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International Uveitis Study Group Document Collection About the Care of Uveitis Patients in the COVID-19 Pandemic
Additional Considerations to Help Manage the Anti-VEGF Injection Burden during the COVID-19 Pandemic
April 4, 2020
Background
At the Association of Canadian University Professor of Ophthalmology (ACUPO) teleconference on March 24, 2020, Canadian Department Heads were interested in developing recommendations to assist balancing crucial reductions in anti-VEGF treatment volumes, driven by the COVID-19 virus, with essential treatments still needed for sight preservation. Following a literature review focusing on randomized clinical trials, the following recommendations were developed. Subsequently, the document was reviewed by ACUPO and the Canadian Ophthalmological Society (COS) for feedback.
This document Additional Considerations to Help Manage the Anti-VEGF Injection Burden during the COVID-19 Pandemic is supplementary to and expands on the foundational CRS March 19, 2020 Canadian Retina Society (CRS) Position Statement on Intravitreal Injections and the Management of Retinal Diseases during the COVID-19 Crisis. Both documents can be found on the COS Practice Resource Center. The data and suggestions that follow, as always, do not replace appropriate clinical judgement; clinicians will need to consider the specifics of each patient’s unique ocular and systemic health status and provide care that is in the patient’s best interest.
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Canadian Glaucoma Society Recommendations for Providing Eye Care to Glaucoma Patients During COVID-19 Pandemic
April 16, 2020
Background
The COVID-19 Pandemic has led to widespread implementation of physical isolating measures and cessation of non-urgent medical visits and procedures. This document is to provide guidance to physicians caring for glaucoma patients to help mitigate the risk to patient and care provider while balancing the need for treatment to preserve vision. As this is a rapidly evolving health care crisis, these recommendations may be modified, and we urge all clinicians to use their own best judgement to individually manage patient care with best practices in mind. These recommendations are based upon and supplemental to the March 20, 2020 COS and ACUPO Guidelines for Ophthalmic Care during COVID-19 Pandemic and guidelines from American Academy of Ophthalmology, and the United Kingdom National Health Society guidelines.
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Read the full recommendations from the Canadian Glaucoma Society.
The Canadian Glaucoma Society Recommendations for Providing Eye Care to Glaucoma Patients During COVID-19 Pandemic was endorsed by the Canadian Ophthalmological Society (COS) and the Association of Canadian University Professors of Ophthalmology (ACUPO) on April 9, 2020.
COS and ACUPO Guidelines for Ophthalmic Care during COVID-19 Pandemic
March 20,2020
Background
We are in the midst of a global crisis, which changes daily. Our federal, provincial, local, hospital, and university authorities provide mandates and recommendations that are applicable to the practice of medicine during the COVID-19 pandemic. The purpose of the guidelines below is not to replace those mandates and recommendations, but to add those specifically relevant to the practice of ophthalmology. The guidelines reflect a collaborative effort among the Canadian Ophthalmological Society, the Association of Canadian University Professors of Ophthalmology, and subspecialty societies. The American Academy of Ophthalmology guidelines at www.aao.org/headline/alert-important-coronavirus-context are also useful for the context of ophthalmic care, and were useful in the development of the guidelines below.
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Read the full COS and ACUPO Guidelines for Ophthalmic Care during COVID-19 Pandemic
Lacrimal irrigation /Surgery/Manipulation During the COVID-19 Pandemic
April 7, 2020
The Canadian Society of Oculoplastic Surgery and the Canadian Association of Pediatric Ophthalmology and Strabismus have evaluated the management of lacrimal disorders and the risks to ophthalmologists during this COVID crisis. The attached statement has been endorsed by the COS Board of Directors. These comments and recommendations are based on the “conditions on the ground” that exists today at the time of this writing.
