Cindy M L Hutnik

The University of Western Ontario | UWO · Ophthalmology and Pathology

Topic: The purpose of the current study was to systematically identify and evaluate existing Patient-Reported Outcome Measures (PROMs) for clinical glaucoma practice. Clinical relevance: Understanding and incorporating patient preferences into decision-making is now recognized as critical for optimal resource allocation, especially in technologi...

Purpose: The gold standard for managing postoperative ocular fibrosis in glaucoma surgery is the chemotherapeutic mitomycin C (MMC) despite its association with significant adverse effects. This study compares in vitro the antifibrotic efficacy and cytotoxicity of the small-molecule TGFβ1 inhibitor SB-431542 (SB) to MMC. Methods: To measure collag...

The current diagnostic aids for red eye are static flowcharts that do not provide dynamic, stepwise workups. The diagnostic accuracy of a novel dynamic Bayesian algorithm for red eye was tested. Fifty-seven patients with red eye were evaluated by an emergency medicine physician who completed a questionnaire about symptoms/findings (without requirin...

Purpose: Vision impairment affects 2.2 billion people worldwide, half of which is preventable with early detection and treatment. Currently, automatic screening of ocular pathologies using convolutional neural networks (CNNs) on retinal fundus photographs is limited to a few pathologies. Simultaneous detection of multiple ophthalmic pathologies wo...

Inflammation-driven scarring is a major contributor to surgical failure after subconjunctival bleb forming glaucoma surgery. The current gold standard anti-scarring adjuvant mitomycin C (MMC) has variable effectiveness and is associated with significant risks. Acetylsalicylic acid (ASA), when delivered locally, repurposes the typically pro-inflamma...

Objective To assess the impact of ophthalmology resident research and its relationship to subsequent practice. Design Cross-sectional study. Participants Three hundred and twenty residents of Canadian ophthalmology programs graduating between 2009 and 2020. Methods Bibliometric data were obtained for each resident from Scopus. Indices of scholar...

Purpose: Starting in 2019, the Global Initiative for Asthma recommended the use of inhaled corticosteroids (ICS) as part of reliever combination therapy in patients 12 years of age and older, thus dramatically increasing the population exposure to ICS. ICS and intranasal corticosteroids (INS) are commonly used for a variety of respiratory diseases...

Objective This study aims to synthesize data quantifying the prevalence and severity of common psychological conditions in patients with glaucoma. Design Systematic review and meta-analysis. Methods Databases including Ovid MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane Library, Web of Science, Open Grey, and ProQuest Theses and dissertations were s...

Aim and objective: Obstructive sleep apnea (OSA) is a known systemic risk factor associated with glaucoma. The purpose of the study was to determine the overall prevalence of sleep apnea among patients with glaucoma. Design: A systematic review and meta-analysis. Participants: Not applicable. Materials and methods: A systematic literature se...

Objective: To outline the current impact of Canadian ophthalmology and vision science research as measured by novel research metrics. Design: Cross-sectional survey. Participants: All Canadian ophthalmologists (n = 687) and vision scientists (n = 119) with an online bibliometric profile and academic appointment at a major ophthalmology trainin...

Purpose: Inflammation is associated with, and may be causal of, a variety of ophthalmic pathologies. These pathologies are currently difficult to model in vitro because they involve complex interactions between the innate immune system, stromal cells, and other cells that normally maintain ocular tissue homeostasis. Using transscleral drainage chan...

Purpose To report a case of accelerated visual field progression secondary to a new orbital apex lesion in a patient with a longstanding history of fatigue and cough. Observations A 73-year-old myopic female with a known open angle glaucoma presented with accelerated unilateral visual field progression. Maximally tolerated medical therapy was inst...

Introduction: To compare the tolerability and efficacy of a preservative-containing latanoprost (PCL) to a preservative-free formulation of latanoprost (PFL) in patients with open-angle glaucoma or ocular hypertension. Methods: A pooled analysis was performed of data from five published studies. The primary outcome was tolerability as evaluated...

Objective Topical cycloplegic agents often are used in ophthalmology in the context of management of ocular inflammation. Preliminary searches of the literature provided little evidence to support their use in relieving pain or reducing inflammation. The goal of this study was to evaluate the current literature for any evidence regarding the effect...

