July 19th, 2022

Canadian Ophthalmological Society (COS) Position Statement on Biosimilars

Biosimilar biologic drugs (or biosimilars*) were introduced in the Canadian market in 2009, however, the first ophthalmic biosimilar is expected to be launched in Canada in the fall of 2022. With the advent of biosimilar drugs into the Canadian market payors (government and insurers) are developing policies on how these medications are integrated into reimbursement programs for existing “innovator” or reference drugs. The trend currently seems to be toward limiting or restricting physician and patient choice in incorporating biosimilars into the Canadian market.

This seems contrary to the European experience where forced substitution has not been necessary to encourage uptake and realize significant savings.

The physician-patient relationship and a patient’s resulting confidence in their treatment plan is crucial to successful treatment. Limiting choice and mandating changes to existing successful treatment regimens undermines that confidence and could be detrimental to patient care.

In addition, given the unique immunological environment and limited tolerance for inflammation which exists with direct administration of the medication into the eye, the COS cautions against mandating large scale, automatic shifts from the reference to biosimilar medications until sufficient human experience has been accumulated to ensure confidence in safety. Furthermore, as individual patient response to medication varies, physicians must have the opportunity to switch back to the original medication if problems develop in order to prevent harm.

The COS welcomes and supports the potential of biosimilars to expand the choices available for effective treatment of eye disease in a cost-effective manner, however it is vital that payors and payor’s policies do not constrain medical choice or undermine patient confidence in treatment plans.

Created June 2022

*A biosimilar biologic drug, or biosimilar, is a biologic drug that is highly similar to a qualifying biologic drug that was already authorized for sale (known as the reference biologic drug). (Health Canada, Handbook for healthcare professionals on biosimilar biologic drugs, https://www.canada.ca/en/health- canada/services/drugs-health-products/biologics-radiopharmaceuticals-genetic-therapies/biosimilar- biologic-drugs/handbook-healthcare-professionals.html#Biosimilar_Drugs accessed June 27, 2022)

The Eye Care in Health Systems: Guide for Action provides practical, step-by-step, guidance to support Member States in planning and implementing the recommendations of the World report on vision with the goal to provide integrated people-centered eye care services.

This new resource leads Member States through a four-step process: situation analysis; development of an eye care strategic plan and monitoring framework; development and implementation of an operational plan; and establishing and maintaining ongoing review processes.

Currently, more than 2 billion people are living with a vision impairment and of these, at least 1 billion people are needlessly living with poor vision due to lack of access to eye care services. This burden is not borne equally: 90 percent of people with vision impairment or blindness live in low- and middle-income countries. Often, all that is needed is a cost-effective intervention, such as a pair of spectacles or cataract surgery.

Implementing integrated people-centred eye care has the potential to improve millions of lives worldwide and produce huge benefits for the economy, gender equity, inclusion, education and the workplace.

The Guide links to other tools developed by WHO, through consultations with international experts, including:

 The Guide currently links four resources, or tools, including:

1. Eye care situation analysis tool (ECSAT)
   Purpose: Questionnaire based survey tool to comprehensively assess eye care in a country.
2. Eye care indicator menu (ECIM) 
   Purpose: List of recommended eye care indicators to be collected regularly.
3. Package of eye care interventions (PECI)
   Purpose: Planning and budgeting for eye care at each level of the health system.
4. Eye care competency framework (ECCF)
   Purpose: Planning tool for eye care human resources based on competencies.

For more information click the link below:

Issue 2 of the 2022 Video Journal of Cataract, Refractive, & Glaucoma Surgery features highlights of the ESCRS Videosymposium bringing the viewer a smorgasbord of challenging cases, intraoperative complications, and complex problems following cataract surgery.  This action-packed program is entitled Pumping Adrenaline!  

The VJCRGS is in its 38^th year of providing the highest quality of education to anterior segment surgeons around the world.  It is a free member benefit of COS in addition to educating residents, fellows, and private practitioners every quarter. 

Table of Contents

Volume 38, Issue 2, 2022

ESCRS 2021 Videosymposium – Pumping Adrenaline Preoperative Challenges

Posterior Lenticonus……………………………………………………………………….. Dr. Ashraf Armia, Egypt

Subluxed Cataract……………………………. Drs. Victoria de Rojas, Marcelino Alvarez, Patricia Simon,

Lorea Zurutuza, Isabel Escofet, Spain Bilateral Anterior Lens Dislocation………………………….. Dr. Hazem El-Nashar, Egypt

Traumatic Cataract with Iris Loss……………………………………………….. Dr. Vladimir Pfeifer, Slovenia

Colored Iris Implant Disaster……………………………………………. Dr. Ahmed M. Abdelrahman, Egypt

Intraoperative Complications

Mature with Anterior Capsule Tear……………………………………………………… Dr. Nandini Ray, India

Fluid Misdirection with Posterior Polar………………………………………………… Dr. Sheetal Brar, India

