The majority of us were taken aback by the Ford government’s announcement of the plan to fund for-profit cataract surgery centers across Ontario. This was a hastily conceived initiative that is being implemented quickly without any consultation of ophthalmology leadership across the province. Many hospitals across the province are not at capacity with their cataract surgery volumes; in fact, they have been asking for more cases year in and year out. Why is the government abandoning these centers in favour of for-profit centers. Most of us are very familiar with the private centers in the GTA. Many of the owners are good ophthalmologists, some of whom are on our faculty and there are some of us who hold clinics and operate there. There are those that are saying “what’s the fuss? The standards are upheld at these centers”. The big concern is that with privatization of our health care and a move of surgery into these private centers, they will be perceived as lucrative investments. The ophthalmologist-owner may quickly sell to private investors and walk away with their nest egg. The private investors will then manage the hiring and firing of surgeons and be responsible for quality, safety, education and patient care. They will oversee the tests ordered by each surgeon, the number of specialty lenses (I dislike the term “premium lenses” and I think we shouldn’t use it with patients, preferring “specialty lenses” instead) inserted by each surgeon and the number of cases each completes daily. Remember, their responsibility is to the shareholders and their bottom line is to maximize return to investors and owners. This will impact ophthalmology in many ways and raises important questions:
Privatization jeopardizes education and residency training. Teaching our young surgeons takes time and effort and the return on investment will be seen as poor by investors. A private center in Kingston is asking for 2/3 of the volume performed at the Kingston Hospitals. If they receive this volume, the Chair of the program says that will leave very few teaching cataracts at the hospital and will ultimately lead to closing of the Queen’s Ophthalmology Residency training program. Who will teach our new generation of ophthalmologists?
Private centers will credential their own surgeons and these ophthalmologists will not be required to have hospital privileges or take call. Who will deal with complications and who will cover the emergency rooms and inpatient consults?
What checks and balances will be in place to prevent inappropriate “up-charging” of patients with private fees that can increase out of pocket costs for patients who are often seniors on a fixed income?
Who will do the complex and difficult cases that could slow down surgery at a private center?
Will private centers allocate OR access based on surgical speed, revenue generation and the surgeon’s ability to upsell “premium” options as opposed to quality, education and patient care.
I believe that ophthalmology provides excellent service, education and research in this province. If we were given the appropriate resources to increase our case volumes in the current setting, waitlists could be quickly reduced. A well thought out plan can look to shift surgeries out of hospitals into non-profit-IHFs and hospital ambulatory centers in the intermediate term. This would enhance efficiency and reduce costs while being minimally disruptive. I do hope the policy makers clearly examine the options before sending Ontario Ophthalmology on a path towards privatization.
Sherif El-Defrawy, MD, PhD, FRCS(C)
Nanji Family Chair in Ophthalmology & Vision Sciences
Chair & Professor, Department of Ophthalmology & Vision Sciences
University of Toronto
In keeping with our Strategic Plan we are pleased to announce the following new Service Chief appointments. For Cornea and Anterior Segment Dr. Neera, Singal, Neuro-Ophthalmology Dr. Edsel Ing, Paediatric & Strabismus Dr. Kamiar Mireskandari, and Retina & Vitreous Dr. Efrem Mandelcorn.
A well deserved thank you to our outgoing Service Chiefs for all their hard work, Dr. David Rootman (Corneal & Anterior Segment), Dr. Ed Margolin (Neuro-Ophthalmology), Dr. Asim Ali (Paediatric & Strabismus) and Dr. Michael Brent (Retina & Vitreous).
Thank you also to those continuing on in their Service Chief roles, Dr. Neeru Gupta (Glaucoma), Dr. Dan DeAngelis (Oculoplastics) and Dr. Larissa Derzko-Dzulynsky (Uveitis).
Dr. Neera Singal (Cornea and Anterior Segment)
Dr. Neera Singal is a cornea surgeon at The Kensington Eye Institute and The Michael Garron Hospital. She graduated from The University of Toronto Ophthalmology and went on to do her fellowship in cornea, external disease and refractive surgery at The University of Toronto. She is an assistant professor at the University of Toronto DOVS, and is the Director of Cornea at KEI. She is also the head of the Collagen Cross Linking Program at KEI, which has one of the largest international CXL experiences. She has worked closely with the Ministry of Health to improve access to care for cornea patients. She is active in education, is a Royal College Examiner, is the education lead for the DOVS cornea program and is the undergraduate medical directory for Ophthalmology at The Michael Garron Hospital. Her clinical and research interests include the management of keratoconus as well as corneal transplant surgery.