Background: Ophthalmic viscoelastic devices (OVDs) used during small-incision cataract surgery have numerous advantages. However, OVDs have longer retention time in an eye after surgery resulting in intraocular pressure (IOP) spikes. The purpose of this study is to analyze and quantify the effect of various OVDs on both IOP and best corrected visu...

The key clinical attributes of preserved dorzolamide/timolol fixed combination (DTFC) and the emerging potential of preservative-free (PF) DTFC are reviewed with published evidence and clinical experience. The indications and role of DTFC in current glaucoma management are critically discussed. Preserved DTFC became the first intraocular pressure (...

Filtration surgery still plays a mainstream role of treatment for glaucoma. Postoperative scarring is the main cause of surgical failure. This study evaluated the biocompatibility and anti-proliferative properties of pure magnesium with three different coatings, which are hydroxyapatite (HA), dicalcium phosphate dihydrate (DCPD) and DCPD + stearic...

Purpose: The aim of this study was to compare human Tenon's capsule fibroblasts (HTCFs) obtained from patients who received medical therapy for glaucoma (glaucomatous patients) and patients not treated for glaucoma (non-glaucomatous patients) in terms of wound healing and fibrosis. Patients and methods: Bioartificial tissues (BATs) were generate...

Background: Glaucoma surgical management has evolved significantly with the introduction of minimally invasive glaucoma surgery. Our aim was to evaluate trends in Canadian glaucoma surgery billing code usage as a surrogate index of the current impact of this new technology in Canada's publicly funded health-care system. Methods: Retrospective ad...

Aim: To identify important explanatory variables of four patient-reported outcomes (PROs): vision-related quality of life (VRQoL), preference-based health-related quality of life (HRQoL), social support and community integration and depressive symptoms. Methods: Cross-sectional study conducted at one ophthalmic practice in a hospital setting. Pa...

Background: According to the World Health Organization, glaucoma is a leading cause of irreversible blindness worldwide. By 2020, 80 million people will be affected by glaucoma in the world, which represents a significant financial burden to society. Glaucoma medications alone make up 38-52% of the total direct cost. The purpose of this research i...

Objective: To evaluate the effect of a 6-week washout period on intraocular pressure (IOP) following long-term monotherapy prostaglandin use. Design: Prospective, randomized, controlled, single-centre, single-blinded, parallel-group clinical study. Participants: Subjects aged >18 years diagnosed with open-angle glaucoma or open-angle glaucoma...

The Harlequin mouse model of premature aging displays increased p53 signaling. Evidence of vascular dysfunction and inflammation in the retina a cerebellum

The use of blue light-filtering optical materials in the prevent photooxidative retinal pigment epithelial damage

Purpose: To analyze the safety of different concentrations of anti-VEGF on retinal cells. Methods: Non-diabetic and streptozotocin (STZ)-induced diabetic rats received intravitreal rat anti-VEGF injections that had final vitreous concentrations of 0, 0.0625, 0.125 (clinical dose), and 0.25 mg/mL. Rats were also injected with the clinical dose of...

Purpose: To evaluate long-term structural and functional changes that happen to the optic nerve and retina following ranibizumab (Lucentis) injections in diabetic macular edema (DME) patients. Methods: Patients with clinically significant DME requiring anti-VEGF injections underwent pre-injection baseline, 6, 12, and 24 month follow-up tests. The t...

Background Primary open angle glaucoma (POAG) patients have hallmark increases in intraocular pressure (IOP) and noted dysfunction of the trabecular meshwork (TM). Connexin43 (Cx43) is a gap junction widely expressed on the TM that is important for intercellular communication. The human gene is known as gap junction alpha‐1 (GJA1). Since the role o...

Topic: Prostaglandin analogues (PGAs) are first-line medical therapy for primary open angle glaucoma (POAG) and ocular hypertension (OHT). Intraocular pressure (IOP) lowering effects in full responders are known to be 25-33% for this class; however, partial responders and nonresponders do exist. In clinical trials or prospective series, discontinu...

