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Posterolateral tibial plateau fractures are technically demanding due to limited exposure imposed by the fibular head and posterolateral corner structures. The standard anterolateral approach visualizes only 36.6% of the posterolateral articular surface, contributing to malreduction rates reaching 32.3%. We report a 26-year-old female who sustained a Kfuri-Schatzker type 2 fracture with combined anterolateral and posterolateral involvement, characterized by depression of the posterior three-quarters of the lateral plateau with an intact posterior cortical rim. This morphology rendered posterior buttress plating not required for stability in this morphology, shifting the surgical priority toward maximizing articular visualization for direct reduction. A three-step extensile anterolateral approach was performed entirely in the supine position: first, Gerdy's tubercle osteotomy to mobilize the iliotibial tract; second, lateral femoral epicondyle osteotomy to release the lateral collateral ligament and popliteus tendon; and third, submeniscal arthrotomy with central meniscal subluxation. This sequential algorithm provided near-complete articular visualization, enabling anatomical reduction and stable fixation with subchondral rafting screws and a lateral locking plate. This case demonstrates the feasibility of a stepwise, supine extensile anterolateral strategy to maximize articular visualization for selected posterolateral tibial plateau fractures with an intact posterior cortical rim, while avoiding prone positioning and a dedicated posterior approach. LEVEL OF EVIDENCE: V.

Recent years have witnessed a surge in FDA approved AI tools for healthcare applications. While this growth offers considerable potential benefits for clinical practice, it also introduces substantial challenges related to ethics, regulation, and patient safety. These challenges are further compounded by previously documented gaps in the regulatory approval pathway. These gaps include inconsistent pre-market evaluation practices, over-reliance on retrospective studies, and the limited systematic post-market surveillance of AI devices in real-world clinical settings. Using publicly available FDA data, we developed therefore an interactive web-based dashboard for assessing and predicting the performance of FDA-approved AI software, called PROACTIVE-AI, for the purpose of pro-viding the user with a structured guidance on the anticipated performance of AI-enabled medical devices in real-world clinical settings. The dashboard supports exploratory analysis by diverse stakeholders via knowledge graph visualization and longitudinal trend monitoring of performance indicators, including device recalls and safety-related issues. In addition, PROACTIVE-AI incorporates an AI-aided post-market surveillance risk assessment calculator, derived from historical recall data, to identify device characteristics and con-textual factors associated with elevated deployment risk. Our findings using the PROACTIVE-AI dashboard highlight some of the important challenges related to real-world monitoring and accountability of deployed AI medical devices. Furthermore, it illustrates the potential value of such dashboard in narrowing the trust gap surrounding AI in healthcare by providing quantitative metrics of expected clinical performance and recall-related risk factors.

Cumulus cells have well-established roles early in ovulation but the key molecules that drive their behavior in later stages, leading to follicle rupture, remain underexplored. Here, we observed that inhibition of proprotein convertases (PCSKs) via a pan-inhibitor (PCI) impaired follicular rupture and disrupted the cumulus matrix integrity within intact follicles. Reduced cumulus cell adherence to the cumulus-oocyte-complex (COC) matrix was also observed in isolated COCs and notably occurred late during the maturation window without affecting oocyte maturation. Visualization of PCSK transcript and protein expression, as well as selective inhibition of specific PCSKs, determined that the observed phenotype in COCs is likely attributed to PCSK5A inhibition. We conducted bulk RNA-sequencing and proteomics of PCI-treated COCs which revealed that PCSK inhibition caused dysregulation of extracellular matrix organization, cell migration/adhesion, and TGF-β signaling pathways. Subsequent validation showed that this inhibition translated to disrupted matrix organization and altered migratory and adhesive behaviors in cumulus cells. The TGF-β ligand GDF9 has a predicted PCSK cleavage site, and supplementation with GDF9 rescued matrix integrity suggesting its role as a downstream substrate of PCSKs to regulate matrix organization. Altogether, this study identified PCSK5A and GDF9 as key regulators of COC matrix integrity and cumulus cell migration during late ovulation. These findings highlight novel factors required for follicle rupture which can be leveraged for the development of fertility therapeutics and contraceptives.

