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.

avril 2021

Depuis ses débuts, la pandémie de COVID-19 reste une situation très dynamique. Les nouveaux développements de la pandémie ont donné lieu à de nouvelles données probantes qui, à leur tour, ont permis d’éclairer ou d’affiner les orientations en matière de santé publique.

Comme vous le savez peut-être, les directives de santé publique canadiennes concernant le vaccin AstraZeneca contre la COVID-19 ont évolué au cours des dernières semaines, en partie en raison des préoccupations entourant les cas de thrombocytopénie thrombotique immunitaire induite par le vaccin (TTIV), aussi appelée la thrombocytopénie immunitaire prothrombotique induite par le vaccin (TIPIV), qui ont été déclarés dans plusieurs pays à la suite de l’utilisation post-homologation du vaccin. Nous comprenons que la modification des directives a des répercussions pour vous, en tant que fournisseur de soins de santé, et en particulier pour ceux qui administrent les vaccins contre la COVID-19 ou qui fournissent une éducation ou des conseils aux patients sur la vaccination.

L’Agence de la santé publique du Canada s’est engagée à répondre aux besoins changeants des fournisseurs de soins de santé en matière de connaissances et de formation sur le vaccin contre la COVID-19. Nous continuerons à offrir des webinaires et d’autres possibilités de formation aux fournisseurs de soins de santé, afin de vous faire part des dernières données probantes et des conseils sur les vaccins autorisés contre la COVID-19, l’innocuité des vaccins et les sujets connexes.

Entre-temps, L’Agence de la santé publique du Canada a préparé un bref bulletin d’information sur le vaccin AstraZeneca et la TTIV .

Détails d’accès

Lire l’ Infobulletin complet de l’ASPC sur la TTIV ici.

Le bulletin regroupe des déclarations et des documents d’orientation sur ces sujets provenant d’un certain nombre de sources fédérales et provinciales.

Si vous avez des questions ou des commentaires, veuillez nous en faire part par courriel à [email protected].

Mise à jour, mars 2021

Ce document, qui fait l’objet de mises à jour régulières, fournit des perspectives factuelles sur les meilleures pratiques pour les ophtalmologistes au Canada. On peut le consulter comme un supplément au document publié par la SCO le 3 juin 2020, intitulé « Immediately Sequential Bilateral Cataract Surgery (ISBCS) – Key Points » (Annexe 1).

AVERTISSEMENT : Ce document ne doit pas être considéré comme préconisant une adoption généralisée de la CCBIS; cependant, si des individus ou des groupes l’envisagent ou débutent cette pratique dans le contexte de la pandémie de COVID-19, nous espérons que les perspectives offertes seront utiles. Il sera important que ceux qui pratiquent la CCBIS suivent les recommandations sur les meilleures pratiques afin d’optimiser les résultats et de minimiser le risque de complications. Il importe également de noter que les normes de la CCBIS et les restrictions dues à la COVID évoluent et que tous les chirurgiens doivent rester informés et faire preuve de discernement et de jugement clinique lorsqu’ils décident des meilleurs soins pour leurs patients.

Détails d’accès

Lire l’intégralité du document, chirurgie de la cataracte bilatérale immédiatement séquentielle (CCBIS) Considérations relatives à la COVID-19

L’édition actuelle de la trousse à outils contient des informations sur les sujets suivants :

• À propos de la COVID-19
• Aperçu des vaccins
• Vaccins autorisés
• Orientations à l’intention des fournisseurs de soins de santé
• Sécurité des vaccins
• Ressources supplémentaires

Détails d’accès

Trousse à outils de vaccination pour les fournisseurs de soins de santé.

December, 2020

Guidelines for the Cleaning and Sterilization of Intraocular Surgical Instruments

These guidelines are intended to assist ambulatory surgery centers (ASCs) in their efforts to adopt appropriate practices for the cleaning and sterilization of intraocular surgical instruments. They are provided for scientific, educational, and informational purposes only. They are not intended to establish the only acceptable or appropriate standards, methods, or practices for cleaning and sterilizing such instruments. Adherence to these guidelines does not guarantee compliance with any legal or regulatory standards, including without limitation the criteria for ASC licensure or certification, or Medicare or other third-party payer reimbursement. In addition, any discussion or recommendation in these guidelines regarding the use of drugs or devices that deviate from the U.S. Food and Drug Administration (FDA)–approved use of such product (ie, an “off-label use”) is made for scientific and educational purposes only and intended to fall within the FDA’s “practice of medicine” exception for off-label uses. Individual physicians must make independent judgments as to whether the off-label use of a particular drug or device is appropriate and in the patient’s best interest based on the facts and circumstances of the particular case.

