Purpose: As the use of hyaluronic acid fillers continues to increase for clinical and aesthetic purposes, associated complications continue to rise as well. Excess hyaluronidase is often used to dissolve filler, which has its own set of adverse effects. This study analyzes 22 commercially available fillers to delineate the lowest single dose of recombinant human hyaluronidase (RHH) required to fully dissolve each filler within 6 hours across 3 trials. Methods: 0.2 ml aliquots of each of 22 hyaluronic acid fillers were placed in wells. A single dose of RHH, titrated to a minimum volume of 0.45 cc, was administered to the center of the aliquot, to a maximum of 140 units. RHH amounts were as follows: 0, 2.5, 5, 10, 20, 40, 60, 80, 100, 120, or 140 units RHH. Bird’s eye and lateral photographs were taken to monitor dissolution progress at several time points over the 6-hour period to monitor aliquot height and appearance changes. Filler aliquots were left undisturbed for 6 hours, after which dissolution was confirmed by stirring the aliquot on video recording. This process was repeated 3 times per filler to determine the minimum dose of RHH required to consistently dissolve each aliquot. Results: For each of the 22 fillers, the minimum dose of RHH required for dissolution was identified with consistent results across 3 trials, demonstrating reliability. Juvéderm Volbella, Juvéderm Vollure, Juvéderm Skinvive, Restylane-L, Restylane Lyft, and Restylane Silk were identified as the least resistant fillers, requiring ≤20 units to dissolve. Resilient hyaluronic acid (RHA) 2, RHA 3, RHA 4, Belotero Volume, Juvéderm Ultra XC, Juvéderm Volux, Restylane Kysse, and Revanesse Versa were classified as most resistant, requiring ≥120 units to dissolve. Conclusions: This study identifies the minimum single dose of RHH from 2.5 units/0.2 ml to 140 units/0.2 ml for dissolution of 22 different hyaluronic acid fillers over 6 hours. These results paired with previous studies help elucidate the dissolution profiles of each filler in the context of their rheological properties, further informing physicians on how to optimally dissolve different hyaluronic acid fillers in a clinical setting. Video Abstract {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video Abstract","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_ejd2p2g3"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video Abstract","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_altk1id6"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video Abstract","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_qo8ak33o"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video Abstract","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_v3jchkii"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video Abstract","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_0sqb02hf"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]}

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.

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.

Background: Musculoskeletal (MSK) discomfort is a significant occupational hazard for eye care professionals, including ophthalmologists, who report high rates of MSK discomfort. This systematic review investigated the impact of various interventions, such as regular exercise, posture-correcting aids, and surgical heads-up displays, on reducing MSK pain in the operating room. Methods: This review was reported following PRISMA guidelines and was prospectively registered in the PROSPERO database (CRD42024559189). A systematic literature search was conducted of Embase, MEDLINE, and Web of Science from inception to 2024. Included studies were categorized as exercise modifications, equipment modifications, or training aids. All MSK pain-related outcomes from any time point were extracted. Risk of bias was assessed using the Murad tool, the Cochrane risk-of-bias tool for randomized trials (RoB 2), and the Risk Of Bias In Non-Randomized Studies-of Interventions (ROBINS-I) tool. Results: The systematic search strategy identified 2276 studies, of which 53 qualified for full-text screening with 13 resultant studies including 712 eyecare specialists. Physical activity was found unanimously to reduce MSK pain, with favourable evidence for the utilization of posture-correcting aids. There was mixed—but mostly favourable—evidence for the use of surgical heads-up displays. Conclusions: Exercise modifications, such as yoga and regular exercise; equipment modification with heads-up displays during surgery; and training aids for posture correction were shown to be beneficial for MSK-related pain among ophthalmologists. Future studies should strive to improve the certainty of evidence on ergonomics-related interventions for ophthalmologists, which will better support practice and guideline development.