Physician Wellness: Reflections on the Challenges and Opportunities

Date: September 12, 2022

Time: 4 p.m. PDT/5 p.m. MDT/6 p.m. CDT/7 p.m. EST / 8 p.m. ADT / 8:30 p.m. NDT

Physicians and healthcare providers face complex challenges that have been amplified by the pandemic and recent global events. These challenges include ongoing workplace stressors, strain on personal relationships and financial stress; and physician wellness is on the line – now more than ever.

Join our expert panel — Dr. Martin Koyle, Hayley Harlock and our own Stephen Hunt — for a candid discussion regarding the challenges the physician community is experiencing related to wellness, relationships and money. The panel will discuss strategies to help mitigate these challenges and strengthen and support the physician community.

You are welcome to comment or ask questions, before and during this session and we will share them with our panel.

To register click here:

Unable to make it? Sign up for the recording here

*This presentation will be in English only.

August 2022

Vision therapy (VT), or behavioural optometry, is a generalized term for behavioural treatments based upon the belief that abnormalities in vision are the underlying cause of learning, neurological and spatial disabilities.

A review of the available literature on these treatments conducted in 2022 by a committee of physicians specializing in pediatric ophthalmology and neuro-ophthalmology found that, with the exception of convergence insufficiency, evidence that these therapies are effective is lacking.

Background

Vision therapy is a term used to refer to a spectrum of in-office supervised exercises that aim to improve visual ability and skill. Vision therapy programs are prescribed for a wide and etiologically diverse group of pathological and non-pathological learning, oculomotor, visual and post-traumatic states. These conditions include strabismus, amblyopia, learning/reading disabilities (dyslexia), myopia, and brain injuries such as stroke, concussion, and trauma with visuospatial neglect. Vision therapy remains an uninsured paramedical service.

Canadian Ophthalmological Society (COS) members have noted a sharp increase in the number of requests to provide an opinion on the effectiveness and validity of prescribed vision therapy programs. These programs can last from several weeks to years and, at times, a lifetime of treatment. The COS Vision Therapy committee feels that additional high-quality evidence-based research must be performed prior to any consideration for public or private insurance coverage.

Read the full position statement here.

The August 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 August visual abstract, Pretreatment with frequent topical betamethasone in Ahmed glaucoma valve implantation.

Review article: Advances in magnetic resonance imaging of orbital disease  

Original research articles:

·        Clinical audit of retinoblastoma management: a retrospective single-institution study

·        Longitudinal assessment of type 3 macular neovascularization using 3D volume-rendering OCTA

• Selective laser trabeculoplasty in steroid-induced and uveitic glaucoma

·        Chalazion: racial risk factors for formation, recurrence, and surgical intervention

·        Challenging the current treatment of residual postoperative ptosis: safety and efficacy of repeat Müller’s muscle conjunctival resection

Research letters, photo essays, and case reports:

·        Bilateral curvilinear chorioretinal streaks [photo essay]

·        Gore-Tex suture exposure following transscleral fixation of an intraocular lens [photo essay]

·        Transplantation of autologous lamellar scleral graft for the treatment of corneal perforation [case report]

·        Experiences from a national webinar with recently matched Canadian ophthalmology residents for medical students [case report]

·        Uveal melanoma presenting as panophthalmitis in the absence of an intraocular mass [correspondence]

Follow the CJO on social media:

Twitter: @CanJOphth

Instagram: @cjo_jco

Facebook: CanJOphth

Canadian Ophthalmology Curriculum Topics & Objectives

This document is the finalized list of curriculum topics and objectives for Canadian undergraduate medical education in ophthalmology. The development of this list was based off  three resources: The 2018 objective list developed by the Association of University Professors in Ophthalmology (AUPO) with endorsement from the American Academy of Ophthalmology (AAO)¹, the AUPO’s 2009 Ophthalmology Core Knowledge and Skills competencies²,and the Medical Council of Canada’s (MCC) objectives pertaining to ophthalmology³.

After a preliminary list of objectives was made based off the previously mentioned resources, a survey was sent to the members of AUPO asking for expert opinion on each curriculum objective and if they warrant inclusion. Based on this survey, talking points were created and later discussed in a virtual meeting where the list was finalized.

*Urgent and red flag conditions have been denoted with a red Asterix. These warrant urgent referral to an ophthalmologist.

Download the full PDF Document here:

Click on the links below to explore the topics:

The third fully virtual Retina Case Conference Canada will be held on Saturday, November 19, 2022. Last year’s meeting had the highest RCCC attendance to date with more than 80 retina colleagues logging in from across Canada!
​
In keeping with the successful RCCC model, our live Zoom program will center around surgical and medical interactive cases presented remotely by participants from across the country. Complementary to the case sessions, we are pleased to welcome international guest speakers Dr. Anat Loewenstein from Tel Aviv University and Dr. Ramin Tadayoni from Université de Paris, who will present on current topics in retina and provide commentary on our cases.

Date: November 19th, 2022

Time: 9:00 am – 3:00 pm EST

Speakers: Drs. Anat Loewenstein and Ramin Tadayoni

Click here for more information and to register:

Varun Chaudhary hosts three International Experts, Dr. Sunir Garg, Dr. Michael Ip, and Dr. Wai-Ching Lam with whom we will explore new surgical and non-surgical treatments for nAMD and DME, and will review the top five signs not to miss in imaging.

Do you Dare Enter the Lions’ Lair? COS 2022 The Lions of Canadian Ophthalmology gathered on Saturday, June 11, 2022 at the Halifax Convention Centre to judge three research presentations related to retinal disease. Dr. Steve Houston delivered a keynote lecture on The future is now: Advances in digital health and technology. The Innovation in Retina Research Award was offered by the Canadian Ophthalmological Society (COS) with the support of Bayer Inc. for clinical trainees (residents or fellows) for a research project proposal related to retinal disease, with preference being given to those using digital innovations in optimizing patient care and screening.

Fuchs VIII Symposium Save-the-Date

Date: April 1st, 2023

Place: Miami, Florida

The upcoming Fuchs VIII Symposium will feature novel therapeutics for endothelial disease as well as in-depth discussions on advanced endothelial Keratoplasty techniques and clinical research, led by thought leaders in the field. 

We hope to see you in Miami, Florida, on April 1st, 2023!

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)