Edsel Ing

University of Toronto | U of T · Department of Ophthalmology and Vision Sciences

Despite the potential for eye injury, most hockey players in the National Hockey League do not use a protective face shield. We examined the effect of a hockey visor and sports goggle on visual function to see whether visual impediment is a substantial factor in the resistance to use of protective eyewear. We measured Snellen visual acuity, Ishihar...

Purpose Giant cell arteritis (GCA) is the most common systemic vasculitis in the elderly and can cause irreversible blindness and aortitis. Varicella zoster (VZ), which is potentially preventable by vaccination, has been proposed as a possible immune trigger for GCA, but this is controversial. The incidence of GCA varies widely by country. If VZ vi...

Objective To determine the effect of bicanalicular silicone intubation (SI) on dacryocystorhinostomy (DCR) success rate in adult primary acquired nasolacrimal duct obstruction. Design Meta-analysis of randomized controlled trials (RCTs). Methods PubMed, Embase, Cochrane CENTRAL, Ovid Medline, Google Scholar, and grey literature search was perform...

Purpose To develop and validate neural network (NN) vs logistic regression (LR) diagnostic prediction models in patients with suspected giant cell arteritis (GCA). Design: Multicenter retrospective chart review. Methods An audit of consecutive patients undergoing temporal artery biopsy (TABx) for suspected GCA was conducted at 14 international med...

Youtube Video review of Thyroid Associated Orbitopathy using a Nicolas Cage/Angelina Jolie movie theme and patient-teaching anaologies. https://www.youtube.com/watch?v=n2_8q1Uwx6w

This book briefly summarizes educational theory, and concentrates on the practical pedagogical pearls of over 25 exceptional instructors from multiple specialties who have been recognized by teaching awards at the University of Toronto, Harvard University, Washington University, the University of Connecticut, and Western University. * * * * A parti...

Equity, diversity and inclusion (EDI) are increasingly important directives in medicine that add further complexity to adjudications. The Analytic Hierarchy Process (AHP) is proposed as a tool for multi-criteria decision-making that can facilitate the incorporation of EDI directives, especially for collective, group determinations.

Background: Authorship is a pinnacle activity in academic medicine that often involves collaboration and a mentor–mentee relationship. The International Committee of Medical Journal Editors criteria for authorship (ICMJEc) are intended to prevent abuses of authorship and are used by more than 5500 medical journals. However, the binary ICMJEc have n...

The Canadian Medical Education Directives for Specialists (CanMEDS) framework is one of the most used physician competency schemas in the world and was last updated in 2016.1However, CanMEDS requires revisions to better embrace the principles of equity, diversity and inclusion (EDI), to improve comprehensive physician learning experiences, promote...

Purpose The editorship of medical journals is a leadership role that can affect recognition and career advancement. We determine the gender representation of the editorial boards of oculoplastic surgery journals in comparison to the proportion of women in oculoplastics societies. Methods The gender composition of the American, European and Asia-Pa...

A 67-year-old woman had delayed initial diagnosis of her right low flow carotid cavernous fistula (CCF) during the coronavirus disease (COVID-19) pandemic due to difficulty detecting ocular signs via online virtual examinations. Her right eye conjunctival erythema and proptosis with medial rectus enlargement on computed tomography scan was initiall...

The relative importance of the ICMJE criteria were ranked by medical editors to develop a numeric index for authorship. This index will hopefully decrease guest authorship, coercive authorship and other potential abuses of authorship.

The incidence proportion and incidence rate of sympathetic ophthalmia after open globe injury was determined. The preliminary data was presented at the Canadian Ophthalmologic Society Conference in June 2021. The article was accepted to the American Journal of Ophthalmology in July 2021.

Purpose Sympathetic ophthalmia (SO) is a rare, bilateral panuveitis that occurs following open globe injury (OGI), with a variable incidence reported in the literature. Our objective was to determine the incidence proportion and incidence rate of SO following OGI to help guide shared physician-patient decision making. Design Systematic review and...