Objective: The effectiveness of selective laser trabeculoplasty (SLT) was compared to argon laser trabeculoplasty (ALT) in a randomized clinical trial for patients with medically uncontrolled open angle glaucoma who have previously received 360 degree SLT. Design: An active equivalence parallel armed randomized control trial. Participants: Pat...

Objective: To identify factors associated with secondary surgical intervention after glaucoma filtration surgery. Design: Population-based retrospective cohort. Methods: Patient records with billing claims for a primary glaucoma filtration surgery occurring between April 2003 and March 2015 were identified. Each identified record was examined...

Objective: Little is known about how low vision services by ophthalmologists are being provided. Here, we analyze the patterns of provision and utilization of vision rehabilitation services in Ontario, Canada. Design: Retrospective population-based study between 2009 and 2015. Participants: Ophthalmologists (n = 92) who billed for vision rehab...

Soft skills are social and emotional intelligences that facilitate harmonious interpersonal interactions. Soft skills enable physicians to understand and build rapport with patients. Soft skills are increasingly considered crucial physician qualities within surgical specialties, including ophthalmology. Although avenues exist for general soft skill...

Purpose: Nitric oxide (NO) has gained attention for its role in facilitating wound healing by promoting cell migration, while being cytoprotective in a variety of cell types. We determined the efficacy of NO, administered using a novel application of copper-chitosan treatments (Cu-Ch), in facilitating corneal epithelial wound healing using an in v...

Technological advances in glaucoma have challenged the traditional treatment paradigm. Historically incisional surgery has been used in cases of advanced disease and/or uncontrolled intraocular pressures resistant to medical or laser interventions. More recently, perhaps due to advancements in imaging, surgery has been suggested to be beneficial ea...

Purpose Early detection, monitoring and understanding of changes in the retina are central to the diagnosis of glaucomatous optic neuropathy, and vital to reduce visual loss from this progressive condition. The main objective of this investigation was to compare glaucoma diagnostic accuracy of commercially available optical coherence tomography (OC...

Appendix 1 –Search strategies. (PDF)

Appendix 2 –Individual study characteristics. (PDF)

Soft skills are social and emotional intelligences that facilitate harmonious interpersonal interactions. Soft skills enable physicians to understand and build rapport with patients. Soft skills are increasingly considered crucial physician qualities within surgical specialties, including ophthalmology. Although avenues exist for general soft skill...

Fundamental cell signaling mechanisms that regulate dynamic remodeling of the extracellular matrix (ECM) in mechanically loaded tissues are not yet clearly understood. Trabecular meshwork (TM) tissue in the eye is under constant mechanical stress and continuous remodeling of ECM is crucial to maintain normal aqueous humor drainage and intraocular p...

Introduction: Clinical practice guidelines (CPG) are regarded by many as critical communications providing guidance within specific medical fields. Over a decade ago, the first microinvasive glaucoma surgical procedures (MIGS) were introduced. Since then, a number of these novel intraocular pressure (IOP) controlling surgical options have been app...

Objective A systematic review and cost comparison were conducted to determine the optimal treatment of active herpes zoster ophthalmicus (HZO) in immunocompetent adults. Design A literature search of MEDLINE, EMBASE, CINAHL, Cochrane Library, BIOSIS Previews and Web of Science, ClinicalTrials.gov, International Clinical Trials Registry Platform, N...

Purpose: This study evaluated the performance of donor corneoscleral rim cultures for predicting infection after corneal transplantation, and determines if there is a correlation between positive corneoscleral rim cultures and postkeratoplasty infection. Design and data sources: This was a systematic review, prognostic accuracy analysis, and cos...

The purpose of this systematic review and meta-analysis was to examine the availability of evidence for one of the earliest available minimally invasive glaucoma surgery (MIGS) procedures, the Trabectome. Various databases were searched up to December 20, 2016, for any published studies assessing the use of the Trabectome as a solo procedure in pat...

Economic evaluations of glaucoma interventions require accurate costs in addition to effectiveness data. However, the impact of different costing methods on cost estimates has not been investigated. Direct cost estimates alongside clinical trials may be labour-intensive and expensive, modelled cost using literature sources and institutional experie...