Dr. Edsel Ing (Neuro-Ophthalmology)
Dr. Edsel Ing completed his medical school and ophthalmology residency at the University of Toronto. His clinical fellowships in neuro-ophthalmology, oculoplastics and strabismus were at the Wills Eye Hospital, the Mayo Clinic and Allegheny General Hospital. He is a graduate of the Harvard Masters of Public Health and Global Clinical Scholars Research Training program, the Evidence-Based Teaching for the Health Professions program at Johns Hopkins, has a Masters of International Affairs through the United Nations Research and Training Institute, and a PhD in diagnostic prediction models for giant cell arteritis from Kingston University.
He is a section editor for the Canadian Journal of Ophthalmology, a member of the World Association of Medical Editors, recipient of the PARO and Aikens teaching awards, and a preceptor for the University of Toronto ASOPRS oculoplastics program.
His neuro-ophthalmology practice focuses on thyroid-associated orbitopathy, orbital tumours, strabismus surgery, eyelid spasms, and facial nerve palsy.
Dr. Kamiar Mireskandari (Paediatric & Strabismus)
Dr Mireskandari is an Associate Professor at the Department of Ophthalmology and Vision Sciences at the University of Toronto. He is the John and Melinda Thompson Chair in Vision Research and a staff Ophthalmologist at The Hospital for Sick Children (SickKids). He did his residency training and PhD at Moorfields Eye Hospital in London, UK. He is double fellowship trained in Cornea and External diseases (Moorfields) and Paediatric Ophthalmology and Strabismus (SickKids).
He is a clinician researcher who focuses on Paediatric Ophthalmology and Strabismus and in particular ways to assess and improve patient care and outcomes. He is the Chair of the Ophthalmology Research Committee and co-director of a fully comprehensive paediatric cornea fellowship program at SickKids. He is on the editorial board of the JAAPOS journal and the Review Committee for the next major revision of the AAO – BCSC Book 6 in Pediatric Ophthalmology and Strabismus 2021-22. His clinical & surgical practice includes corneal transplantation, External diseases, cataract, glaucoma, retinopathy of prematurity and Strabismus.
Dr. Efrem Mandelcorn (Retina & Vitreous)
Dr. Efrem Mandelcorn is an attending vitreoretinal surgeon at the Toronto Western Hospital, University Health Network. He received his medical degree with honours and subsequently completed his ophthalmology residency at the University of Toronto Department of Ophthalmology and Vision Sciences. He is a Fellow of the Royal College of Surgeons and a Fellow of the American Board of Ophthalmology. He completed 2 surgical fellowships, first at the University of Toronto followed by the Bascom Palmer Eye Institute at the University of Miami, Florida. He is an associate professor at the University of Toronto, Department of Ophthalmology and is the Director of the Vitreoretinal Fellowship Program at the Toronto Western Hospital & Sunnybrook sites.
Physician Wellness in Ophthalmology
In a recent supplemental issue of CJO with a theme on "Physician Wellness in Ophthalmology," our own Dr. Agnes Wong has written an astute, comprehensive, and thought-provoking article on the many factors that contribute to physician distress. For those of you might have missed it, I would highly recommend it as it is particularly timely during this pandemic. The link is:
After a year like no other, a year that that highlighted striking inequities in society, culture, and medicine – this new year is an apt time for reflection and making an active commitment to fostering an environment of inclusion and practicing allyship in. The EDI Committee has been hard at work behind the scenes on initiatives to enhance and uplift a culture of equity, diversity, and inclusion in the DOVS.
DOVS Code of Conduct
In April 2020, the Faculty of Medicine (FOM) revised and approved new Standards of Professional Behaviour for Clinical (MD) Faculty. In alignment with this policy, as well as other existing U of T and CPSO policies, the EDI Committee is in the process of drafting a DOVS Code of Conduct. This policy document will serve to highlight the expectations regarding professional behaviour for faculty and learners, as well as formalize a commitment to creating a learning and work environment of inclusion and equity. Once finalized and approved, this Code of Conduct will become part of appointment and reappointment processes.