Access Details

Download the full OICS Guidelines in English.

November, 2020

This guide is designed for policy-makers, public health leaders and senior clinicians involved in planning, designing and implementing diabetic retinopathy screening programmes in the WHO European Region. The purpose of screening is to identify people with diabetes who are at higher risk of developing sight-threatening diabetic retinopathy so that early treatment or intervention can be offered to reduce the incidence of vision impairment or blindness. It demonstrates how the Wilson & Jungner principles apply to diabetic retinopathy screening, describes the pathway to follow and explains how to initiate new programmes or improve the effectiveness of those already existing. The guide forms part of WHO’s efforts to increase the effectiveness of screening programmes within the Region, maximizing benefits and minimizing harm.

Access details

Download the full guide in English (PDF, ‎1.632 MB)

This program was developed under the leadership of a multi-disciplinary steering committee, chaired by Dr. David Wong, ophthalmologist and Dr. Peter Lin, Family Physician. Steering committee members include Dr. Bernard Hurley and Dr. David Maberley (ophthalmologists), Dr. John Axler and Dr. Carl Fournier (family physicians), and Dr. Alice Cheng (endocrinologist).

This Self-Learning program has been certified by the College of Family Physicians of Canada for up to 1 Mainpro+ credits. The initiative was supported in part by an educational grant from Bayer.

• English: www.diabetesandtheeyes.com

• French: www.lediabeteetlesyeux.com

This program will reinforce the importance of primary care providers in the care of the eye of patients with diabetes. An overview is provided on the ways in which primary care providers can help close the current screening and care gap for diabetic eye disease here in Canada. Participants will understand the consequences of delays in screening and they will be introduced to a practical tool developed by COS which will help encourage eye screening in people with diabetes. To help to reduce eye complications due to diabetes, the session will also emphasize the importance of good diabetes care in general.

Program Learning Objectives:

• Describe the importance of retinopathy in patients with diabetes
• Define macular edema, and proliferative and non-proliferative retinopathy
• Recognize how to screen for these conditions
• Summarize the current treatment options for our patients

CPD Credits
This Self-Learningprogram has been certified by the College of Family Physicians of Canada for up to 1 Mainpro+ credits

Patient Brochure

Access Details

• English: www.diabetesandtheeyes.com

• French: www.lediabeteetlesyeux.com

24 August, 2020

COVID-19 – Preliminary Clinical Guidelines for Ophthalmology Practices

Authors: Reza Gharebaghi,Jordan Desuatels,Majid Moshirfar, Maryam Parvizi,Seyed-Hashem Daryabari, and Fatemeh Heidary

Abstract

The zoonotic Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and its resultant human coronavirus disease (COVID-19) recently appeared as a global health threat that can cause severe respiratory infection and terminal respiratory distress. By the first week of April, more than 1.3 million people had been globally infected and more than 70,000 had lost their lives to this contagious virus.

Clinical manifestations occur shortly after exposure, or a few days later. There is controversy regarding the transmission of the virus through the tear and conjunctiva; however, there are reports that the ocular surface might be a potential target for COVID-19. The ease of transmission of this virus at close proximity presents a risk to eyecare workers. Several recommendations have been issued by local and national organizations to address the issue of safe ophthalmic practice during the ongoing COVID-19 pandemic. These guidelines have numerous similarities; however, subtle differences exist. The purpose of this paper was to discuss measures, with a specific focus on standard precautions, to prevent further dissemination of COVID-19 at Eye Clinics. We have proposed procedures to triage suspected cases of COVID-19, considering emergency conditions.

Access Details:

Read the full article COVID-19: Preliminary Clinical Guidelines for Ophthalmology Practices here