Objective: To determine the incidence of giant cell arteritis (GCA) in China. Background: GCA is the most common primary vasculitis in the elderly and can cause bilateral irreversible blindness, aortitis, stroke and rarely death. The incidence of GCA in China is thought to be low, but has not been formally examined. Methods: A narrative review of t...

The gender proportion of female medical editors of three major oculoplastics societies was compared with the percentage of female members in the society. The female editors were under-represented in each society. The eventual paper was accepted by the journal Orbit, and will be pulbished under the doi = {10.1080/01676830.2021.1975771},

The vision of the University School of Continuing Studies (USCS) is to be a global leader in university continuing education. To accomplish this a corporate strategy of continued national and international growth of its diverse academic programs is required. The primary business unit strategy is differentiation with an essential pivot towards the o...

This is a hypothetical patient-oriented interprofessional community research program, or PICR program for a community hospital. PICR programs are important for health research because of the “death valleys” in medical knowledge translation with respect to basic science and clinical research studies. Patient-oriented community research bridge the...

A review of giant cell arteritis for comprehensive ophthalmologists and ophthalmic technicians.

Multiple oculomotor nerve palsies (MONP) involving cranial nerves III, IV or VI in one or both eyes can be mimicked by myasthenia gravis. MONP of sudden onset are usually due to trauma, stroke, aneurysm or pituitary apoplexy. Incisional strabismus surgery for acute onset MONP is not considered for the first 6-9 months, unless there is muscle entrap...

https://www.facebook.com/watch/live/?v=326104328721590&ref=watch_permalink The talk begins at 2:25:57 The objectives of this presentation are to: 1) Illustrate the Pretenders i.e. many mimics of GCA 2) Compare the Presentation of GCA in India vs North America 3) Catalogue the Paradigm shifts in GCA “Panorama” of GCA Partial truths (ACR criteria,...

We thank Dr. Modenese and Professor Gobba for their comments on COVID-related physician deaths in Italy. The course of pandemic continues to change since our tabulations from April 15, 2020.1 As of June 18, 2020 the countries with the most deaths from COVID-19 in descending order are the United States, Brazil, the United Kingdom and Italy.2 All cou...

1) Rubenstein's 2020 metanalysis suggests the sensitivity of TABx is 77%, a far cry from the TABUL study sensitivity of 39%. The TABUL study TABx failure rate was 7%, which is unusually high. 2) Prediction models can help determine the pretest probability of GCA. 3) Platelets are an acute phase reactant, and an elevation in the platelet count may...

Barra et al estimated the incidence of CLINICALLY-DIAGNOSED GCA in Ontario, Canada was 25 per 100,000 individuals over the age of 50 using inference techniques based on provincial billing data. Unfortunately the provincial billing data in Ontario, Canada does not use specific ICD-9 codes to identify GCA. Our 2019 study determined the incidence of...

In 2020 the British Society of Rheumatology formulated guidelines for the workup of cranial giant cell arteritis (GCA). Comments on the improved clinical interpretation of risk with prediction models rather than subjective judgment, and the possible problems with the ultrasound "verification" of GCA are discussed.

Laser refractive surgery (LRS) is one of the most frequently performed and successful operations in medicine. The possible sequelae of LRS include dry eye syndrome, blurred vision, glare, and night vision disturbance that are usually transient, but sometimes persist. Psychiatric complications such as psychosis, depression, suicidal ideation, attemp...

Purpose. To determine sources of variation between countries in per-capita mortality from COVID-19 (caused by the SARS-CoV-2 virus). Methods. Potential predictors of per-capita coronavirus-related mortality in 200 countries by May 9, 2020 were examined, including age, sex, obesity prevalence, temperature, urbanization, smoking, duration of infect...

To aid in the ophthalmic monitoring for HCQ toxicity, we developed an online calculator (https://tinyurl.com/ yxzhwg4u) that provides a suggested weekly dosing schedule based on a patient’s weight and risk factors for HCQ retinopathy (e.g. renal function)

Prachand and colleagues1 recently published a surgical scoring system for the triage of procedures during and after the COVID-2019 pandemic. We developed an Excel (Microsoft) spreadsheet calculator of this surgical scoring system, programmed in Visual Basic (eAppendix 1), to save time and increase the accuracy of data entry.