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Canadian Eye and Tissue Bank Operational Status Update
March 24, 2020
| Province | Program Status March 24, 2020 |
| British Columbia | The Eye Bank of BC is continuing to recover, albeit at a reduced level. During this time, BC is deferring all respiratory-related deaths and those from ICUs; and will be asking supplemental Med/Soc questions (1. Has the donor been diagnosed with or suspected to have had COVID-19 in the past two months; 2. Has to donor had any contact with someone diagnosed with or suspected to have had COVID-19 in the past 28 days; 3) Did the donor have any of the following symptoms in the past 28 days: fever, dry cough, or shortness of breath; 4. Did the donor travel outside of Canada in the past 28 days; and 5. Did the donor have any contact with someone who travelled outside of Canada in the past 28 days). A positive response to Q#1 is an automatic deferral, positive responses for any other questions will be sent for a medical director consult. |
| Alberta North | CTC is still recovering tissue. Cornea transplants are on hold as an elective procedure, so CTC has no need to recover corneas. CTC is determining its approach to have emergent supply on hand but will likely continue with a limited recovery program in order to have corneas on hand for emergencies. |
| Alberta South | |
| Saskatchewan | Eye bank has suspended recovery. |
| Manitoba | Tissue Bank Manitoba: Currently business as usual. Remembering that we are a recovery agency & allograft distributor, not a source establishment, here is my update: Allograft Distribution: 0 = Surgeries canceled or delayed4 donors in the last 8 days (this is high for us, normally we do 4 a month –people are feeling very generous right now)Enhanced Covid-19 screening as per Health Canada, AATB etc. Experiencing slight delays at US border, but not significant enough to impact operations; 0 issues with materials or supplies; We are currently supplied for ~3 months.In anticipation of this event I increased our allograft inventory by ~25% three weeks ago, so no anticipated issues thereAll staff present and accounted for, not a single part-time/full-time staff member has requested leave for child care or other Modifications to our service are minimal: No visitors allowed in the facilityModified shift schedule to reduce the amount of people at work at one timeReduction on face-to-face meetings, any necessary huddles/meeting is held in lobby or from office door, where ample space is availableGeneral reminders around use of universal precautions At this time we are not planning to alter our services, however that status could change at any time as the situation evolves. We anticipate that this event will last for months and will continue to provide service as we are able. Misericordia Eye Bank Eye Bank is limiting recovery based on the Donor Assessment record and 28-day criteria of EBAA. Are being cautious with tissue recovery as we will need tissue for emergency cases when those occur. Frozen would be the first choice as we have a supply of frozen globes and amnion. |
| Ontario | Screening Changes: TGLN using 28 days threshold free of any respiratory symptoms, etc. Ocular Recovery: Eye Bank had a potential staff exposure so temporarily not receiving tissue. As of March 23rd Eye Bank is now prepared to receive tissue. TGLN working through recovery staff concerns before re-starting recoveries and providing education on the new screening. Expected date to re-start recoveries for emergency use is March 25 or 26 assuming decision to move forward. Recovery of whole globe to meet emergency ocular surgery needs using revised screening criteria. All other ocular recoveries deferred. Elective eye surgeries cancelled throughout the province. Recovery to be completed at TGLN’s surgical suite, not hospitals Multi Tissue Recovery: Recovery as in the past using revised screening criteria.Donations continue but reduced volume. Recovery completed at TGLN recovery suite, not hospitals. |
| Quebec | No tissue recovery is being performed at hospitals, donors are transported to our facilities to limit the travel and exposure of recovery staff. Staff are asked to stay home or are reassigned to other departments. Multi-tissue activity reduced to week-days only (recovery and processing day and evening shifts). Reduced but will ensure heart, skin and eye recovery.Will maintain a limited supply of cornea, mainly for urgent tissue requests.Hospitals have cancelled non-urgent surgeries, resulting in 25 corneal transplants cancelled this week. If the situation worsens the need for tissue will be minimal and the tissue bank will reduce its activities further and prioritize life-saving tissues (skin grafts and pediatric heart valves) It will be increasingly difficult to qualify tissue donors in those that have been infected or in contact with infected people. There is a recommendation to limit movement from one region to another within the province, and in the event, travel is prohibited, this will reduce the number of donors. Have added two new specific qualifying questions: have they been diagnosed or expected diagnosed with COVID 19 (28-day deferral) and has there been contact or have they been ordered to quarantine. Following the recommendation from Public Health, they will be modifying the deferral period to 14 days. |
| New Brunswick | As of Feb. 27th, new questions were added to the DRAI (in accordance to EBAA & AATB recommendations).On March 16th, under the guidance of our Medical Director, Dr Seamone, and in consultation with Nova Scotia Health’s Regional Tissue Bank (where most corneas recovered in NB are sent for processing and allocation), we suspended all ocular tissue recovery in consideration of the following: OR now being restricted to urgent and emergent cases only (hence no corneal transplant surgeries) and some frozen tissue being available (for tectonic use).The NBOTP-Ocular Division has no corneal tissue in the bank. Some NB tissue has been frozen and available from Regional Tissue Bank. For MS tissue, because of the same reductions taking place in NB’s Horizon Health Network (cancellation of elective surgeries) and the fact that, for NBOTP, Eye Bank Technicians are responsible to perform initial screening for MS tissue donors, under the guidance of our Medical Director, Dr Mitton, we have also decided to suspend MS tissue recoveries temporarily.We do have some tissues on inventory which can be shipped to NB facilities sill ordering these; our current inventory consisting mostly of bone products (cancellous chips, femoral & tibial struts, femoral heads, tricortical wedges, fibula segments, with some hemi-patellar tendons). |
| Nova Scotia | Has suspended all eye and tissue recovery as COVID continues to spread. Decision is based on risk assessment to staff, patients and in relation to utilization of resources.Bank PPE and supplies may be redirected to patient care. Suspension is expected to be extended as COVID continues to spread. |
New Recommendations Regarding Urgent and Nonurgent Patient Care from AAO
Due to the COVID-19 pandemic, the American Academy of Ophthalmology now finds it essential that all ophthalmologists cease providing any treatment other than urgent or emergent care immediately.
