Guidelines for Supply Triage During Visudyne (Verteporfin) Shortage
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
A New Guide for Retinoblastoma Families and Survivors.
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]
Reports of Myocarditis/pericarditis after COVID-19 vaccination
June 3, 2021
Communiqué to health practitioners Reports of Myocarditis/pericarditis after
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.
Evidence-Informed Approaches to Teleglaucoma in Canada
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.
Public Health Agency of Canada information bulletin on VITT for health care providers
Since it began, the COVID-19 pandemic has been a highly dynamic situation. New developments in the pandemic have led to new evidence, which, in turn, have informed new or refined public health guidance.
As you may know, Canadian public health guidance around the AstraZeneca COVID-19 vaccine has evolved in recent weeks, in part due to concerns around vaccine-induced immune thrombotic thrombocytopenia (VITT, also known as vaccine-induced prothrombotic immune thrombocytopenia/VIPIT), which has been reported following post-licensure use of the vaccine in several countries.
The Public Health Agency of Canada is committed to addressing the evolving COVID-19 vaccine-related knowledge and training needs of health care providers. We will continue to offer webinars, and other training opportunities, to health care providers, to share the latest evidence and guidance with you on authorized COVID-19 vaccines, vaccine safety and related topics.
In the meantime, The Public Health Agency of Canada has prepared a short information bulletin on AstraZeneca and VITT .
Read the complete PHAC VITT infobulletin here.
The bulletin compiles statements and guidance documents on these topics from a number of federal and provincial sources.
If you have any questions or comments, please share them through email at [email protected]
Immediate Sequential Bilateral Cataract Surgery (ISBCS) COVID-19 Considerations
Updated March, 2021
This document, which is subject to regular updates, provides best practice evidence informed perspectives for ophthalmologists in Canada and can be viewed as a supplement to the June 3, 2020 COS issued document entitled “Immediately Sequential Bilateral Cataract Surgery (ISBCS) – Key Points”. (Appendix 1).
DISCLAIMER: This document should not be viewed as advocating widespread adoption of ISBCS; however, if individuals or groups are considering this or already engaging in the practice in the context of the COVID-19 pandemic, then we hope that the perspectives shared will be helpful. It will be important for those doing ISBCS to follow best practice recommendations so as to optimize outcomes and minimize the risk of complications. It is also important to note that standards of ISBCS and restrictions due to COVID are evolving and all surgeons must stay updated and use clinical acumen and judgement when deciding what is best- care for their patients.
Read the Full Immediate Sequential Bilateral Cataract Surgery (ISBCS) COVID-19 Considerations here.
COVID-19 Vaccination Tool Kit for Health Care Providers
The current edition of the tool kit includes information on the following topics:
- About COVID-19
- Overview of Vaccines
- Authorized Vaccines
- Vaccine Safety
- Additional Resources
COVID-19 Vaccination Tool Kit for Health Care Providers.
OICS Guidelines for the Cleaning and Sterilization of Intraocular Surgical Instruments
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.
Download the full OICS Guidelines in English.
WHO’s Diabetic Retinopathy screening: a short guide (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.
Download the full guide in English (PDF, 1.632 MB)