Intraocular malignant tumors are rare; however, they can cause serious life-threatening complications. Uveal melanoma (UM) and retinoblastoma (RB) are the most common intraocular tumors in adults and children, respectively, and come with a great disease burden. For many years, several different treatment modalities for UM and RB have been proposed, with chemotherapy for RB cases and plaque radiation therapy for localized UM as first-line treatment options. Extraocular extension, recurrence, and metastasis constitute the major challenges of conventional treatments. To overcome these obstacles, immunotherapy, which encompasses different treatment options such as oncolytic viruses, antibody-mediated immune modulations, and targeted immunotherapy, has shown great potential as a novel therapeutic tool for cancer therapy. These anti-cancer treatment options provide numerous advantages such as selective cancer cell death and the promotion of an anti-tumor immune response, and they prove useful in preventing vision impairment due to macular and/or optic disc involvement. Numerous factors such as the vector choice, route of administration, dosing, and patient characteristics must be considered when engineering an oncolytic virus or other forms of immunotherapy vectors. This manuscript provides an in-depth review of the molecular design of oncolytic viruses (e.g., virus capsid proteins and encapsulation technologies, vectors for delivery, cell targeting) and immunotherapy. The most recent advances in preclinical- and clinical-phase studies are further summarized. The recent developments in virus-like drug conjugates (i.e., AU011), oncolytic viruses for metastatic UM, and targeted immunotherapies have shown great results in clinical trials for the future clinical application of these novel technologies in the treatment algorithm of certain intraocular tumors.

Diabetic retinopathy (DR) remains the leading cause of preventable blindness among working-age adults worldwide, driven by the growing prevalence of diabetes mellitus. The aim of this comprehensive literature review is to provide an insightful analysis of recent advances in the pathogenesis of DR, followed by a summary of emerging technologies for its diagnosis and treatment. Recent studies have explored the roles of cell death pathways, immune activation, and lipid peroxidation in the pathology of DR. However, at the core of DR pathology lies neovascularization driven by vascular endothelial growth factor (VEGF), and mitochondrial damage due to dysregulated oxidative stress. These dysregulated pathways manifest clinically as DR, with specific subtypes including non-proliferative DR, proliferative DR and diabetic macular edema, which can be diagnosed through various imaging modalities. Recently, novel advances have been made using liquid biopsy and artificial (AI)-based algorithms with the goal of transforming DR diagnostics. AI models show distinct promise with the capacity to provide automated interpretation of retinal imaging. Furthermore, conventional anti-VEGF injectable agents have revolutionized DR treatment in the past decades. Today, as the pathogenesis of DR becomes better understood, new pathways, such as the ROS-VEGF loop, are being elucidated in greater depth, enabling the development of targeted therapies. In addition, new innovations such as intravitreal implants are transforming the delivery of DR-specific medication. This paper will discuss the current understanding of the pathogenesis of DR, which is leading to new diagnostic and therapeutic tools that will transform clinical management of DR.

Prolonged wait times in Canada's Emergency Departments (EDs) adversely impact patients, hospital staff, and the healthcare system. Despite the growing literature on ED wait times in Canada, our understanding of what strategies work to reduce wait time remains sporadic due to the absence of a current, comprehensive mapping of the interventions implemented within EDs. This scoping review aims to address this gap and map ED interventions in Canada, which may be useful for policymakers and healthcare professionals to make evidence-informed decisions. Scoping Review. Utilizing Arksey and O'Malley's methodological framework, we summarized peer-reviewed articles on interventions in Canadian EDs from January 2010 to May 2024. To categorize and interpret the diverse interventions, we conducted a narrative synthesis using Braun and Clark's thematic analysis method. We identified 21 articles, predominantly focusing on Ontario (n = 16). Most studies utilized retrospective evaluations (n = 16), followed by cluster randomized trials (n = 2), quasi-experimental design (n = 1), prospective survey (n = 1), and before-after design (n = 1). Nearly all were in high-volume urban EDs, with one in a rural setting. Interventions were categorized into five themes: Alternative Location, Financial Incentives, Health Workforce Enhancement, Process Improvement, and Integrated Intervention. While alternative ED locations, health workforce enhancement, and integrated approaches showed promise in reducing ED wait times, financial incentives and process improvement initiatives showed mixed results. The reviewed interventions focused on strengthening ED operational efficiencies, but sustainable wait time reduction necessitates multifaceted, context-specific approach. Future research should consider broader health system challenges and ED contextual issues.

