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To provide an overview of the effect that the COVID-19 pandemic has had on visual electrophysiology referral patterns and the subsequent effect this may have on patients.All electrodiagnostic tests performed at Kensington Vision and Research Centre, Toronto Canada, in a 3-month period prior to the COVID-19 pandemic (1 September 2019 to 30 November 2019) were compared to a 3-month period after the start of the COVID-19 pandemic (1 September 2021 to 30 November 2021).A total of 502 patients had electrodiagnostic testing carried out in the designated time periods: 292 in the time period prior to the COVID-19 pandemic and 210 patients after. There was a significant change in the reason for referral in patients pre-COVID compared to post-COVID (p = 0.004). There was a 43% reduction in referrals for drug monitoring, 25% reduction for hereditary pathology and a 27% increase in acquired pathology after the start of the COVID-19 pandemic compared to before.There was a substantial decrease in the total number of patients referred after the start of the COVID-19 pandemic compared to pre-COVID with inherited retinal pathology and drug monitoring patients being 2 populations most affected by the disruption to healthcare services.

BACKGROUND Mobility challenges, transportation, and finances may serve as barriers to diabetic retinopathy (DR) screening in the growing elderly population in Ontario. Screening of patients in their own nursing homes using teleophthalmology may improve accessibility to DR screening. OBJECTIVE To report the feasibility, results, and patient satisfaction of a pilot expansion of the Toronto Tele-Retinal Screening Program in an elderly long-term care home. METHODS A pilot project was initiated with a cohort of elderly patients with Type II diabetes mellitus (DM) in long-term care who were referred to the Toronto Tele-Retinal Screening Program for DR screening between April 1, 2022 and July 1, 2022. RESULTS A total of 28 patients were screened for DR. Half (14/28) of patients suffered from a fall within the last year and 35% (10/28) were fully dependent for mobility. Overall, 14.3% (4/28) of patients could not be successfully imaged. Of the patients imaged, 8.3% (2/24) were advised to arrange an urgent follow-up. Pathologies identified included uncontrolled glaucoma (4.1%, 1/24), non-proliferative DR (NPDR) (8.3%, 2/24), wet age-related macular degeneration (AMD) (8.3%, 2/24), and dry AMD (37.5%, 9/24). A total of 20.8% (5/24) patients could not undergo tabletop imaging due to mobility issues. Screening of 60% (3/5) of these patients were successful with the handheld camera. Overall, 90% (17/19) of patients rated their subjective screening experience as either “brilliant” or “really good.” CONCLUSIONS This pilot project demonstrated that the implementation of the Toronto Tele-Retinal Screening Program into elderly long-term care homes may mitigate common barriers to eye screening with a good subjective patient experience.

Gilbert’s syndrome (GS) is an extensively mild condition characterized by periods of elevated levels of bilirubin in the blood. The bilirubin is an orange yellowish tinted molecule which is produced when red blood cells are broken down and this substance is eliminated from the body only after it undergoes bio-transformation in the liver which converts unconjugated bilirubin to conjugated bilirubin. When the level of unconjugated bilirubin increases beyond a determined point, the bilirubin pigment starts to discolour the cornea of the eyes (making them to appear light yellow) and with higher levels the skin may also turn to yellow (jaundice). Gilbert’s syndrome also known as constitutional hepatic dysfunction and familial non haemolytic jaundice. People with Gilbert’s syndrome have an inherited abnormality that causes reduced production of an enzyme involved in processing of bilirubin. A presumptive diagnosis of Gilbert’s syndrome is made when unconjugated hyperbilirubinemia is noted on several occasions.

The main moto of the present study is to evaluate the anticonvulsant property of Ficus carica fruits in Swiss albino mice using Maximal electroshock seizures (MES) model. Animals were divided into 5 groups of n=6 each using Phenytoin (25 mg/kg i.p) as the standard drug. The Aqueous extract of Ficus carica was given at three doses of 250 mg/kg, 500 mg/kg and 750 mg/kg p.o. The test samples had been given one hour prior to the induction of convulsions. The present study reveals that the aqueous extract of Ficus carica at the doses of 250 mg/kg, 500 mg/kg and 750 mg/kg p.o significantly reduced the duration of tonic hind limb extension (THLE) in mice (P

Diabetes mellitus is metabolic disorder characterised by hyperglycaemia of human blood due to inadequate secretion and action of hormone insulin. Different classes of DM are Type-1, Type-2, neonatal, gestational and maturity onset of diabetes at young stage. The main pathologic cause for the DM is autoimmune destruction of β-cells and insulin deficiency due to resistance of insulin action caused by the abnormalities in metabolism of carbohydrates, protein and lipids which intern cause lack of insulin action on target tissues. Chronic stage of hyperglycaemia is associated with permanent damage, failure and dysfunction of various organs system, which includes heart, blood vessel, eyes, neurones and kidney. Long term DM may causes some health complications in patient such as nephropathy, neuropathy, retinopathy and other complications like peripheral vasculopathy and ischemia of heart. In current era ocular complications associated with DM are rapid and progressive, becoming world top most cause of morbidity. This article covers brief information regarding ocular complications and vision loss in patient with DM.

