Sci. Apr 2014;55(13)

9.         Prata TS, De Moraes CGV, Kanadani FN, Ritch R, Paranhos A. Posture-induced Intraocular Pressure Changes: Considerations Regarding Body Position in Glaucoma Patients. Survey of Ophthalmology. Sep-Oct 2010;55(5):445-453. doi:10.1016/j.survophthal.2009.12.002

10.       Lee TE, Yoo C, Lin SC, Kim YY. Effect of Different Head Positions in Lateral Decubitus Posture on Intraocular Pressure in Treated Patients With Open-Angle Glaucoma. Am J Ophthalmol. Nov 2015;160(5):929-936 e4. doi:10.1016/j.ajo.2015.07.030

11.       Flatau A, Solano F, Idrees S, et al. Measured Changes in Limbal Strain During Simulated Sleep in Face Down Position Using an Instrumented Contact Lens in Healthy Adults and Adults With Glaucoma. JAMA Ophthalmol. Apr 2016;134(4):375-82. doi:10.1001/jamaophthalmol.2015.5667

12.       Buys YM, Alasbali T, Jin YP, et al. Effect of Sleeping in a Head-Up Position on Intraocular Pressure in Patients with Glaucoma. Ophthalmology. Jul 2010;117(7):1348-1351. doi:10.1016/j.ophtha.2009.11.015

13.       Higginbotham EJ, Kilimanjaro HA, Wilensky JT, Batenhorst RL, Hermann D. The effect of caffeine on intraocular pressure in glaucoma patients. Ophthalmology. May 1989;96(5):624-6. doi:10.1016/s0161-6420(89)32852-1

14.       Kim J, Aschard H, Kang JH, et al. Intraocular Pressure, Glaucoma, and Dietary Caffeine Consumption: A Gene-Diet Interaction Study from the UK Biobank. Ophthalmology. Jun 2021;128(6):866-876. doi:10.1016/j.ophtha.2020.12.009

15.       Kang JH, Willett WC, Rosner BA, Hankinson SE, Pasquale LR. Caffeine consumption and the risk of primary open-angle glaucoma: a prospective cohort study. Invest Ophthalmol Vis Sci. May 2008;49(5):1924-31. doi:10.1167/iovs.07-1425

16.       Kang JM, Lin S. Ginkgo biloba and its potential role in glaucoma. Curr Opin Ophthalmol. Mar 2018;29(2):116-120. doi:10.1097/ICU.0000000000000459

17.       Lee CS, Owen JP, Yanagihara RT, et al. Smoking Is Associated with Higher Intraocular Pressure Regardless of Glaucoma

®. Ophthalmol Glaucoma. Jul-Aug 2020;3(4):253-261. doi:10.1016/j.ogla.2020.03.008

18.       Green K. Marijuana smoking vs cannabinoids for glaucoma therapy. Arch Ophthalmol-Chic. Nov 1998;116(11):1433-1437. doi:DOI 10.1001/archopht.116.11.1433

19.       Abdelaal A, Fouda MF, Elmallahy M, et al. The Efficacy of Mindfulness Meditation in Medically-Treated Glaucoma. Invest Ophth Vis Sci. Jun 2023;64(8)

20.       Dada T, Mittal D, Mohanty K, et al. Mindfulness Meditation Reduces Intraocular Pressure, Lowers Stress Biomarkers and Modulates Gene Expression in Glaucoma: A Randomized Controlled Trial. J Glaucoma. Dec 2018;27(12):1061-1067. doi:10.1097/Ijg.0000000000001088

21.       Dada T, Mondal S, Midha N, et al. Effect of Mindfulness-Based Stress Reduction on Intraocular Pressure in Patients With Ocular Hypertension: A Randomized Control Trial. American Journal of Ophthalmology. Jul 2022;239:66-73. doi:10.1016/j.ajo.2022.01.017

Black History Month: Honoring Pioneers in Ophthalmology

This article is authored by M. Shayyan Wasim, who has ancestral ties to the African Siddi community in Pakistan
Post reviewed and approved by: Dr. Marie-Josée Aubin and Dr. Anne Xuan-Lan Nguyen

Celebrating Black Excellence in Ophthalmology
Black History Month recognizes the significant contributions of Black individuals in various fields, including medicine. In ophthalmology, Black pioneers have made groundbreaking advancements in clinical practice, research, education, and advocacy. Their work has improved patient care while promoting diversity, equity, and inclusion in the field.

Pioneers in Ophthalmology

Dr. David K. McDonogh (c. 1821–1893)
Born into slavery, Dr. McDonogh pursued medical education after gaining his freedom and became one of the first Black physicians in the United States. He specialized in ophthalmology and dedicated his career to improving eye care for underserved populations while advocating for increased opportunities for Black medical students. 

Dr. Charles Victor Roman (1864–1934)
Dr. Roman was a pioneering ophthalmologist and educator who founded and chaired the Department of Ophthalmology and Otolaryngology at Meharry Medical College. Born to parents who were fugitive slaves, he overcame significant hardships to become a respected advocate for Black healthcare and medical education. 

