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Membership Update - Fall 2019

To guide us into 2020 and beyond, we are excited to announce our updated five-year Strategic Plan. In the fall of 2018, key informant interviews were conducted with 18 key stakeholders and opinion leaders, and a Membership Survey was circulated to our members. The COS Board met in late November 2018 to review the findings, and again on April 7, 2019 to develop our Strategic Priorities for 2020-2025. Our new five strategic pillars build on our previous priorities, but include some subtle changes in our strategic direction. The new plan is organized around Advocacy and Lobbying, Communications and Brand Strategy, Organizational Excellence, Education, and Strategic Relationships. Outputs and outcomes in each area will continue to be measured against key deliverables using a performance management system.

Advocacy and Lobbying

  • Advocacy continues to remain a key strategic priority for COS. In order to fulfill its mission to be the national, recognized authority on eye and vision care in Canada, COS asked members to each voluntarily contribute a minimum of $700 to an Advocacy and Public Awareness Fund. To date, we have reached 94% of our 2019 target goal and continue to see great support. The monies gathered from the Fund, along with a significant investment from COS, will be used to support COS to continue its strong advocacy and public awareness work at a federal level, and to empower the provinces, subspecialty societies and academic community with advocacy tools, training and resources to help raise the profile of the profession.
  • To support public awareness efforts, COS is now implementing Year 3 of its See The Possibilities campaign. To date in 2019, COS has achieved 31.6 million media impressions.
  • Since its launch in 2017, the See The Possibilities campaign www.seethepossibilities.ca has featured five patient videos, as well as produced a campaign launch video. Together, the videos appeared in front of 7.6 million Canadians and 1.5 million Canadians paused to watch.
  • COS is now hard at work on the newest video for the See The Possibilities campaign - this one on cornea transplants.
  • Through the advocacy team, COS has developed a series of four posters that differentiate ophthalmologists from optometrists and outline the conditions and impacts of key diseases such as cataracts, glaucoma and age-related macular degeneration. COS will make these posters available to all its members in time for World Sight Day on October 10th with instructions to place the posters in their offices.
  • COS continues to issue a quarterly Advocacy in Action e-newsletter that summarizes COS's national, provincial and subspecialty advocacy and lobbying initiatives.
  • In January 2018, an editorial by Dr. Phil Hooper on the unemployment and underemployment of new graduates in ophthalmology was published in Politics magazine and profiled in Sixth Estate. The primary audiences are government, opposition members and bureaucrats at the federal level. The article was recently updated and COS received a number of new media enquiries on this front.
  • The Council on Advocacy has created four "Regional Physician Representative" roles. These representatives will work with the provincial physician representatives to identify, evaluate and/or report on issues of importance at a multi-province or regional level, in order to help COS identify pan-Canadian advocacy trends.
  • In 2016, the COS produced a report on the Valuation of Uninsured Services and this report is still widely used by COS members, other eye and health care providers and government.