Airway remodeling is a convergent feature across respiratory diseases, yet current CT tools provide limited characterization of the airway tree. We present Radiomics of the Airway (RadAr), an automated framework for multi-scale airway phenotyping from routine chest CT. RadAr extracts multi-scale, interpretable airway measurements capturing luminal dimensions, tapering, architectural distortion, and global morphology and provides an interactive web portal for analysis and visualization. It was evaluated across four settings: 63-week mortality prediction in fibrotic interstitial lung disease (fILD; N=147), COVID-19 severity prediction (N=1164), structure-function association in progressive pulmonary fibrosis (PPF; N=9) and structure-inflammation markers in pediatric cystic fibrosis (CF; N=11). Unsupervised clustering identified airway phenotypes across the fILD and COVID-19 cohorts. In fILD, lower-lobe architectural distortion was associated with mortality (balanced accuracy 0.654). In COVID-19, severe disease was independently associated with luminal dilation (AUC 0.719, odds ratio 2.32, p=0.017). In PPF, airway phenotypes correlated with forced vital capacity (ρ=0.83), mid-expiratory flow (ρ=0.87), and ¹²⁹Xe MRI alveolar gas exchange impairment (ρ=0.70). In pediatric CF, reduced tapering and increased cylindricity were associated with prior exacerbations and bronchoalveolar lavage neutrophilia (ρ=-0.64 to -0.78). Five phenotypes were identified from extensive, tapered airway trees to sparse, dilated, thick-walled, tortuous trees, with increasing COVID-19 severity and fILD mortality across this spectrum. RadAr identified interpretable, disease-specific airway signatures associated with function and outcomes across restrictive, obstructive, and mixed lung diseases in adult and pediatric settings. It provides a scalable framework that may support diagnosis, risk stratification, and longitudinal monitoring across pulmonary diseases.

Lateral lymph node dissection (LLND) in low rectal cancer is technically demanding due to the narrow pelvis and risk of nerve injury. Robotic surgery may improve visualization and precision, but evidence on domestic Chinese robotic systems for this procedure is limited. This study compared the safety and short-term outcomes of the KangDuo Surgical Robot-01 (KD-SR-01) robotic system with conventional laparoscopic surgery in patients undergoing radical resection with LLND. This retrospective single-center study included 278 patients with low rectal cancer who underwent radical resection plus LLND from June 2022 to June 2025. Patients were divided into robotic (n = 120, KangDuo KD-SR-01) and laparoscopic (n = 158) groups. Perioperative, pathological, postoperative, and short-term oncological outcomes were compared. Baseline characteristics were comparable between groups. After 1:1 propensity score matching (119 pairs), the robotic group showed significantly shorter total operation time (238.7 &#xb1; 45.9 vs. 304.1 &#xb1; 58.9 minutes, P < .001), shorter LLND time (86.5 &#xb1; 23.2 vs. 121.1 &#xb1; 27.2 minutes, P < .001), lower blood loss (134.5 &#xb1; 52.3 vs. 351.8 &#xb1; 183.2 mL, P < .001), and higher lateral lymph node yield (7.87 &#xb1; 2.19 vs. 5.87 &#xb1; 2.34, P < .001) compared with the laparoscopic group. These advantages persisted in the matched cohort. Robotic surgery was also associated with, borderline lower overall complication rate (P = .047), and nominally lower sexual dysfunction (P = .047). Pathological outcomes and DFS (log-rank P = .163) were comparable. The domestic KangDuo KD-SR-01 robotic system is safe and feasible for radical resection with LLND in low rectal cancer. It provides significant perioperative and functional benefits compared to laparoscopy without compromising short-term oncological results.