Implantation Surprise………………………………………………………………….. Dr. Dres. Kohler, Germany

Flecked IOL…………………………………………………………………….. Dr. Lionel Raj Daniel Ponniah, India

Monster Plaque………………………………………………………………………………… Dr. Robert Osher, USA

Postoperative Surprises

Secondary Implantation following Choroidal Hemorrhage…………………. Dr. Mayank A. Nanavaty,

United Kingdom Chronic Anisometropia…………………………………………………… Dr. Ahmed H. Assaf, Egypt

Fuchs Dystrophy with Extreme Hyperopia………………………………. Drs. M. Dominques, J. Mendes,

H Luz Guimaraes, Portugal CME, Dislocated IOL, and Aphakia: 3 Techniques      Drs. MJ Quiroz-Quiroga, Jorge Armentia,

Pablo Marti, Emilio Segovia, Ana Matheu, Paula Burgos, Spain Decentration of Premium IOLs          Drs. Durval M. Carvalho Jr., Lara Picanco, Caroline Lima, Brazil

Subluxed IOL/Bag Complex with Pseudoexfoliation………………………. Dr. Evripidis Sykakis, Greece

Click here to watch the latest issue:

Registration for the 2022 Sally Letson Symposium Now Open! 

Join us for the 53rd Sally Letson Symposium chaired by Dr. Michael E Snyder, Cincinnati Eye Institute, and Dr. Mona Koaik (Co-chair), University of Ottawa Eye Institute.

This year’s topic is “Adopting Innovation: Staying Ahead Without Falling Behind”.

Learn from international speakers on topics on adapting innovation into practice in the field of ophthalmology. The program will include high-yield sessions on cataract and refractive surgery planning and techniques, subspecialty pearls and updates, and general eye care topics. 

Take advantage of our Early Bird rates and register today! Advanced registration before the meeting date is encouraged to avoid long wait times onsite. We look forward to seeing you September 8-10 in Ottawa.

Register Today

Preliminary Schedule, Accommodation and Travel Discount Information

Early Bird Deadline ends August 15

Drs. Robert Osher and Richard Lindstrom unite to bring you a comprehensive CME meeting
FEBRUARY 15-19, 2023
Location: Tampa Marriott Water Street Hotel

This meeting was established by Dr. Robert H. Osher a decade ago to deliver a candid style of teaching and learning on anything that cataract surgeons (and rising trainees) might find useful. To keep up with the educational needs of the attendees as their role in patient care continues to evolve, this meeting is about to enter phase two in 2023. Dr. Richard L. Lindstrom joins Dr. Osher as Program Director and the meeting is now titled “Telling It Like It Is” to more accurately indicate the program will cover all critically important areas for ophthalmologists.

To find out more and to register click the link below.

The June 2022 CJO is now available online. Here are some of the highlights:

Resident Perspectives + visual abstract: Our amazing team of residents have summarized 7 articles with a focus on what’s most relevant to ophthalmology learners here in Canada and around the globe, including the article featured in our June visual abstract, Postoperative supine position after primary Descemet-stripping automated endothelial keratoplasty reduces graft detachment rate.

Original research articles:
• Clinical features, visual outcome, and poor prognostic factors in occlusive retinal vasculitis
• Effectiveness of a 3D-printed mask fitter in an Ophthalmology setting during COVID-19
• Research productivity and impact of Canadian academic ophthalmologists: trends in H-index, gender, subspecialty, and faculty appointment
• Comparison of outcomes in patients with and without soft contact lens wear following Boston keratoprosthesis type 1
• Incidence of steroid response in microinvasive glaucoma surgery with trabecular microbypass stent and ab interno trabeculectomy

Research letters, photo essays, and case reports:
• Outcomes of first cases of DMEK at a Canadian university hospital centre [research letter]
• Retinal racemose hemangioma characterization with multimodal imaging [photo essay]
• IgG4-related orbital disease [photo essay]
• Rare case of extramacular choroidal macrovessel [case report]
• Multiple myeloma with concurrent herpes zoster ophthalmicus [case report]
• Wellness among Canadian ophthalmology resident physicians: a national survey [correspondence]

Follow the CJO on social media:

Twitter: @CanJOphth

Instagram: @cjo_jco

Facebook: CanJOphth

For this special Orbis Speaker Series event, we teamed up with the Canadian Council of Ophthalmology Residents (CCOR). Dr. Hunter Cherwek dives into the world of our Orbis Volunteer Faculty and discusses his personal experiences throughout his incredible career. Attendees also heard from three speakers who have recently graduated and their own experiences attending an Orbis trip in 2019. They shared important lessons learned in their schooling, Orbis involvement, and current careers, helping to guide and shape possible new opportunities for attendees.

Guest Speakers: Drs Hunter Cherwek, Dr. Solin Saleh, Dr. Irfan Kherani, Dr. Cristina Bostan

View the video here:

2022 ePosters and Surgical Videos are available for on-demand viewing at eposters.cosprc.ca  You can create your account now. You can also visit the ePoster kiosk at the Halifax Convention Centre in the Convention Hall Atrium to view ePosters and Surgical Videos onsite at the 2022 COS Annual Meeting. To create your account, please CLICK HERE.