Giant cell arteritis (GCA) is the most common primary vasculitis in the elderly and can cause irreversible blindness, aortitis, and stroke. Diagnostic confirmation of GCA usually entails temporal artery biopsy (TABx) – a time-consuming and invasive test, or ultrasound. The primary treatment of GCA is with high dose glucocorticoids that have numerou...

Background. There is wide variation between countries in per-capita mortality from COVID-19 (caused by the SARS-CoV-2 virus). Determinants of this variation are not fully understood. Methods. Potential predictors of per-capita coronavirus-related mortality in 198 countries were examined, including age, sex ratio, obesity prevalence, temperature, u...

Dermoids are the most common cystic choristomas of the orbit. However, medial intraconal dermoids are rare.

Nomenclature in medicine affects scientific accuracy, patient perceptions, communication, and information retrieval. We opine that the terms “thyroid eye disease” (TED) or “Graves ophthalmopathy” (GOp) used to designate the most common nontraumatic orbitopathy we encounter as ophthalmologists are inappropriate; a better appellation for this autoimm...

Background. Wide variation between countries has been noted in per-capita mortality from the disease (COVID-19) caused by the SARS-CoV-2 virus. Determinants of this variation are not fully understood. Methods. Potential predictors of per-capita coronavirus-related mortality in 198 countries were examined, including age, sex ratio, obesity prevalen...

Background. Wide variation between countries has been noted in per-capita mortality from the disease (COVID-19) caused by the SARS-CoV-2 virus. Determinants of this variation are not fully understood. Methods. Potential predictors of country-wide per-capita coronavirus-related mortality were examined, including age, sex ratio, obesity prevalence,...

Objective: The management of advanced basal cell carcinoma (BCC) in the periocular region remains a clinical challenge. Vismodegib (ErivedgeTM) has been approved in 2013 by Health Canada for adult patients with "histologically confirmed metastatic BCC or locally advanced BCC inappropriate for surgery or radiation." An expert consensus was sought t...

Background. Wide variation between countries has been noted in per-capita mortality from the disease (COVID-19) caused by the SARS-CoV-2 virus. Determinants of this variation are not fully understood. Methods. Potential predictors of country-wide per-capita coronavirus-related mortality were studied, including age, sex ratio, temperature, urbanizat...

Background. Wide variation between countries has been noted in per-capita mortality from the disease (COVID-19) caused by the SARS-CoV-2 virus. Determinants of this variation are not fully understood. Methods. Potential predictors of country-wide per-capita coronavirus-related mortality were studied, including age, sex ratio, temperature, urbanizat...

Background: The COVID-19 pandemic has caused much morbidity and mortality to patients but also health care providers. Aims: We tabulated the cases of physician deaths from COVID-19 associated with front-line work in hopes of mitigating future events. Methods: On 15 April 2020, a Google internet search was performed using the keywords ‘doctor’, ‘phy...

15-May-2020 Rheumatology RHE-20-0935: Comment on: Incidence and prevalence of giant cell arteritis in Ontario, Canada Dear Dr Edsel Ing, Thank you for submitting your manuscript to Rheumatology. The review process has now been completed and your paper has been accepted for publication pending style queries from the editorial office. Congratulati...

Aims: The incidence of giant cell arteritis (GCA) in China is thought to be low. However, a recent radiology study from Lanzhou, China found an unusually high number of GCA patients. We review the possible reasons for this discordance. Method: Literature review Results: The First Hospital of Lanzhou China recently reported 140 to 336 patients with...

Purpose To evaluate the efficacy of slit lamp breath shields to prevent droplet spray from a simulated sneeze. Design Experimental study to test effectiveness of personal protective equipment. Methods The nozzle of a spray gun was adjusted to angularly disperse a mist of colored dye that approximated a patient sneezing on a dimensionally accurate...

Canadian Society of Oculoplastic Surgery suggested guidelines for COVID-19.