Receptor tyrosine kinase-like orphan receptor 1 (ROR1) is an attractive molecular target for anti-tumor therapies undergoing late-stage clinical development. Quantitative imaging of ROR1 expression could enable identification of patients likely to respond to such treatments. This study aimed to assess the feasibility of specific in vivo imaging of ROR1 using radiolabeled affibody molecules. The affibody molecule ZROR1:A10, with high affinity for human (4&#xa0;nM) and murine (2&#xa0;nM) ROR1, was labeled with indium-111 using a DOTA chelator. In vitro binding specificity, affinity, and cellular processing were evaluated using a panel of ROR1-expressing cell lines. The affibody [111In]In-DOTA-Zcov19s, which does not bind ROR1, served as a nonspecific control. The biodistribution of [111In]In-DOTA-ZROR1:A10 and [111In]In-DOTA-Zcov19s was measured in immunodeficient mice bearing ROR1-positive tumors, with ROR1-negative Ramos xenografts used as an additional specificity control. [111In]In-DOTA-ZROR1:A10 bound specifically to ROR1-expressing cells, with significantly higher uptake than [111In]In-DOTA-Zcov19s. The apparent equilibrium dissociation constant for ROR1 binding in vitro was 1-4&#xa0;nM. Tumor uptake of [111In]In-DOTA-ZROR1:A10 in MDA-MB-468 xenografts was saturable and significantly (p&#x2009;<&#x2009;0.05) higher than in Ramos tumors, as well as higher than uptake of the control affibody. At 4&#xa0;h post&#x2011;injection of 1&#xa0;&#xb5;g (50&#xa0;&#xb5;g/kg), tumor&#x2011;to&#x2011;blood, tumor&#x2011;to&#x2011;bone, and tumor&#x2011;to&#x2011;muscle ratios were 14&#x2009;&#xb1;&#x2009;6, 19&#x2009;&#xb1;&#x2009;6, and 11&#x2009;&#xb1;&#x2009;1, respectively. Micro-SPECT/CT imaging clearly visualized ROR1&#x2011;positive tumors and discriminated them from ROR1&#x2011;negative xenografts. The preclinical evaluation shows that visualization of ROR1-expressing tumors using a radiolabeled affibody molecule is feasible.

To define directly visualized endoscopic posterior sensory network interruption (endoscopic transection/neurectomy of targeted dorsal ramus tributaries) as surgically distinct from percutaneous fluoroscopy-guided radiofrequency lesioning, and to propose a bounded, physiology-informed pathway that positions it after functional confirmation, and before structural reconstruction in selected phenotypes. Narrative, mechanism-informed perspective. Selective synthesis of peer-reviewed evidence on dorsal root ganglion (DRG) neurobiology, functional diagnostics, imaging-symptom noncorrelation, and endoscopic posterior sensory procedures; and development of an operational decision framework specifying pragmatic diagnostic anchors, exclusion thresholds, reassessment expectations, and stopping rules. Axial and radiating/appendicular symptoms frequently coexist along a continuum influenced by DRG excitability rather than separating cleanly into "facet" vs "compression" categories. In imaging-noncorrelative presentations, magnetic resonance imaging noncorrelation is treated as a diagnostic classification rather than an indication: directly visualized endoscopic neurectomy is considered only when a suspected level/pathway is physiologically localized using predefined functional confirmation (eg, concordant diagnostic testing with clinically meaningful immediate relief) and when competing dominant mechanisms (instability, deformity, or predominant neuromuscular failure) are reasonably excluded. The framework constrains procedural "dose" and retreatment through explicit safety boundaries, including conservative multilevel use, interval objective neuromuscular reassessment, and stopping rules-particularly in patients with multifidus compromise, sarcopenia/frailty phenotypes, extensor-compartment vulnerability, or radiographic instability. Directly visualized endoscopic interruption of medial branch and related dorsal ramus tributaries is a surgical procedure with verified anatomic access under endoscopic visualization and should be distinguished from needle-based fluoroscopic radiofrequency lesioning when interpreting technique, reach, outcomes, and risk. Within a restricted, auditable selection framework requiring functional confirmation and defined safety boundaries, it may serve as a motion-preserving, escalation-friendly option in selected DRG-dominant axial-radiating pain phenotypes, while preserving escalation pathways to decompression or fusion when structural progression becomes dominant. A DRG-centered, endoscopic framework may address a common treatment gap-function-limiting symptoms with noncorrelative routine imaging-by pairing functional diagnostics with directly visualized posterior sensory network interruption while maintaining longitudinal accountability for neuromuscular and biomechanical risk.

Focused ion beam (FIB)-milling has been adapted to thin frozen cells for visualization of macromolecular structures in situ with cryogenic electron microscopy. However, only a few large and abundant complexes have been annotated to date. FIB-milling introduces damage which limits the recoverable information from cellular sections. Here, we present Nilas, a low-energy milling strategy optimized to minimize damage and produce thin lamellae. Nilas-milled lamellae show minimal FIB-milling damage, contain areas at or below 50 nm and produce higher resolution in situ 3D reconstructions. Nilas improves the recovery of ribosomal subunits and reduces the predicted minimal detectable molecular mass with two-dimensional template matching (2DTM) to 220 kDa. Consistently, we recover additional non-ribosomal complexes including RNA polymerase III with 2DTM in Nilas-milled lamellae. Nilas is compatible with common milling hardware, making it accessible to diverse users. By extending the size limit for in situ structural biology we bring visual proteomics closer to reality.