Provincial Advocacy Initiatives

  • Drug shortages: COS has engaged with Health Canada on the issue of persistent drug shortages and the impact this is having on ophthalmology and our patients. In June, COS was invited to participate in a meeting with Health Canada to discuss the Miostat and Miochol E shortages with Health Canada's Tier Assignment Committee (TAC), a multi-stakeholder pilot project that seeks to address any gaps in the efficient identification, assessment and communication of the most critical drug shortages. The TAC meeting also included representatives from several branches of Health Canada, the Canadian Medical Association, and the Provincial/Territorial Drugs Shortages Task Team. After discussing the impact of both shortages, TAC unanimously decided that the current shortage of Miochol E qualifies as a Tier 3 shortage. At the COS Annual Meeting, COS met with Bausch + Lomb and Alcon to discuss how drug shortages and discontinuations are communicated. Both companies committed to providing more direct communication about shortages and potential discontinuations, as well as providing updates on mitigation strategies, anticipated availability levels and anticipated start and end dates. In response to current drug shortages, COS is in the process of compiling a list of "essential drugs" for ophthalmology that it plans to share with government and industry. The essential drugs list will be categorized by subspecialty and broken into drugs administered orally and topically. Bausch + Lomb and Alcon agreed that no medications on this list will be discontinued without prior discussion and coordinated mitigation efforts.
  • COS advocates for increased coverage of intravitreal eye injections: In June, COS wrote to the Honourable John Haggie, Minister of Health in the Government of Newfoundland and Labrador, concerning the need for sustained coverage of intravitreal eye injections. Minister Haggie responded that as part of the government's "effort to increase access to effective therapies for individuals suffering with neovascular age-related macular degeneration, the Newfoundland Labrador Prescription Drug Program is investigating opportunities to provide coverage for Avastin in the future." This is a positive step and allows the eye physicians and surgeons of Newfoundland to begin discussing the issue with government. A joint COS-Canadian Retina Society position paper on the issue authored by Dr. Alan Berger accompanied the letter. This position statement was approved by the COS Board on June 12, 2019.
  • Eye Physicians and Surgeons Association of Alberta respond to government's request for higher sterilization of equipment: COS leveraged its relationship with the Canadian Agency for Drugs and Technologies in Health (CADTH) and CADTH produced a statement on the current evidence regarding sterilization of ophthalmic equipment that touches the eye. A call was held with the provincial leads for Infection Prevention & Control (IPC) from Calgary and Edmonton on June 24, 2019. During the call, it was agreed that high-level disinfection, with potential risks to patients and equipment, is not the way to go. IPC has been looking at various options for "higher-level" disinfection and there was interest in evaluating Tristel, which involves wipes rather than a complex reprocessing system. Though not approved in Canada, Tristel is used in parts of Europe and Australia. IPC is willing to see if Health Canada would permit a trial of Tristel.
  • BC Society of Eye Physicians and Surgeons (BCSEPS): Following a formal request, the BCSEPS Executive Committee has agreed to appoint a COS member as an Observer on the Provincial Health Services Authority's Joint Accountability Committee. This physician leader will provide input into the ongoing investigation around the incidence of glaucoma in patients treated with anti-VEGF injections.
  • Optometry scope creep: In recent months, COS has been made aware of several incidents of optometrists receiving training on lasers in Canada with the intention of providing laser eye treatments as part of the services they offer patients. COS continues to monitor the issue of expanded scope of practice as it relates to optometry in Canada and will engage with governments, industry and optometry associations as appropriate.

Communications and Brand Strategy

  • Canadians were exposed to the positive impact ophthalmologists have on their lives through COS's See The Possibilities public awareness campaign. COS members appeared in the media and in social media blogs to tell Canadians more about ophthalmology. From 2017 to 2018, the number of available physician COS spokespeople increased by 500 percent, ensuring that many COS members were available to respond to media requests.
  • COS also highlighted specific subspecialty disease days and months through a combination of earned and paid media opportunities. Highlights included: interviews for World Glaucoma Week in March; articles in Global News regarding AMD Awareness Month; a paid supplement in Maclean's magazine for National Diabetes Awareness Month (with an audience reach of 2.4 million readers); and COS and CAO's Joint Position Statement on the Effects of Electronic Screens on Children's Vision and Recommendations for Safe Use (which earned more than 8 million media impressions).
  • COS will continue to move forward with the implementation of its Advocacy and Communications and Media Relations Plan, including planning for Year Four of the See The Possibilities public awareness campaign, ongoing meetings with key contacts within the federal government, and more. Year Three of the campaign focused on national and regional media relations, patient video testimonials and influencer engagement. New initiatives include a Physician Toolkit, which will feature campaign materials, such as waiting-room posters, videos for physician waiting-room screens, advertisements that can be placed in local media outlets, and more.
  • In addition to the See The Possibilities campaign, COS responded to hundreds of media requests on a variety of vision and eye health-related topics.
  • COS's new public-facing website will be launched by year's end.