DOVS EDI Interdisciplinary Grand Rounds
The EDI Committee is pleased to announce two EDI Grand Rounds scheduled for this year. These sessions will be held jointly with the Department of Anaesthesia and Pain Medicine, and the Department of Obstetrics and Gynecology. The speakers are highly sought-after leaders in their fields, and are known for their engaging and thought-provoking sessions. Please bookmark these dates and join for a stimulating discussion!
March 26, 2021, 7:30-8:30 AM: “Embracing our Duty of Care Obligation for Deeper Inclusion”
By Nouman Ashraf, Assistant Professor & Director, Equity, Diversity & Inclusion, Rotman School of Management
May 28, 2021, 7:30-8:30 AM: “Black Health and Anti-Racism in Medicine”
By Dr. Onye Nnorom, Assistant Professor and EDI Lead, Dept of Family and Community Medicine, & Black Health Theme Lead, MD Program, Temerty Faculty of Medicine
Update on FOM Learner Experience & Learner Mistreatment Disclosure Tool
In 2020, the FOM created an Office of Learner Experience, directed by Dr. Reena Pattani from the Department of Medicine. With a goal of addressing barriers to reporting learner mistreatment, guidelines for managing disclosures of learner mistreatment are currently being finalized. Residents, fellows, and elective PGME trainees will have access to an anonymous online disclosure tool via the Office of Learner Experience. While this disclosure tool is already available for medical students, the anticipated rollout for PGME learners is spring/summer 2021, once broad consultation has been completed by the FOM regarding the investigation, resolution, and appeals processes.
Please Reach Out!
The EDI committee is actively seeking input from faculty members, staff and trainees on future projects, research initiatives, and directions. If you have any ideas, concerns, or thoughts, please email firstname.lastname@example.org
Honours, Awards & Grants
Dr. J. Ray Buncic appointed to the Order of Ontario
On January 1, 2021, Dr. J. Raymond Buncic is appointed to the Order of Ontario, the province's highest honour.
Dr. Ray Buncic’s contributions to Ophthalmology have been magnanimous and there is nobody more deserving of this honour. Dr. Buncic has been a transformational leader and under his leadership, the ophthalmology Department at the Hospital for Sick Children became one of the most recognized pediatric ophthalmology departments on the globe. He developed expertise in a rare area of our specialty and has been able to help tens of thousands of patients. He’s an exceptional teacher who has trained hundreds of specialists internationally and a superb academic enhancing the world’s understanding of pediatric neuro-ophthalmology. And he has done all this with humility, kindness and friendliness. A true role model for what we all hope a physician should be.
Dr. Neeru Gupta appointed Editor-in-Chief of the Journal of Glaucoma
Prof. Neeru Gupta is the new Editor-in-Chief of the Journal of Glaucoma, the Official Journal of the World Glaucoma Association, effective January 1, 2021. The Journal of Glaucoma is the world’s premier scientific journal for glaucoma research, devoted to new fundamental understandings, innovations in diagnosis and technology, and advancements in glaucoma medical and surgical care. The Journal of Glaucoma is the only scientific journal dedicated to the field of glaucoma that is both indexed and has an impact factor. Established by Founding Editor Prof. Michael Van Buskirk, this year marks its 30th anniversary of service to the research community. Prof. Gupta is the 4th Editor-in-Chief of the Journal of Glaucoma and becomes the first woman to be appointed to this role.
Jovi Wong received the Joule 2020 Innovation Grant
Jovi Wong, MD, MSc, DPhil (PGY-1), received the 2020 Joule Innovation Grant for Retinographer (link to www.retinographer.com). She is one of twelve CMA members to receive a Joule Innovation Grant this year. Retinographer is an inexpensive smartphone-based fundoscope that is powered by artificial intelligence and is capable of detecting multiple retinal diseases.
The Joule Innovation Grant will support Dr. Wong and her team with testing prototypes and improving Retinographer through close collaboration with experts from the Department of Ophthalmology and Vision Sciences at the University of Toronto, as well as with rural and remote front-line health care workers through the Ontario tele-ophthalmological network.