We now live and practice in a critically different medical reality—a rapidly evolving viral pandemic that is projected to, if unchecked, kill millions of Americans and tens of millions around the world. Public health experts agree that we must do two things on an urgent basis:
First, we must reduce the risk of the SARS-CoV-2 virus transmission from human to human and the rate of new case development. Only in that way can we flatten the curve and not overwhelm our very limited supply of hospital beds, ICU beds, ventilators and extracorporeal membrane oxygenation (ECMO) machines. We have already hit that stage in a few hard-hit metropolitan areas.
Second, we must as a nation conserve needed disposable medical supplies and focus them to the hospitals where they are most needed.
This disease is now in every state and the number of new cases is currently doubling every one to two days. Already, a handful of our ophthalmologist colleagues have died from COVID-19. It is essential that we as physicians and as responsible human beings do what we can and must to reduce virus transmission and enhance our nation’s ability to care for those desperately ill from the disease. Public health experts unanimously agree that our window to modify the spread of disease is a narrow and closing one.
Accordingly, the American Academy of Ophthalmology strongly recommends that all ophthalmologists provide only urgent or emergent care. This includes both office-based care and surgical care. The Academy recognizes that “urgency” is determined by physician judgment and must always take into account individual patient medical and social circumstances. Each of us has a societal responsibility to not function as a vector of a potentially fatal disease—and one for which a widely available treatment or vaccine does not currently exist.
All other factors—business, finance, inconvenience, etc.—are remotely secondary. This is an existential crisis. We as physicians must respond to it and support our colleagues and our communities. Be safe.
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For additional information go to aao.org/coronavirus.
CMA Policy on Physician Health
This policy provides a series of broad, aspirational recommendations to help guide stakeholders at all levels of the health system to promote a healthy, vibrant, and engaged profession.
For more details visit the Canadian Medical Association website.
CMQ Regulation 2019
As you know, the College des médecins du Québec (CMQ) has approved a new regulation (Règlement sur la formation continue obligatoire des médecins), which came into force on January 1, 2019. The regulation stipulates that all physicians licensed in Quebec must report their continuing professional development (CPD) activities to the CMQ.
We want to reassure our Quebec members that COS accredited CPD activities are accredited through the Royal College Maintenance of Certification (MOC) Program and will qualify under the CMQ’s new requirements. This means you will still be able to meet your CPD requirements by participating in COS accredited CPD activities.
The Royal College has confirmed that physicians licensed in Quebec will be able to fulfil their new CMQ requirements through the Royal College MOC Program and they will not have to report CPD activities twice. To facilitate this, the Royal College is mapping their MOC requirements to the CMQ requirements, which are reported in hours rather than credits. After that, the Royal College will expand MAINPORT ePortfolio to ensure the reporting of MOC data is seamlessly aligned with the CMQ requirements and platform.
If you have any questions about the new regulation and the new CPD reporting requirements, please contact the CMQ at [email protected].
We have also curated the following list of resources about the new CMQ regulation:
- CMQ website: Formation continue obligatoire (French only): http://www.cmq.org/page/fr/formation-continue-obligatoire-intro.aspx.
- Royal College, Dialogue, December 2018, Quebec specialists: MOC cycles are changing — here’s what you need to know:
- Fédération des médecins specialists du Québec (FMSQ) webinar: Demystifying the Règlement sur la formation continue obligatoire des médecins: https://studiocast.ca/client/fmsq/event/5883/en/
- FMSQ, Le Spécialiste, December 2018, p. 15:
A message from the COS Maintenance of Certification (MOC) Committee:
Colin Mann (Chair), MD
Chloe Gottlieb, MD
Glen Hoar, MD
Phil Hooper, MD
Rob Schertzer, MD