Organizational Excellence and Membership Activities

  • COS exists because of and for its members, and retaining and attracting members is fundamental to its ability to be the unified voice of ophthalmology in Canada. COS currently has 1,159 members.
  • COS maintains strong ties with the academic community (through the Council on Advocacy), with the subspecialty societies (through the Council on Advocacy, the Annual Meeting Planning Committee and the Editorial Board of CJO) and with the provinces.
  • COS has identified the many benefits for the academic community, subspecialty societies and provinces of being associated with COS. These Affiliate Services are outlined in the document entitled What is the Value of Being Affiliated with COS? Maintaining a strong relationship between organizations helps to elevate the respective brands. As the unified voice for ophthalmology in Canada, COS works with all of its subspecialty societies, the provinces and the academic community to position the expertise and skill of ophthalmology to government, the media, the public and other medical and eye healthcare providers. Provinces, subspecialty societies and the academic community have access to accredited CPD, and receive advocacy, communications, media and government relations support. In addition, subspecialty societies and the academic community benefit from communication via listservs. Subspecialty societies that are linked to COS benefit from insurance coverage through COS's insurance program, complimentary management of annual membership renewal services, and links to other major national and international affiliated organizations.
  • In November 2018, COS began managing the joint annual membership program for the Canadian Association of Pediatric Ophthalmology and Strabismus (CAPOS) and the Canadian Society of Oculoplastic Surgeons (CSOPS) at no cost. COS continues to manage the joint Canadian Retina Society (CRS) annual membership program at no cost. The Canadian Glaucoma Society (CGS) will also have joint annual membership starting in 2020.
  • Engagement of residents and young ophthalmologists is critical to the future of the Society and COS highly values its 202 resident members. A resident physician leader serves on the Annual Meeting Planning Committee and COS provides numerous benefits to residents and young ophthalmologists, including a half-day symposium at the Annual Meeting and a webpage that includes information on resident events, research initiatives, fellowships and job opportunities.
  • In June 2019, the Committee on Specialties of the Royal College of Physicians and Surgeons of Canada approved an application from the Canadian Retina Society to recognize retina as an Area of Focused Competence (AFC) diploma. The first step toward operationalization of the discipline involves the organization of a working group to oversee the initial stages of implementation prior to the appointment of an AFC committee. The working group, which includes a representative from COS, will be responsible for finalizing the standards documents, including the summative portfolio, and the appointment of the AFC committee to oversee the discipline. The working group will review the core competencies for ophthalmologists and, specifically, the shared competencies of comprehensive ophthalmologists in retina. This will ensure that the development of the AFC in retina is a robust and transparent process that benefits the ophthalmology community and enhances retina care for patients across Canada through the standardization of surgical retina fellowships.
  • The number of female ophthalmologists in Canada has continued to increase year over year. In recognition of the unique issues that female ophthalmologists face, COS has hosted a Women in Ophthalmology symposium at the COS Annual Meeting since 2012.
  • COS will continue to engage its membership in new and innovative ways to ensure that the organization remains nimble, relevant and responsive to the needs of its members.