Dr. Jovi Wong is a PGY-1 ophthalmology resident at the University of Toronto. She holds a DPhil in Clinical Neurosciences (retinal physiology) from the University of Oxford. She is a member of the ARVO Advocacy and Outreach Committee.
Retinographer Team - Jovi Wong and Prashant Pandey
Most-viewed clinical video of 2020 on the American Academy of Ophthalmology ONE Network
The American Academy of Ophthalmology recognizes two clinical videos from DOVS as the top first and third most viewed videos of 2020 on the ONE Network. These two videos depicted simulations that assessed the spread of respiratory droplets during a slit lamp exam and ophthalmic surgery. In combination, they received close to 100,000 views and comments from ophthalmologists around the world including the US, Ecuador, Guatemala, Turkey, Jamaica, and Japan. Congratulations to Drs. Tina Felfeli, Efrem Mandelcorn, Amrit Rai, Amandeep Rai, Rosa Braga-Mele, Hatim Batawi, Sultan Aldrees, and Wendy Hatch on this achievement.
These initiatives were made possible by the generous support of the DOVS QI Committee Grant awarded to Drs. Felfeli and Mandelcorn.
Jason Kwok and Austin Pereira's OCTcases received Bayer Medical Education Grant and accredited by COS
During the pandemic, Jason Kwok (PGY-4) and Austin Pereira (PGY-1) created a website (www.octcases.com) to teach learners how to interpret a commonly used imaging modality in ophthalmology, Optical Coherence Tomography (OCT). The Bayer Medical Education Grant ($5,000) was awarded to their team to continue improving on the website and to implement additional interactive features.
OCTcases is also accredited by the Canadian Ophthalmological Society. Reviewing its contents allows for Maintenance of Certification Section 2 credits:
Marko Popopovic received Chisholm Memorial Fellowship
Marko Popovic (PGY-2) recently received Chisholm Memorial Fellowship from the Temerty Faculty of Medicine, University of Toronto. Award valued at $8,500 presented to the top ranked resident physicians at the University of Toronto for excellence, dedication and potential in academic research, based on an evaluation of academic endeavours, comments from referees and a proposal for a proposed research study.
Other Honours, Awards & Grants
Ong Tone, Stephan:
Pooler Charitable Fund Grant - $21,500
Invited grant reviewer for CIHR Operating Grant: Network of Clinical Trials Networks: Collaboration to Evaluate COVID-19 and Intervention Strategies (Dec 2020)
Reviewer for ARVO Advocacy Handbook
The Association for Research in Vision and Ophthalmology (ARVO) released an updated Advocacy Handbook recently to support efforts towards advocacy for eye and vision research. Previously updated in 2008, this refresh gives the guidance in the handbook a new life and includes strategies to lobby government and policymakers for eye and vision research funding both in-person and using technology to overcome distance barriers. We hope this resource will help ARVO members begin or continue their advocacy journeys, and ultimately advance the eye and vision research enterprise around the world.
Dr. Jovi Wong (PGY-1 ophthalmology resident) contributed to the updated ARVO Advocacy Handbook as a reviewer on behalf of the Advocacy and Outreach Committee. Link to the ARVO advocacy handbook: https://www.arvo.org/advocacy/resources/advocacy-handbook/
Grant for Patient Navigator and Low Vision Rehab Pilot, Fighting Blindness Canada (Dec 2020)
Invited Lectures and Visiting Professorships
Biophotomodulation for dry age-related macular degeneration, Low Vision program, 23nd Ophthalmology Congress of the University of Sao Paulo, Sao Paulo, Brazil, December 4, 2020 (virtual presentation)
Corneal Photovitrification for dry age-related macular degeneration, Low Vision program, 23nd Ophthalmology Congress of the University of Sao Paulo, Sao Paulo, Brazil, December 4 (virtual presentation)
Macular perimetry and clinical applications in low vision rehabilitation in patients with age-related macular degeneration, at the Centennial Ophthalmology Congress of the University of Sao Paulo, Sao Paulo, Brazil, December 4, 2020 (virtual presentation)
Ophthalmic Findings and Controversies in THI-CM. Canadian Symposium on Advanced Practices in Child Maltreatment. Virtual Meeting, Calgary, Alberta, Canada. Presenter: K Mireskandari. (Invited Speaker)
“The Eye: Window to the Brain”, 8th Neuroscience Days, Bilkent University, Ankara, Turkey, on Dec 20 2020 (Invited Lecture)
NASA Human Research Program Panel on the Spaceflight Associated Neuro-ocular Syndrome. Dec 2020 - Mar 2021 (Panel Reviewer)
Congratulations to Dr. Amandeep and Amy Rai on the birth of their baby boy on December 21st, 2020. Shay Singh Rai was born at Mt. Sinai Hospital, weighing 7 lbs 8 oz. Older brother Seva is very thrilled to have a little brother!