Fibrotic remodeling of extracellular matrix is a central driver of autosomal dominant polycystic kidney disease (ADPKD) progression since early stages of the disease. Unfortunately, it cannot be assessed with currently available methodologies before irreversible structural and functional decline, creating a diagnostic blind spot that hinders accurate early risk stratification and management. Here, we report the development of Gd-hProCA32.Collagen, a collagen -targeted protein MRI contrast agent that enables precision molecular MRI (pMRI) of early fibrosis by directly imaging collagen type I deposition in vivo before conventional laboratory and imaging methods detect changes in kidneys and liver of Pkhd 1 PCK/PCK (PCK) rats and Pkd2 mutant mice. Gd-hProCA32.Collagen, used at 10-fold lower dose, outperformed the widely clinically used agent gadobutrol (Gadovist), detecting approximately 2.8-fold greater total renal cyst volume (&#x223c;8,500 vs &#x223c;3,000 mm&#xb3;, p<0.0001) and 1.5-fold higher total cyst count (&#x223c;245 vs &#x223c;160, p<0.0001), with superior T1W and T2W kidney AUC (p<0.01 and p<0.001) and preferential sensitivity to small and medium cysts. Signal enhancement in kidneys and liver correlated strongly with histological collagen burden quantified by Sirius red staining, whereas Gadovist showed no meaningful correlation. Gd-hProCA32.Collagen also enabled in vivo visualization of previously undetectable changes resembling radial striations at sites of microcyst cluster-adjacent microfibrosis and sustained delayed MRI enhancement due to specific collagen binding. These results reveal a previously inaccessible subclinical fibrotic phase of cystic kidney and liver disease and establish collagen-targeted pMRI as a strategy for early noninvasive detection and spatial mapping of multi-organ extracellular matrix remodeling when conventional biomarkers remain non-discriminating. We report a first-in-class collagen-targeted MRI contrast agent with Precision molecular MRI that noninvasively reveals a previously inaccessible subclinical fibrotic phase of polycystic kidney disease across kidney and liver, overcoming limitations of current diagnostic methodology.

Despite increasing interest in functional magnetic resonance imaging techniques, compartment-specific comparisons between donor kidneys and the same kidneys shortly after implant have remained limited. Therefore, in this preliminary case series, we aimed to explore early postoperative cortex- and medulla-specific multiparametric magnetic resonance imaging patterns in living-donor kidney transplant by directly comparing donor and recipient measurements within matched grafts. We assessed multiparametric magnetic resonance imaging parameters by comparing donor and early postoperative measurements acquired between postoperative days 19 and 23 in 3 transplant recipients. We categorized percent differences in parameters as stable, mild, moderate, or marked according to their magnitude; these classifications were descriptive. In analyses, donor-to-recipient variations were more pronounced in medullary parameters than in cortical measurements across all 3 grafts, and whole kidney values generally paralleled medullary behavior. Perfusion-related metrics, particularly pseudodiffusion and perfusion fraction, demonstrated the most prominent postoperative changes. In radar plots, donor kidneys displayed compact and overlapping medulla-to-cortex profiles, whereas transplanted kidneys showed expansion or distortion of medullary-dominant parameters, particularly in perfusion-related indices. These ratio-based visualizations emphasized redistribution toward medulla-driven physiological alterations in the early postoperative phase. The reproducible compartment-specific patterns observed in this series support the feasibility of multiparametric magnetic resonance imaging as a tool for early physiological monitoring after kidney transplant. Further validation in larger, longitudinal cohorts will be required to determine the clinical utility of corticomedullary metrics as potential biomarkers of early graft status.