Education

  • COS is committed to maintaining the highest ethical standards, following guidelines established by Royal College of Physicians and Surgeons of Canada (RCPSC). COS has received commendation for its submission to renew its status as an accredited Continuing Professional Development (CPD) provider with RCPSC. COS has been granted an accreditation period of eight years (the maximum number of years).
  • From September 2018 to August 2019, COS accredited 23 group learning activities, five Simulation courses, and three Self-Assessment Programs. Accredited activities spanned subspecialty areas and took place across Canada and online.
  • The 2019 COS Annual Meeting was held from June 13-16 at the Québec City Convention Centre. Almost 1,500 delegates attended the meeting, which included four days of scientific content, 55 sessions and 18 keynotes speakers.
    • New this year, COS hosted the inaugural joint symposium with the Société Française d'Ophtalmologie (SFO, the French Society of Ophthalmology). This was part of the COS Board's vision to expand COS's reach globally and to encourage a higher level of participation from delegates internationally. COS is in the process of designating members to participate in the SFO's conference in Paris.
    • COS hosted a small-group workshop on informed consent, during which participants were led through a series of vignettes with a focus on communication style, capacity and liberty. This session was hosted in partnership with the Canadian Medical Protective Association (CMPA).
  • In May 2019, COS launched the Practice Resource Centre: www.cosprc.ca. The PRC is an online space that provides Canadian ophthalmologists with access to a variety of CPD resources, including CPD opportunities and events, accredited and unaccredited activities, position statements, and information about CPD for program planners and learners. The PRC aims to be the "go-to" online CPD resource for Canadian ophthalmologists.
  • COS continues to deliver the INSIGHT glaucoma and cornea modules (co-developed with Allergan) to ophthalmologists across Canada. The program offers interactive cases in cornea and glaucoma topics that consider diagnoses, investigations and treatment options, by exploring the work-up, initial management, surgical options and when to refer.
  • The 50th Sally Letson Symposium, Neuro-ophthalmology, took place from September 13-15, 2018 in Ottawa, Ontario. The Symposium was co-chaired by Dr. Anthony C. Arnold (University of California Los Angeles) and Dr. Rustum Karanjia (University of Ottawa). Welcoming 15 Canadian and international speakers and nearly 700 delegates, the meeting was an overwhelming success. The 2019 symposium, entitled Glaucoma: Thriving Under Pressure, will take place from September 12-14 and will be co-chaired by Dr. Iqbal (Ike) Ahmed and Dr. Garfield Miller.
  • Two accredited Self-Assessment Programs were co-developed by COS and the Canadian Cataract Institute and are available as online modules: Managing Complicated Cataract Surgeries and IOL and Cataract Cases.
  • COS and the Canadian Cataract Institute (CCI) co-developed an accredited webinar on informed consent that was delivered on November 14, 2018 by an ophthalmologist and a member of CMPA.
  • COS launched an online accredited Self-Assessment Program entitled Private Eye: Connecting the Dots in Dry Eye Disease. This program was co-developed with Takeda (formerly Shire Pharma ULP) and is an interactive module designed for ophthalmologists to explore the identification, diagnosis and management of patients with dry eye disease.
  • COS continues to deliver a program entitled Update on Diabetes and the Eye for the Primary Care Provider, which is accredited by the College of Family Physicians of Canada (CFPC) for 1.5 Mainpro+ credits. The program is co-developed with Bayer. This initiative aims to assist family physicians in diagnosing, referring and encouraging ongoing monitoring of the eyes of patients with diabetes. The program has reached over 800 family physicians to date.
  • Dr. Varun Chaudhary took over the role of Canadian Journal of Ophthalmology (CJO) Editor-in-Chief in June 2018. Under his innovative leadership, CJO has undertaken several new initiatives, including creating a Resident Advisory Council (RAC), with representation from 13 academic programs across Canada. In conjunction with the RAC, CJO launched two new features in the June 2019 issue: 1) Resident Perspectives, a digest that highlights four to six articles from each issue with summaries written by members of the RAC, and 2) a one-year visual abstract pilot project, in which one visual abstract will be included in each issue. These graphical summaries allow readers to quickly assess an article's findings and are an excellent way to disseminate scientific research. In addition, under Dr. Chaudhary's leadership, CJO has added two new sections: Health Economics and Ocular Imaging. CJO has also added two new manuscript types: Research Letters and Photo Essays.
  • In 2018, CJO received over 1000 manuscript submissions, which was a modest increase from the previous year. The rejection rate was 77%, and CJO's impact factor decreased slightly-from 1.543 in 2016 to 1.314 in 2017. According to Elsevier, this type of decrease is normal when a journal increases its number of articles, which CJO has done over the last two years.