Dr. Harold Stein
It is with great sorrow that we inform you of the sudden passing of Dr. Harold Stein on January 31st, 2021. Dr. Stein will always be remembered as a wonderful person and a great ophthalmologist. He will be missed by his colleagues and patients.
On behalf of the Department of Ophthalmology & Vision Sciences, our sincere condolences to the entire Stein family at this time.
It is with great sadness that we announce the death of Harold Aaron Stein on January 31, 2021, beloved husband of Anne Stein. Loving father of Ray (Nancy), Laurie (Bob), and Gary (Debra). Treasured grandfather of Rebecca (Michael), Emma (Jake), Maxwell, Teddy, Kelsey, Elliott, Alexa, Casey and Olivia. Dear brother and brother-in-law of Richard and Pam Stein. Dr. Harold Stein was a brilliant, kind, warm, and generous man with a great sense of humor. He was larger than life, a talented ophthalmic surgeon, an innovative and creative thinker, a renaissance man with a wide range of interests, and a storyteller with a twinkle in his eye. He loved to recount his adventures of working in developing countries, discovering new surgical techniques and to share his many ideas for academic studies. Harold practiced ophthalmology for over fifty years and was well known to doctors around the globe for his academic achievements and for pioneering the profession of Ophthalmic Assistants. During his career, he received many distinguished awards including the Lifetime Achievement Award from The Canadian Society of Ophthalmology. He enjoyed teaching residents and authored over thirty-five textbooks. He was very proud to co-found The Bochner Eye Institute named for his former partner and father-in-law, Dr. Maxwell Bochner. Harold's most constant companion was his loving wife, Anne, and their bond was exceptionally strong. She supported him in every adventure, accomplishment and challenge that came along. He was an adoring father to his three children and a treasured grandfather of nine. Harold left his mark on his family, his patients, and on the ophthalmic community worldwide. He will be deeply missed by all who knew him. A family graveside service was held on Tuesday, February 2, 2021. Memorial donations may be made to The Dr. Harold Stein Memorial Fund, c/o Benjamin Foundation, www.benjamins.ca, 416-780-0324.
Online Rounds Schedule and Events
Save the date!
Department of Ophthalmology & Vision Sciences
Annual Research Day 2021
We are pleased to announce the dates for the 2021 DOVS Sixty-Fourth Annual Research Day and Fortieth Clement McCulloch Lecture Virtual Rounds.
The sessions will be held between 7:00 – 9:00 pm on the following Tuesdays: April 27th, May 4th, and May 11th. Each Round will consist of a Guest Speaker and a series of Trainee talks. We will send out the agenda once the speakers have been confirmed.
Let us know if you have any questions.
Best, Matt Schlenker Mano Chandrakumar Valerie Wallace Rajeev Muni Sherif El-Defrawy
FREE REGISTRATION NOW OPEN
To register/access the conference website, Click here
The 31st Annual Jack Crawford Day Virtual Conference:
Kids Beyond The Eyes
Date: Friday April 16, 2021
Designed for comprehensive ophthalmologists, paediatric ophthalmologists, and anyone who sees children (or likes children!), the theme in 2021 is "Kids Beyond The Eyes" covering many relevant topics including:
Disorders of the Zonule
Role of VEP in Ophthalmology
ROP in Canada: How are we doing?