Fetal bowel remains challenging to assess antenatally. Ultrasound assessment is limited to its echogenicity and luminal diameter. Although MRI has been used to visualise fetal bowel, uncertainties remain and reference ranges for 2D diameter of large bowel have only recently been reported. Advanced MRI techniques now facilitate motion-corrected 3D analysis of fetal abdominal structures. This study aimed to apply these techniques to fetal large bowel enabling generation of high-resolution datasets for volumetric visualisation and quantification. All participants underwent fetal MRI on a 3T system, with T2-weighted images acquired in multiple orthogonal planes. Motion-correction pipelines were applied to obtain 3D reconstruction of fetal abdomen, and manual segmentation of five large bowel regions was performed to generate a 3D reconstruction of large bowel facilitating volumetric measurements. To assess reproducibility, intra- and inter-observer variability were performed using intraclass correlation coefficient (ICC). Linear regression was used to assess relationship between large bowel volume and gestation. Forty datasets from fetuses between 16 and 38 weeks' gestation were analysed. The whole fetal large bowel was identified in 100% of datasets. Intra- and inter-observer agreement were good to excellent. Volume increased linearly with advancing gestational age in all five large bowel segments. Model-derived estimates of total large bowel volume increased from 1266 cm3 at 18 weeks' gestation to 13,550 cm3 at 38 weeks (p<0.001). This study demonstrates 3D reconstruction and volumetric assessment of fetal large bowel is a feasible and reproducible technique in all large bowel regions. This technique may improve understanding of normal fetal bowel development enabling antenatal identification of pathologies, currently rarely detected antenatally.

We present Loom, a spatial transcriptomics (ST) visual computing system to support the analysis of pseudo-temporal trajectories, comparative investigation across samples and regions of interest, and the examination of spatially structured processes within local microenvironments. ST is a molecular profiling technology that measures gene expression directly within a thin tissue section while preserving its spatial organization. For practical application-driven analyses, the ST local microenvironment data needs to be integrated with cell reference datasets and temporal simulations of cell behavior. This integration is challenging due to multi-modal registration issues and the complexity of the pseudo-temporal patterns, spatial enrichment data, and gene expression dynamics. Loom leverages a novel glyph coupled with a computational backbone to facilitate the detailed pseudo-temporal exploration of local microenvironments, cross-sample comparisons, and investigation of spatiotemporal biological mechanisms. We evaluate Loom through two case studies developed with experts in tissue pathology and oncologists and through an external usability study. The results demonstrate that Loom supports effectively the discovery of cellular transitions and spatiotemporal expression dynamics.

The folding of the cortical sheet within the human brain is related to its functional organization at the level of major sulci and gyri. Yet how smaller folding features hidden within the two thirds of cortex buried in sulci may relate to functional specialization of the cortex is not clear. Using human visual cortex as a test bed, we identify four hidden brain folds within the major sulcus which spans the dorsal visual stream and demonstrate that their spatial consistency across individuals is related to functional boundaries of visual cortex. In separate observation and replication participant groups, we combine structural and functional magnetic resonance imaging to show that the boundaries separating the visual field maps comprising the dorsal stream can be predicted from these hidden gyri with an accuracy matching current probabilistic definitions of visual cortex. By further demonstrating that these hidden gyri colocalize with cytoarchitectonic regions of the human brain, and that the variability in their shape and size correlates with individual differences in visual behaviors known to rely on the dorsal stream, we provide evidence for a novel neuroanatomic framework which suggests that mesoscale pleating patterns of the cortex within human sulci are functionally and behaviorally relevant.

We readily perceive stereoscopic depth in correlated random dot stereograms (RDS), in which every dot presented to one eye has a matching dot in the other eye. In contrast, anti-correlated RDS, in which corresponding dots have opposite contrast polarity between the two eyes, do not evoke a perception of depth. Nevertheless, anti-correlated RDS still generate local same-polarity matches within the receptive fields of individual neurons. Inhibitory circuitry has been proposed to suppress these false matches and thereby prevent the perception of illusory depth. To investigate how inhibitory circuits in visual cortex contribute to this process, we measured disparity selectivity to correlated and anti-correlated RDS in two major classes of inhibitory neurons in mice: parvalbumin-expressing (PV+) and somatostatin-expressing (SST+) neurons. We found that the disparity tuning of PV+ neurons was highly correlated with the average activity of surrounding neurons. In contrast, the disparity tuning of SST+ neurons was poorly predicted by local population activity, suggesting that PV+ and SST+ neurons integrate excitatory inputs through distinct mechanisms. Optogenetic suppression of PV+ or SST+ neurons further revealed divergent functional roles. Although both cell types contributed to sharpening selectivity for correlated RDS, only SST+ neurons reduced selectivity for anti-correlated RDS. These findings suggest that PV+ and SST+ circuits both enhance responses to correct binocular matches in correlated RDS, whereas SST+ circuits contribute to suppressing false matches in anti-correlated RDS.

