Canadian Retina Society (CRS) Position Statement on Intravitreal Injections and the Management of Retinal Diseases during the COVID-19 Crisis

The Executive of the CRS has reviewed recommendations from local, national and international Medical and Ophthalmology groups regarding the management of patients and the risks to health care workers during this COVID crisis.

The below commentary has been provided by the CRS Executive and endorsed by the COS Board of Directors. These comments and recommendations are based on the “conditions on the ground” that exist today at the time of this writing.

About Us

The Canadian Retina Society is composed of members of the Canadian Ophthalmological Society whose primary area of patient care consists of surgical and/or medical vitreoretinal (VR) disease.

The mission of the Canadian Retina Society is to maintain the highest quality of patient care and teaching, particularly as it relates to the investigation and treatment of vitreoretinal (VR) disease; promote the interchange of information and scientific material and facilitate meetings of those who have a special interest in the diagnosis and management of VR pathology; work with the Canadian Ophthalmological Society on matters relating to health advocacy, health policy, and clinical guidelines on a national level.

Education

Ultra-widefield fluorescein angiography in the full venous phase reveals hypofluorescence within the atrophied hemispheric-patterned areas in (A) and (B) secondary to loss of choriocapillaris and RPE.

Figure 1.
(A) Ultra-widefield pseudocolour images of the right and left eyes show hemispheric atrophy of the temporal retina bilaterally sparing the fovea and nasal retina.
(B) Fundus autofluorescence demonstrates a well-defined region of hypoautofluorescence corresponding to the hemispheric atrophic areas in (A) due to loss of retinal pigment epithelium (RPE).
(C) Ultra-widefield fluorescein angiography in the full venous phase reveals hypofluorescence within the atrophied hemispheric-patterned areas in (A) and (B) secondary to loss of choriocapillaris and RPE.

Title:

Pie in the eye

Credits:

Neetin Prabhu BSc (Medical Student, Dalhousie University), Douglas Iaboni MD (PGY1 Ophthalmology, Dalhousie University), R. Rishi Gupta MD FRCSC (Assistant Professor, Dalhousie University)

Location:

Department of Ophthalmology, QEII Hospital, Dalhousie University, Halifax, Nova Scotia

Description:

A 65-year-old gentleman was referred to the retina service with a 10-year history of nyctalopia and bilateral pigmentary retinal changes, thought to be in keeping with retinitis pigmentosa (RP). Past ocular history was significant only for foreign body. There was no family history of RP.

Examination revealed a best-corrected visual acuity of 6/7.5-1 and 6/6-2 in the right and left eyes, respectively. Intraocular pressures were 17 and 18 in the right and left eyes, respectively. Slit lamp examination demonstrated deep and quiet anterior chambers OU. Dilated fundus examination revealed retinal atrophy with pigment clumping in the mid-peripheral retina bilaterally sparing the fovea and nasal retina.

Optical coherence tomography showed thinning of the right optic nerve and slight thinning of left superior optic nerve, maculae were within normal limits. Goldmann and Humphrey 24-2 visual fields revealed partial ring scotomas, sparing the temporal visual fields bilaterally. Ultra-widefield pseudocolour imaging (Figure 1A), fundus autofluorescence (Figure 1B), and fluorescein angiography (Figure 1C) demonstrated findings in keeping with a diagnosis of posterior annular choroidal dystrophy.

Posterior annular choroidal dystrophy (PACD) is a rare disease characterized by annular patterned atrophy of the retinal pigment epithelium and choriocapillaris surrounding the optic nerve and vascular arcades1,2,3. Case reports have shown that patients with PACD commonly present with painless reduced visual acuity worsened by dim lighting4. Although our patient presented with hemispheric atrophy, some reports indicate that hemispheric atrophy may progress to annular atrophy if monitored through long-term follow-up4.

1 Del Valle-Nava F, Sánchez-Ramos J, Hernández-Vázquez A, Gonzalez-Saldivar G, Ramirez-Estudillo A. Posterior polar annular choroidal dystrophy association with cystoid macular edema. Clin Case Reports. 2019;7(2):389-390. Doi:10.1002/ccr3.1967

2 Dikkaya F, Özsütçü M, Özbek M, Erdur SK, Şentürk F. Posterior polar central choroidal dystrophy: A case report. Turkish J Ophthalmol. 2017;47(5):298-301. Doi:10.4274/tjo.56873

3 E de Carlo T, Adhi M, Salz DA, et al. Analysis of Choroidal and Retinal Vasculature in Inherited Retinal Degenerations Using Optical Coherence Tomography Angiography Talisa. Ophthalmic Surg Lasers Imaging Retin. 2016;47(2):120-127. Doi:10.13928/23258160-20160126-04

4 Narayanan R. Posterior polar annular and hemispheric choroidal and retinal dystrophy: Optical coherence tomographic angiography description of a rare case. Indian J Ophthalmol. 2018;66(12):1874. Doi:10.4103/ijo.IJO_367_18

The Canada Retina Society publishes an interesting and educational vitreo-retinal case monthly. We welcome submissions for consideration; please contact us at:

Snapshot of the Month Editors:

  • Ananda Kalevar, MD, University of Sherbrooke
  • Jason Noble, MD FRCSC, University of Toronto

Please note that the CRS reserves the right to edit Snapshot of the Month submissions

Professional Development

February 4, 2021

To our Valued Industry Partners:

At this time of year, traditionally our Board and staff would be gearing up to welcome you to our Annual Meeting. Due to the COVID-19 pandemic, the CRS Scientific Planning Committee is pivoting to organize a virtual meeting for Fall, 2021. Should circumstances change and the pandemic allow, we are also making tentative plans for small face-to-face gatherings to allow for more concentrated discussion and camaraderie during the Annual Meeting.

We acknowledge that a virtual meeting is a significant step-change from our traditional format, and we want to ensure we provide value in content and connection to both our physician and industry attendees. Your experiences and learnings from the past ten months of virtual meetings are valuable, and we welcome your comments and suggestions for how we can most effectively meet your expectations.

We appreciate your support and attendance at previous CRS events, and we look forward to connecting with you in a new and exciting format this year.

Sincerely,

Varun Chaudhary MD, FRCSC

Co-Chair, Scientific Planning Committee

2021 Canadian Retina Society Annual Meeting

Robert Gizicki MD, FRCSC, DABO

Co-Chair, Scientific Planning Committee

2021 Canadian Retina Society Annual Meeting

Canadian Retina Society Board Members

Amin Kherani, MD

Amin Kherani, MD

Alberta

President

Cynthia Qian, MD

Cynthia Qian, MD

Québec

Vice-President

James Whelan, MD

James Whelan, MD

Newfoundland

Past-President

Arif Samad, MD

Arif Samad, MD

Nova Scotia

Secretary-Treasurer

Alan Berger, MD

Alan Berger, MD

Ontario

Director, Advocacy

Varun Chaudhary, MD

Varun Chaudhary, MD

Ontario

Director, Continuing Professional Development

Robert Gizicki, MD

Robert Gizicki, MD

British Columbia

Co-Chair, Scientific Meeting

Jason Noble, MD

Ontario

Past Co-Chair, Scientific Meeting

Adverse Event Reporting

Click the following link to submit an adverse event report to CRS.