Case Based Emergencies
Literature of 2020: Studies of the Year
Optic Nerve Malformations and Associated Systemic Disorders
Don’t be Afraid of Wiggly Eyes
Finessing the Paediatric Eye Exam: Vision Beyond 20/20
Our excellent international guest speaker this year:
Dr. Elias Traboulsi
Stanley Stone Endowed Chair of Pediatric Ophthalmology
Director, The Center for Genetic Eye Diseases,
Cleveland Clinic’s Cole Eye Institute
Dunk CE, van Dijk M, Choudhury R, Wright TJ, Cox B, Leavey K, Harris LK, Jones RL, Lye SJ. Functional Evaluation of STOX1 (STORKHEAD-BOX PROTEIN 1) in Placentation, Preeclampsia, and Preterm Birth. Hypertension. 2020 Dec 28:HYPERTENSIONAHA12015619. doi: 10.1161/HYPERTENSIONAHA.120.15619. Epub ahead of print. PMID: 33356399.
Georgiou M, Robson AG, Fujinami K, Leo SM, Vincent A, Nasser F, Cabral De Guimarães TA, Khateb S, Pontikos N, Fujinami-Yokokawa Y, Liu X, Tsunoda K, Hayashi T, Vargas ME, Thiadens AAHJ, de Carvalho ER, Nguyen XT, Arno G, Mahroo OA, Martin-Merida MI, Jimenez-Rolando B, Gordo G, Carreño E, Carmen A, Sharon D, Kohl S, Huckfeldt RM, Wissinger B, Boon CJF, Banin E, Pennesi ME, Khan AO, Webster AR, Zrenner E, Héon E, Michaelides M.KCNV2-associated Retinopathy: Genetics, Electrophysiology and Clinical Course - KCNV2 Study Group Report 1. Am J Ophthalmol. 2020 Dec 10:S0002-9394(20)30656-5. doi: 10.1016/j.ajo.2020.11.022. Online ahead of print.PMID: 33309813Free article.
Tyndel F, Sundaram A, Bebedjian R, Bookman I, Bookman A, Levin LA. Crohn-related chronic relapsing inflammatory optic neuropathy. Can J Neurol Sci. 2020 Dec 14:1-10. doi: 10.1017/cjn.2020.270. Online ahead of print.
Vig A, Poulter JA, Ottaviani D, Tavares E, Toropova K, Tracewska AM, Mollica A, Kang J, Kehelwathugoda O, Paton T, Maynes JT, Wheway G, Arno G; Genomics England Research Consortium, Khan KN, McKibbin M, Toomes C, Ali M, Di Scipio M, Li S, Ellingford J, Black G, Webster A, Rydzanicz M, Stawiński P, Płoski R, Vincent A, Cheetham ME, Inglehearn CF, Roberts A, Heon E. DYNC2H1 hypomorphic or retina-predominant variants cause nonsyndromic retinal degeneration. Genet Med. 2020 Dec;22(12):2041-2051. doi: 10.1038/s41436-020-0915-1. Epub 2020 Aug 5.PMID: 32753734
Kaufman S, Yoganathan P, Small K et al. Genetics and AREDS Formulation Interaction in Neovascular Age-Related Macular Degeneration. Journal of VitreoRetinal Diseases. J Vitreoretin Dis 2021;5(1):46-52.
Ong Tone S, Kocaba V, Böhm M, Wylegala A, White TL, Jurkunas UV. Fuchs endothelial corneal dystrophy: The vicious cycle of Fuchs pathogenesis. Prog Retin Eye Res. 2021 Jan;80:100863. doi: 10.1016/j.preteyeres.2020.100863. Epub 2020 May 8. PMID: 32438095; PMCID: PMC7648733.
Pereira A, Choudhry N. Diagnostic and therapeutic challenges. Retina;doi:10.1087/IAE.0000000000003108.
Pereira A, Popovic M, Lloyd JC, El-Defrawy S, Schlenker MB. A comparison of applanation and immersion ultrasound with optical biometry using the Barrett Universal II intraocular lens power formula. International Ophthalmology 2021;doi.org/10.1007/s10792-021-01714-3.
Ranalli PJ, Barton JJS. Reply to Ciuffreda et al. Surv Ophthalmol. 2021 Jan 27:S0039-6257(21)00019-9. doi: 10.1016/j.survophthal.2021.01.007. Online ahead of print.PMID: 33515550
This edition of Ophthalmic News was produced by the University of Toronto Department of Ophthalmology & Vision Sciences. The University of Toronto respects your privacy. We do not rent, trade or sell our mailing lists. Want to change how you receive these emails? You can update subscription preferences or unsubscribe from this list.