Purpose The coronavirus pandemic has prompted unprecedented delays to treatment with anti-VEGF intravitreal injections due to the need to reduce hospital attendances and prioritise the patients at highest risk of vision loss. This study aims to quantify the effect of these delays on visual acuity (VA) outcomes and optical coherence tomography (OCT) features for patients receiving treatment for neovascular age-related macular degeneration (nAMD), retinal vein occlusions (RVO) and diabetic macular oedema (DMO) and correlate to the Royal College of Ophthalmologists guidelines (RCOphth). Methods A retrospective data analysis of an electronic medical record was performed on a random sample of eyes receiving anti-VEGF injections for nAMD, RVO or DMO. Data collected included age, sex, reason for injection, number of weeks delay if > 8 weeks from that planned, VA at baseline and follow-up and the OCT features, if delayed. For those eyes not delayed, a visual acuity at 20 weeks was recorded to provide a control group. Results A sample of 981 eyes (858 patients) were analysed. There was a delay in review of 8 weeks or more in 39.6% of patients of which 30.4% had since returned for review (28.4% nAMD, 37.6% RVO and 30.0% DMO). There was no demographic difference identified between the delayed and non-delayed patients; however, the delayed group was significantly more likely to have better vision in their non-treated eye (p = 0.0003). A statistically significant difference was found in the change in VA between the delayed and the not-delayed group for eyes with nAMD (p = 0.001) but not for RVO or DMO. For the delayed group, mean CMT increased by 33 and 100 μm, respectively, for nAMD and RVO and decreased by 7.8 μm for DMO. The VA of 89.7% of DMO eyes returned to baseline, compared to 74.6% and 76.9% of nAMD and RVO eyes. Conclusion The RCOphth guidance to prioritise intravitreal injections for nAMD over DMO appears appropriate in this cohort but not for RVO. Eyes with nAMD experienced the greatest loss of vision with treatment delay, and nAMD and RVO eyes were less likely to return to baseline on restarting treatment.

We report a case of a 72-year-old female who developed bilateral pseudo-vitelliform dystrophy after taking desferrioxamine for the treatment of chronic iron overload. The patient then developed a right superior hemiretinal vein occlusion associated with intraretinal fluid in the right eye and was treated with monthly intravitreal aflibercept injections for 3 months followed by as required treatment. In addition to the intraretinal fluid responding to anti-VEGF treatment, there was a reduction in the size of the pseudo-vitelliform subfoveal deposit height, which was not seen in the untreated eye. Our case of an uncommon presentation of desferrioxamine-related maculopathy associated with a vein occlusion and the changes associated with intravitreal anti-VEGF treatment may help with the potential hypotheses of the pathophysiology of desferrioxamine-related pseudo-vitelliform retinal lesions and help with the potential future treatments of the condition.

Genetic epilepsy with febrile seizures plus (GEFS+) is an autosomal dominant familial epilepsy syndrome characterized by distinctive phenotypic heterogeneity within families. The SCN1B c.363C>G (p.Cys121Trp) variant has been identified in independent, multi-generational families with GEFS+. Although the variant is present in population databases (at very low frequency), there is strong clinical, genetic, and functional evidence to support pathogenicity. Recurrent variants may be due to a founder event in which the variant has been inherited from a common ancestor. Here, we report evidence of a single founder event giving rise to the SCN1B c.363C>G variant in 14 independent families with epilepsy. A common haplotype was observed in all families, and the age of the most recent common ancestor was estimated to be approximately 800 years ago. Analysis of UK Biobank whole-exome-sequencing data identified 74 individuals with the same variant. All individuals carried haplotypes matching the epilepsy-affected families, suggesting all instances of the variant derive from a single mutational event. This unusual finding of a variant causing an autosomal dominant, early-onset disease in an outbred population that has persisted over many generations can be attributed to the relatively mild phenotype in most carriers and incomplete penetrance. Founder events are well established in autosomal recessive and late-onset disorders but are rarely observed in early-onset, autosomal dominant diseases. These findings suggest variants present in the population at low frequencies should be considered potentially pathogenic in mild phenotypes with incomplete penetrance and may be more important contributors to the genetic landscape than previously thought.

Purpose: To describe a prospective case series of patients with acute macular neuroretinopathy (AMN) associated with acute influenza virus infectionMethods: Patients who presented with acute macular neuroretinopathy associated with confirmed influenza virus infection were subject to a detailed clinical history, HLA typing and longitudinal ophthalmological and imaging examinations.Results: Four female patients aged 18 to 32 years were studied. They reported the onset of ocular symptoms between 2 and 5 days after the development of flu like symptoms. Three patients had confirmed acute influenza B infection, while the fourth had influenza A. OCT angiography only demonstrated abnormal choriocapillaris perfusion in 1 patient and early oral Oseltamivir treatment appeared not to affect the ophthalmic outcome in one patient.Conclusion: This is the first report of AMN associated with virologically confirmed acute influenza virus infection. Variation in HLA alleles do not appear to predispose patients to influenza associated AMN.