Temporal lobe epilepsy (TLE), particularly mesial temporal lobe epilepsy (MTLE), often presents with visual working memory (VWM) impairments, with potential heterogeneity between hippocampal sclerosis (HS) and MRI-negative subtypes. However, task-related electrophysiological (EEG) evidence regarding brain network alterations during VWM processing in MTLE remains limited. This study aims to identify shared brain network alterations and their behavioral correlates in patients with MTLE and to further characterize subtype-specific differences between HS-MTLE and MRI negative-MTLE. We recruited 60 right-handed participants, including 30 patients with MTLE (12 HS-MTLE, 18 MRI negative-MTLE) and 30 healthy controls (HCs). All participants completed the Chinese version of the Wechsler Memory Scale-Revised (WMS-RC) and performed a VWM task during simultaneous EEG recording. Graph theory analysis was used to assess the in-degree and out-degree of directed functional networks in the theta and gamma frequency bands; the results were correlated with clinical and cognitive behavioral indicators. Behaviorally, patients with MTLE showed significant VWM impairments compared with HCs, with no significant difference between HS and MRI-negative subtypes. Common network alterations in patients with MTLE included decreased theta-band connectivity from occipital to temporal regions, with this theta-band connectivity significantly associated with slower task responses and reduced accuracy. In subgroup analysis, the HS-MTLE group showed reduced theta outflow and abnormally enhanced gamma activity in posterior occipital regions. Conversely, the MRI negative-MTLE group showed more widespread increases in gamma-band in-degree and out-degree across anterior regions, including prefrontal, frontocentral, and temporal areas. Patients with MTLE share a common alteration in occipital-to-temporal information transfer during VWM. Exploratory analyses suggest distinct network alterations between HS-MTLE and MRI negative-MTLE, presenting with abnormalities in posterior and anterior networks, respectively. These hypothesis-generating findings provide electrophysiological evidence to support precise subtyping of MTLE and targeted cognitive intervention development.

Music, which is organized hierarchically (notes, phrases, sections), provides an ideal model for studying fine-grained motor sequence production. However, it is unknown how musicians' brains integrate tonal structure over multiple timescales during real-life performance. Here, we scrambled an unfamiliar Tchaikovsky piano suite at four timescales (every 1/2/8 measures, or fully intact) and asked expert pianists to play (sightread) all four versions in the fMRI scanner. Responses in the motor network, default mode network, and hippocampus were strongly impacted by scrambling, indicating that they integrate tonal structure over relatively long timescales. Additionally, the emergence of functionally connected sub-networks between auditory, visual, motor, and default mode network regions across scramble levels supported this hierarchical integration process. Our results cannot be explained by lower-level cues (tempo, timbre, dynamics; local pitch height or rhythmic density) and instead reflect processing of high-level tonal structure. Our study highlights novel mechanisms of complex auditory-motor action planning during live music performance.

Visual impairment affects &#x223c;2.18 million Canadians and is associated with reduced quality of life and substantial economic burden. Although low-vision services (LVS) improve independence and functioning, utilization remains low. This systematic review examines barriers to accessing and utilizing LVS in Canada. A systematic search of MEDLINE, EMBASE, Cochrane Library, CINAHL, grey literature sources, and Google Scholar was conducted from inception to June 15, 2025, and registered with PROSPERO: (CRD420251082000). English-language studies examining barriers to accessing or utilizing LVS in Canada were included. Screening and data extraction were performed independently by multiple reviewers following PRISMA guidelines. Thematic analysis categorized barriers into systemic/structural, personal, and societal domains. Study quality was assessed using the Mixed-Methods Appraisal Tool (MMAT). Of 730 records identified, 25 studies met inclusion criteria. Systemic barriers included limited-service availability, inconsistent provincial funding, high out-of-pocket costs, geographic maldistribution, and provider-related gaps in referral knowledge and training. Personal barriers included lack of awareness of LVS, financial insecurity, lower educational attainment, comorbid health conditions, and psychosocial resistance, such as stigma or denial. Societal barriers included negative attitudes toward disability, limited family support, cultural and linguistic challenges, and inaccessible public infrastructure. Study quality was moderate to high, with 60% rated 4 stars or higher on MMAT. Access to LVS in Canada is limited by intersecting structural, personal, and societal factors. Coordinated reforms in provider education, public awareness, funding policy, and inclusive design are needed to improve equitable access and reduce underutilization of low-vision rehabilitation services.