We describe the evolution of the demographics in the Canadian ophthalmology workforce and compare these trends to other surgical specialists. A longitudinal observational study. Surgical specialists identified in the Canadian Institute for Health Information's "Supply, Distribution, and Migration of Physicians in Canada" (SDMP) database from 1971 to 2022. Categories included cardiac, general, orthopedic, plastic, and vascular surgery; obstetrics and gynecology; ophthalmology; otolaryngology; and urology. Demographic data were extracted from the SDMP database. Descriptive statistics were used to determine mean age, male-to-female ratio, urban-to-rural ratio, percentage of physicians under age 40 and above age 65, Canadian-to-foreign trained ratio, and physicians-to-100,000 population ratio for ophthalmologists and other surgeons by decade. Ophthalmologists and other surgeons aged significantly, and ophthalmologists were significantly older than other surgeons (mean age: 52.15 vs 49.73 years; p < 0.01). The percentage above age 65 doubled for both groups, reaching 21.51% for ophthalmologists and 15.31% for other surgeons. Male-to-female ratios decreased 11-fold for ophthalmologists, now 2.54:1, and 17-fold for other surgeons, now 2.01:1. Surgeon-to-100,000 population ratio increased from 22.97 to 25.53 (p < 0.001), whereas ophthalmologist ratios increased slightly from 3.27 to 3.51 (p < 0.001). Urban-to-rural distribution increased by 34.67% for surgeons but decreased by 32.27% for ophthalmologists. Both groups saw an increase in Canadian-trained practitioners, with ratios rising to 5.23:1 for surgeons and 5.41:1 for ophthalmologists by the 2020s. The percentage of ophthalmologists and other surgeons above age 65 years has doubled. Ophthalmologists remain significantly older than other surgeons. The ophthalmologists-to-100,000 population ratio, presently 3.51, meets the recommended goal of 3.37-to-100,000 population.

Post-surgical panophthalmitis and necrotizing fasciitis are rare but potentially sight- and life-threatening complications requiring urgent treatment. We report a case of invasive Group A Streptococcus infection following combined cataract and Ahmed Glaucoma Valve implantation surgery. A 69-year-old man with advanced neovascular glaucoma, diabetes, hypertension, and atrial fibrillation underwent uneventful cataract surgery with intraocular lens placement and glaucoma drainage device implantation using a donor scleral patch. On postoperative day (POD) zero, the graft was adherent with intact conjunctival closure. By POD4, he presented with fever, confusion, orbital pain, swelling, chemosis, and purulent discharge, and was found to be in septic shock. Imaging showed exophthalmos, periocular swelling, fat stranding, and lateral rectus thickening. Examination revealed light perception vision, relative afferent pupillary defect, hypopyon, and vitreous haze. Blood and conjunctival cultures grew Group A Streptococcus. Despite intravenous and topical antibiotics, infection progressed. He underwent device explantation and subsequent enucleation with silicone implant, partial dacryoadenectomy, conformer placement, and temporary tarsorrhaphy. Orbital healing was satisfactory with resolution of infection and pain. Hospital course was complicated by aspiration pneumonia, Clostridium difficile colitis, and type two myocardial infarction with new heart failure. Although infection improved after a two-week course of antibiotics, the patient later suffered cardiac arrest and passed away. This case documents exogenous panophthalmitis and necrotizing fasciitis following glaucoma drainage device implantation caused by invasive Group A Streptococcus. The case highlights the aggressive nature of infection and underscores the importance of early recognition, aggressive management, and careful postoperative monitoring in high-risk patients.

Gender inequality remains a persistent issue in healthcare, especially in ophthalmology, where women face systemic barriers such as pay gaps, limited surgical opportunities, harassment, and unequal family expectations. Despite increasing entry into the field, women remain underrepresented in leadership, affecting career advancement and patient care. This study examines how virtual platforms, and co-led initiatives can address gender disparities in eye health. In 2021, Women in Ophthalmology, Seva Foundation, and Orbis International launched the Women’s Leaders in Eye Health (WLEH) initiative—a global community promoting mentorship, networking, and leadership development. Starting with virtual webinars and informal networking, the initiative expanded to in-person events in 2023 due to strong global engagement and demand. Early virtual programming, including webinars and “Coffee Hour” sessions, proved effective and laid the groundwork for broader offerings such as mentorship and professional development grants. WLEH’s success underscores the power of collaboration in promoting gender equity. By fostering connections and leadership pathways, WLEH offers a scalable model to break down gender challenges and uplift the next generation of women leaders to deliver more accessible eyecare globally.