Dr. Patricia Bath (1942–2019)
A trailblazing ophthalmologist, inventor, and academic, Dr. Bath was the first Black female physician to receive a medical patent for her invention of the Laserphaco Probe, which revolutionized cataract surgery. She was also the first Black female ophthalmology resident at NYU and co-founded the American Institute for the Prevention of Blindness. 

Dr. Maurice F. Rabb Jr. (1932–2005)
Dr. Rabb was a renowned ophthalmologist recognized for his work in cornea and retinal vascular diseases. As one of the first African American students at the University of Louisville, he later became the first Black chief resident at the University of Illinois Eye and Ear Infirmary. His leadership in ophthalmic research and education remains influential today. 

Dr. Howard P. Venable (1913–1998)
Dr. Venable played a pivotal role in desegregating hospitals and ophthalmology training programs. A dedicated mentor, he expanded opportunities for Black physicians in the field. His civil rights activism extended beyond medicine, as he fought against racial discrimination in housing and healthcare. 

Dr. Lois Young-Thomas
Dr. Young-Thomas was the first Black female graduate of the University of Maryland School of Medicine in 1960. She dedicated her career to serving disadvantaged communities and fostering medical education. She later became a professor and mentor, receiving numerous teaching awards for her contributions to ophthalmology education. 

Dr. Eve Higginbotham
A leader in academic medicine, Dr. Higginbotham became the first Black woman to chair an ophthalmology department in the United States at the University of Maryland. A glaucoma specialist, she has made significant contributions to research, healthcare policy, and diversity in medicine. 

Dr. Keith Carter
Dr. Carter is a distinguished leader in academic ophthalmology. As Chair of Ophthalmology at the University of Iowa and past president of the American Academy of Ophthalmology (AAO), he has championed diversity initiatives and mentored underrepresented medical students and residents. 

Dr. Fasika Woreta
A pediatric ophthalmologist and geneticist, Dr. Woreta is an Associate Professor at Johns Hopkins University. She has conducted significant research on congenital cataracts and retinal diseases in children while advocating for global pediatric eye care access and increasing diversity within ophthalmology. 

Conclusion
These individuals have left a lasting impact on the field of ophthalmology and beyond. Their perseverance, innovation, and advocacy continue to inspire future generations of physicians and researchers. As Black History Month is celebrated, their contributions are acknowledged, reaffirming a commitment to fostering diversity and equity in medicine.

CJO: February 2025 Issue Highlights

The February 2025 CJO is now available online. Here are some of the highlights: 

Resident Perspectives + visual abstract: Our talented team of residents have summarized 4 articles from this issue with a focus on what’s most relevant to ophthalmology learners here in Canada and around the globe. And our February visual abstract provides a visual summary of an article on the Morphometric analysis of bony nasolacrimal canal and sinonasal anatomical variations in primary acquired nasolacrimal duct obstruction.

Reviews and Original Research Articles:

Research Letters, Photo Essays, Case Reports, and more:

Follow the CJO on social media:

BlueSky: @cjo-jco.bsky.social

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Instagram: @cjo_jco

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CJO January 2025: Featured Highlights on Glaucoma

The following CJO Highlight summarizes key findings from the journal article “Acute Angle-Closure Glaucoma Risk: A Comparative Study of Escitalopram and Antidepressants.”1

Acute angle-closure glaucoma (AACG) is an ophthalmic emergency that has been linked to selective serotonin reuptake inhibitors (SSRIs) due to their mild anticholinergic effect and possibility of mydriasis. Escitalopram, one of the most prescribed SSRIs, has been implicated in the risk of AACG in case reports. However, prior to this CJO study by Khan et al., it remained unclear whether AACG secondary to escitalopram is a class effect or carries a higher risk than other SSRIs. The highlighted study investigated whether escitalopram poses a greater risk of AACG compared to other SSRIs or non-SSRI antidepressants. A total of 865,546 subjects were included to assess the incidence of AACG among new users of citalopram, escitalopram, sertraline, and venlafaxine. Results indicated trends toward a lower AACG risk in users of citalopram, escitalopram, and venlafaxine compared with sertraline, though none of these differences reached statistical significance. Findings suggest that escitalopram may be associated with a reduced risk of AACG, but further research with larger cohorts is needed. Clinicians should remain cautious when prescribing antidepressants, particularly for patients at risk of glaucoma.

To access the full article, please follow the link below:

Download Full Article PDF

Reference:

  1. Khan HM, Schendel S, Mikelberg FS, Etminan M. Acute angle-closure glaucoma risk: a comparative study of escitalopram and antidepressants. Can J Ophthalmol. 2025 Jan 24:S0008-4182(25)00004-3. doi: 10.1016/j.jcjo.2025.01.004. Epub ahead of print. PMID: 39870359.

Submitted by: Audrey-Anne Lapierre
Reviewed and Approved by: Anne Xuan-Lan Nguyen, MD