PurposeTo evaluate long-term structural and functional changes to the retina and optic nerve following panretinal photocoagulation (PRP) in diabetic retinopathy (DR) patients.Methods Participants were patients with DR requiring PRP and control patients with DR not requiring PRP. The Heidelberg retinal tomography (HRT) and optical coherence tomograp...

Purpose The aim of this trial is to study the effectiveness of currently available low-vision devices in glaucoma patients with moderate-to-severe vision loss. Design This is a randomized pilot clinical trial. Participants Sixteen low-vision glaucoma patients participated in this study. Methods Patients with a best-corrected visual acuity betwee...

Purpose Impression cytology in combination with a cell autophagy marker was used to demonstrate the utility of a novel frozen section technique, to assess the health of the ocular surface, as well as to correlate autophagic cell death with the commonly used clinical tests for dry eye. Methods Female patients over the age of 18 years who attended a...

PURPOSE. For patients with co-morbid cataract and primary open angle glaucoma (POAG), guidance is lacking as to whether cataract extraction and traditional filtering surgery should be performed as a staged or combined procedure. Achieving this guidance requires an evidence-based understanding of the effects of phacoemulsification alone on intraocul...

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Appendix 1A: Keyword String; Appendix 1B: Database Search; Appendix 1C: Grey Literature Search; Appendix 2: Screening Questions.

Background: Microinvasive glaucoma surgery (MIGS) is a relatively new addition to the glaucoma treatment paradigm. Small metallic stents are inserted into the trabecular meshwork in order to increase aqueous humour drainage. MIGS procedures are rapidly being adopted due to a more favourable side effect profile when compared to traditional surgery....

Purpose To determine the surgical indications, outcomes, and complications with the use of modified capsular tension rings (CTRs) during cataract surgery. Setting Ivey Eye Institute, Western University, London, Ontario, Canada. Design Systematic review. Methods A systematic review of databases was conducted for studies related to the use of modi...

Background: New glaucoma diagnostic technologies are penetrating clinical care and are changing rapidly. Having a systematic review of these technologies will help clinicians and decision makers and help identify gaps that need to be addressed. This systematic review studied five glaucoma technologies compared to the gold standard of white on whit...

Wet lab and surgical simulation can reduce the learning curve of difficult surgical techniques, accelerate the rate for trainees to achieve surgical competency, and improve patient safety. To provide the most up-to-date information and hands-on experiences with novel ophthalmic surgical techniques and instruments, the Department of Ophthalmology at...

Glaucoma is a medical term describing a group of progressive optic neuropathies characterized by degeneration of retinal ganglion cells and retinal nerve fibre layer and resulting in changes in the optic nerve head. Glaucoma is a leading cause of irreversible vision loss worldwide. With the aging population it is expected that the prevalence of gla...

Matrix metalloproteinases (MMPs) are reported to contribute to the mechanism of argon laser trabeculoplasty (ALT) but it is unknown whether they are also secreted after selective laser trabeculoplasty (SLT). The aim of this study was to investigate whether human primary trabecular meshwork (HTM) cells secrete MMP-3 after stimulation by SLT. The rel...

Background: Minimally invasive glaucoma surgeries (MIGS) have attracted significant attention, as they have been reported to lower intra-ocular pressure (IOP) and have an excellent safety profile. The iStent is an example of a minimally invasive glaucoma device that has received particular attention due to its early and wide spread utilization. Th...

Glaucoma is a leading cause of irreversible blindness. It is firmly entrenched in the traditional treatment paradigm to start with pharmacotherapy. However, pharmacotherapy is not benign and has been well documented to have a number of significant challenges. Minimally invasive glaucoma surgery (MIGS) that targets the outflow pathway with minimal t...

To report a case of an aqueous misdirection-like presentation in a pseudophakic patient. Retrospective case review. An 84-year-old pseudophakic gentleman presented with bilateral blurred vision 8 years after cataract surgery. A refractive shift with shallow anterior chambers and elevated intraocular pressures were noted. No corneal edema was noted....

Objective: To evaluate the literacy level of patients with glaucoma in a tertiary care teaching centre compared with a rural community centre and to assess comprehension of and pre