Giant cell arteritis (GCA) is one of the prime emergencies in ophthalmology. The "gold standard" confirmatory test for GCA is temporal artery biopsy (TABx), although ultrasound and MRI are making inroads. Knowledge of the pretest and post-test probabilities of GCA can aid management decisions regarding glucocorticoids and the need for investigation...

This letter demonstrates that countries in which the public wears masks have a lower coronavirus-related mortality than in non-mask wearing countries.

Polish translation of article

Masks Can Decrease the Viral Load with an Adequately Powered Study On non-parametric testing comparing the viral loads of the control coughs and masked viral loads are not statistically significant. However, if the questionable ND results are excluded and we take the liberty of using a paired t-test in this small study to examine trends (see below...

OBJECTIVE: The COVID-19 pandemic has caused much morbidity and mortality to patients but also health care providers. We tabulated the cases of physician deaths from COVID-19 associated with front-line work in hopes of mitigating future events. METHOD: On April 5, 2020, Google internet search was performed using the keywords doctor, physician, death...

Background. Many authorities have assumed that the novel coronavirus (COVID-19) pandemic will inevitably infect large fractions of the population in most countries. In addition, public health authorities and governments have varied in their policies regarding the use of face masks by the public. Methods. Mortality data from COVID-19 and policies re...

Temporal artery biopsy (TAB) is frequently still required in patients with suspected cranial giant cell arteritis (GCA). The literature on the performance characteristics of TAB versus imaging is conflicting, and several meta-analyses suggest that TAB is more sensitive than ultrasound. False-positive ultrasound results can occur. Also, diseases tha...

MACULAR PUCKER OR CELLOPHANE MACULOPATHY Question: How common are bilateral epiretinal membranes? Epiretinal membrane (ERM), macular pucker or cellophane maculopathy is a wrinkling of the retina associated with changes in the vitreous humor. ERMs can be idiopathic, or secondary to trauma, surgery, ischemia or inflammation. Bilateral ERMs have bee...

Background: The COVID-19 pandemic has caused much morbidity and mortality to patients but also health care providers. Aims: We tabulated the cases of physician deaths from COVID-19 associated with front-line work in hopes of mitigating future events. Methods: On 15 April 2020, a Google internet search was performed using the keywords 'doctor', 'p...

From the Acoustic Neuroma Association of Canada Newsletter https://www.anac.ca/member-article/2019/11/05/scleral-contact-lenses-for-patients-with-acoustic-neuroma-and-facial

To determine whether temporal artery biopsy (TABx) or Doppler ultrasound (US) of the temporal artery is the preferred confirmatory test for giant cell arteritis, an online survey of ophthalmologists and neurologists in North America, Europe and Israel was conducted in 2019; Canadian rheumatologists were also included. There were 406 survey particip...

I read with interest the article by Moraña et al. (1) An alternative giant cell arteritis (GCA) risk calculator employing both neural network and logistic regression models (NN-LR) was published in early 2019, (1) and is available online at https://goo.gl/THCnuU. The NN-LR prediction model was developed using retrospective data from 1,201consecut...

Title: Neural network and logistic regression predictive calculator for giant cell arteritis I read with interest the article by Moraña et al. (1) An alternative giant cell arteritis (GCA) risk calculator employing both neural network and logistic regression models (NN-LR) was published in early 2019, (1) and is available online at https://goo.gl/...

We read with interest the article by Ross et al that discussed 27 patients with diplopia and giant cell arteritis (GCA). We contribute the perspective of 40 additional patients with diplopia and biopsy-proven GCA, based on our recent retrospective study of 1,666 subjects who underwent consecutive temporal artery biopsy for suspected GCA at 12 medic...

Purpose of review: To summarize recent advances in the diagnosis of giant cell arteritis (GCA). Recent findings: Less common manifestations of GCA include corneal edema, proptosis from lacrimal gland ischemia and sensorineuronal hearing loss. Histology studies have suggested that temporal artery biopsies (TAB) with fixed specimen lengths of 15 m...

