April 2, 2019

Position Statement by the Canadian Ophthalmological Society (COS) Regarding Diversity and Inclusion

The Canadian Ophthalmological Society (COS) encourages inclusivity and opposes discrimination based on (but not limited to) religion, race, citizenship, country or ethnic origin, language, age, political affiliation or opinion, sex, sexual orientation, gender identity and expression, cognitive or physical ability, and economic status. As the recognized unified voice for ophthalmology in Canada, COS is strengthened by its diversity. COS members come from broad and diverse backgrounds, and this variety of experiences, training, and personal qualities is fundamental to ophthalmologists’ ability to provide the highest quality and culturally competent care for all patients.

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)

March 11th, 2022

Canadian Ophthalmological Society (COS)and Canadian Retina Society (CRS) Joint Position Statement on Polysulfate Sodium (Elmiron)

Pentosan Polysulfate sodium (PPS), also known as Elmiron, is an oral medication prescribed for the treatment of interstitial cystitis (IC). PPS has been used to treat IC since 1996.

A dose-related progressive retinal maculopathy is associated with the use of PPS. The retinal changes from PPS include macular edema, choroidal neovascularization and retinal pigment epithelial hyperpigmentation followed by atrophy. Severe vision loss is associated with late PPS maculopathy.

Read the Full Position Statement Here

February 16th, 2022

The Canadian Ophthalmological Society (COS) embraces inclusivity and opposes discrimination based on (but not limited to) religion, race, citizenship, country or ethnic origin, language, age, political affiliation, sex, sexual orientation, gender identity and expression, cognitive or physical ability, and economic status. As the recognized unified voice for ophthalmology in Canada, COS is strengthened by its diversity, and the COS is committed to being a leader in equity, diversity and inclusion in ophthalmology. COS members come from broad and diverse backgrounds, and this variety of experiences, training, and personal qualities is fundamental to a physician’s ability to provide the highest quality and culturally competent care for all patients.

October 2021

Canadian ophthalmologists have asked the Canadian Ophthalmological Society (COS) to provide guidance with regard to physician fees for services that are presently uninsured by provincial and territorial health insurance in many jurisdictions.

COS commissioned Health Intelligence Inc, an independent and well-respected health research firm, to conduct a study using recognized methodologies to determine fair market value for these uninsured services. Their report, along with the underpinning formulae, are provided following this summary.

Read the full Article here:

Guidelines for Supply Triage During Visudyne (Verteporfin) Shortage

July 16, 2021

Visudyne is an essential therapeutic agent for the treatment of specific sight-threatening retinal and choroidal diseases, including choroidal tumours, anti-VEGF resistant neovascular age-related macular degeneration (nAMD) and centroserous choroidopathy (CSR). There is an active global shortage of Visudyne, and the next resupply is not expected to be available in Canada until the end of January 2022 (see: www.drugshortagescanada.ca).

The Canadian Retina Society (CRS) and Canadian Ophthalmological Society (COS) are working with Health Canada’s Drug Shortages Unit on this issue. Further, the CRS and the COS are suggesting the following mitigation strategies and suggest that the remaining supply of Visudyne be prioritized as follows:

• Priority 1: For the full course of treatment and management of sight threatening Ocular Tumours
• Priority 2: For the treatment of non-resolving CSR
• Priority 3: For the treatment of anti-VEGF resistant nAMD

The CRS and COS provide this information for guidance and urge all treating Ophthalmologists to collaborate with their local and regional oncology and retinal specialist groups to ensure careful triage of this agent to those patients in most dire

The Canadian Retinoblastoma Research Advisory Board would like to introduce you to the Retinoblastoma Research and You! booklet; a new guide to patient engagement for retinoblastoma families and survivors.

Retinoblastoma is a rare childhood eye cancer. The clinical treatment and follow-up of retinoblastoma patients can take several different and complex paths that can be stressful and confusing for patients and their families. People affected by retinoblastoma have indicated that they want to learn about and help shape the direction of current research.
Patient engagement in research refers to the meaningful involvement of patients throughout any or all aspects of the research process. It involves patients working alongside clinicians and researchers to create research that is relevant to patients and improves care and quality of life. The Canadian Retinoblastoma Research Advisory Board aims to create meaningful, co-directed retinoblastoma research that is relevant to patients and improves outcomes.

This is where the ‘Retinoblastoma Research and You!’ booklet comes into play. This guide was created to raise awareness about and catalyze patient engagement in retinoblastoma research in Canada. It highlights real-world examples of patient-partnered research activities and opportunities — illustrated through testimonials written by Retinoblastoma Champions, patients who actively promote patient engagement in research by drawing from their personal experience and participate in the Canadian Retinoblastoma Research Community.

A digital copy of this booklet may be accessed here. (or copy and paste this link into your browser bit.ly/COSRBResearchAndYou) You can request a hard copy by e-mailing at [email protected]

June 3, 2021

Communiqué to health practitioners Reports of Myocarditis/pericarditis after
COVID-19 vaccination.

Given the international reports and attention relating to myocarditis and pericarditis following vaccination with mRNA COVID-19 vaccines, the Public Health Agency of Canada has prepared this communiqué that can be shared with your health practitioner networks or that can be used to inform content for other documents that you may be developing on this topic.

April 2021

EXECUTIVE SUMMARY

This report provides a review of evidence-informed approaches to teleglaucoma (TG) care in Canadian contexts as of January 2021. TG is defined as a spectrum of options that adapts telemedicine approaches to enhance care for glaucoma patients (those diagnosed with as well as at risk for developing glaucoma). The objective of this document is to act as a foundation for Canadian ophthalmologists who wish to establish their own TG practice.

This work was undertaken by the Canadian Glaucoma Society Teleglaucoma Working Group, comprised of glaucoma specialists and comprehensive ophthalmologists from across the country.

Many physicians have transitioned to a partially virtual care paradigm since the onset of COVID-19. The rationale for widespread adoption of TG is three-fold. First, the demand for ophthalmic services in Canada is projected to increase with our ageing population and rising prevalence of sight-threatening conditions such as glaucoma, age-related macular degeneration, and cataract. Enhancing access to these services with a limited budget and supply of providers remains critically unresolved. Second, rural and remote communities continue to grapple with underservicing for specialist care, leading to poorer health outcomes. For many decades, health equity has been a central focus of Canadian health policy with limited progress. Third, there is a strong patient and provider preference for virtual care as it is more time- and cost-effective. Virtual care offers a feasible solution to meet the health needs of our population while allowing our health systems to optimally utilize finite resources.

This report outlines three models of care in TG with sample case scenarios and offers a template for a standardized TG setup. The models of care elaborated upon include modular extension, in-office, and collaborative.12 These models describe how clinicians can accomplish virtual screening (including triage), consultation and monitoring of patients. Clinicians may wish to incorporate one or more elements of these models into their practice depending on their own situational context. This report also acknowledges an important gap in TG, which is the absence of gonioscopy. Clinicians should consider alternative methods to evaluate the risk of angle closure glaucoma.

This report also offers suggestions for practice patterns, outlines tools for remote assessment, summarizes licensure, medicolegal and safety considerations (including missing angle closure and other secondary glaucomas), reviews merits and challenges of TG (including the billing landscape), considers the promising future of TG, and offers suggestions on how to overcome barriers in order to optimize care for patients in the virtual environment.

COVID-19 has illuminated the ways in which limitations to virtual care have been largely self-imposed. Much of our advocacy in advancing virtual care must occur at the health systems level. We hope that this document can equip providers with the knowledge and inspiration to carve their own path in the realm of teleglaucoma and teleophthalmology at-large.

Read the full report here.