The Treatment of Corneal Abrasions

Objective We estimate the incidence and characteristics of post-cataract-surgery nonarteritic ischemic optic neuropathy (PCNAION) after topical clear corneal cataract extraction (CCCE) in Canada. Design Canada-wide internet survey and meta-analysis Participants All certified Canadian ophthalmologists in the Canadian Ophthalmological Society direc...

Comprehensive Neuro-ophthalmic Examination; Differential Diagnosis

Clinical Considerations in the repair of Eyelid Laceration

Eyelid tophi can be a systemic manifestation of gout

In response to Laskou F, Coath F, Mackie SL, Banerjee S, Aung T, Dasgupta B. A probability score to aid the diagnosis of suspected giant cell arteritis. Clin Exp Rheumatol. 2019 Feb 15. [Epub ahead of print] Objective: To evaluate the Giant Cell Arteritis Probability Score (GCAPS) proposed by Laskou et al. Methods: The GCAPS was compared with publ...

Lethal autonomous weapons (LAWeap) are robots that can independently identify, and terminate targets without human oversight. They are potential weapons of mass destruction that generate many ethical and legal concerns. Despite numerous attempts brokered by the United Nations, they have not been banned by the Convention on Certain Conventional Weap...

Objective: The incidence of giant cell arteritis (GCA) is insufficiently documented for Canada, but important to ascertain for public health planning. We estimate the incidence of biopsy-proven GCA (BPGCA) in Kingston, Ontario, and for the province of Ontario. Method: The number of cases of BPGCA was tabulated from retrospective chart review of...

This study discusses local anesthetic agents, administration techniques, ancillary considerations, and safety precautions for oculoplastic surgery including eyelid, lacrimal, orbital, and temporal artery biopsy procedures. Methods for reducing patient apprehension and discomfort including systemic premedication, topical pre-anesthetic, visual, audi...

Is there any evidence for treating younger patients (e.g., 40s, 50s) with lutein supplementation to prevent macular degeneration? We could not find any evidence-based articles supporting the prophylactic use of micronutrients. 1 The AREDS2 study utilizing a combination of lutein, zeaxanthin, vitamin C, vitamin E, zinc, and cupric oxide did demonstr...

Objective: Support vector machines (SVM) is a newer statistical method that has been reported to be advantageous to traditional logistic regression for clinical classification. We determine if SVM can better predict the results of temporal artery biopsy (TABx) for giant cell arteritis compared to logistic regression. Method: A database of 530 TABx...

The diagnosis and treatment of eyelid ectropion.

Background Dynamic Contour Tonometry (DCT) is touted to be the most accurate tonometer for Intraocular Pressure (IOP) measurement. Non-Contact “air puff” Tonometry (NCT) may be the most commonly used tonometer for screening of IOP. Elevated IOP is important to exclude in patients presenting with headache or vision loss. Objective To determine the...

Purpose: To determine the positive yield (utility rate) of temporal artery biopsy (TAB) in patients with suspected giant cell arteritis (GCA). Study Design: Systematic review (CRD42017078508) and meta-regression. Materials and Methods: All articles concerning TAB for suspected GCA with English language abstracts from 1998 to 2017 were retrieved. Ar...

I congratulate Oh et al.1 on their important work. Our recently published validated, TRIPOD-compliant, multivariable prediction model for giant cell arteritis (GCA)2 also found that thrombocytosis was a stronger predictor for GCA than erythrocyte sedimentation rate (ESR). It is very useful to compare prediction models from different institutions. A...

Objective: To illustrate the utility of a nomogram for the prediction of giant cell arteritis (GCA). Method: A nomogram was constructed from a multivariable logistic regression prediction model with 10 covariates: age, sex, clinical temporal artery abnormality, new-onset headache, jaw claudication, vision loss, diplopia, erythrocyte sedimentation r...

FL-41 lens tint has been suggested as adjunctive treatment for conditions such as essential blepharospasm and migraine. However, this lens tint was difficult for patients to find in Toronto, Canada. As such a survey of optical shops in Toronto and Vancouver was performed to tabulate the percentage of shops offering this optical service, and the ad...

An approach to history taking; Differential Diagnosis; Checklists