Strategic Relationships

  • COS has a representative on the International Council of Ophthalmology (ICO) and will be offering a 90-minute symposium at the 2020 World Ophthalmology Congress in South Africa.
  • Dr. Guillermo Rocha was appointed as a COS representative on the Pan-American Association of Ophthalmology (PAAO) Board of Directors. COS President, Dr. Yvonne Buys, serves as the other representative on the PAAO Board.
  • COS would like to congratulate Dr. Stephanie Dotchin for her acceptance into the Pan-American Association of Ophthalmology Leadership Development Program 2019.
  • COS continues to work closely with the American Academy of Ophthalmology (AAO), including regular calls with key physician leaders to discuss issues of importance, including Advocacy. Dr. Ken Roberts completed the AAO Leadership Development Program in the fall of 2018. As part of this program, Dr. Roberts produced "Canadian Ophthalmologist Accessibility as Measured by Driving Time". This report is immensely helpful to COS by providing data to counteract optometry's claim that they are more accessible than ophthalmology. The report concluded that 90% of Canadians are within a one-hour drive of an ophthalmologist.
  • COS is engaged with Canadian Blood Services in the development of a leading practice to enhance cornea transplantation in Canada. Stakeholder engagement, system performance improvement and data and analytics are key components of this work.
  • COS will continue to work with its partners to address key areas of Advocacy, including: expanding scope of practice for optometry; Human Resources for Health; and strategies that will help enhance patient care for specific patient populations, such as children.
  • COS continues to collaborate with the Canadian Association of Optometrists (CAO) in areas of mutual interest: the two organizations meet twice annually and have developed a Joint Clinical Practice Guideline for the Periodic Eye Examination in Canada (0 to 5 years), with representation from the Canadian Association of Pediatric Ophthalmology and Strabismus (CAPOS), the Canadian Paediatric Society (CPS) and the College of Family Physicians of Canada (CFPC). This guideline will be simultaneously published in the Canadian Journal of Optometry and the Canadian Journal of Ophthalmology in December 2019.
  • In September 2018, COS received a request from Health Canada to provide clinical input regarding the risk of limbal stem cell deficiency (LSCD) in individuals using contact lenses. This request came from a recent literature review conducted by Health Canada that suggested that the use of soft contact lenses may put users at risk of LSCD.
  • Health Canada is in the process of renewing tobacco product labels, which include health warnings and health information messages. COS has been working with Health Canada to provide medical images that graphically depict the risks of tobacco on eye health for the new labels.
  • In October 2018, in conjunction with the federal Cannabis Act coming into effect, COS updated its position statement on the Medical Use of Cannabis for Glaucoma, which was also endorsed by the Canadian Glaucoma Society. The final statement was published in CJO, and also provided to the Canadian Medical Association (CMA), which shared it though its national network and its provincial and territorial medical associations. The Canadian Cornea, External Disease & Refractive Surgery Society developed a position statement on the Medical Use of Cannabis for Dry Eye Disease, which was endorsed by the COS Board in June 2019. CMA also shared this position statement through its national network and its provincial and territorial medical associations.
  • COS actively engages with its subspecialty societies in working with the Canadian Agency for Drugs and Technologies in Health (CADTH) to address gaps in healthcare delivery in Canada. For example, COS collaborated with the Canadian Glaucoma Society to prepare responses to CADTH's draft recommendations on Optimal Use of Minimally Invasive Glaucoma Surgery (i.e., MIGS).

Major Initiatives for the Year

  • COS is working hard to engage all the provinces, subspecialty societies and the academic community to meet its goal to be the unified voice for ophthalmology in Canada, and to continue to position ophthalmologists as the recognized medical and surgical leaders of the eye and vision care team with government, the media and the public.
  • COS will continue to move forward with the development of its new Five-year Strategic Plan with a goal to begin implementation of the new plan in January 2020.
  • COS must embrace the RCPSC's Competence by Design in 2019. This will require widespread stakeholder engagement in the process to ensure that the ophthalmology community is fully on board with the new direction.
  • COS will further enhance programs and initiatives that are focused on physician wellness. COS is the recipient of targeted funding from MD Financial Management Inc. for physician wellness initiatives and will receive $200,000 over three years for CPD activities that address physician wellness, specifically geared toward the ophthalmologist.
  • COS will continue to produce position statements on areas of importance to its membership and will continue with Year 4 of the See The Possibilities campaign.
  • Jennifer Brunet-Colvey will be retiring in September 2019, after having served as Executive Director/CEO of COS for 10 years. At the COS Annual General Meeting in June, she was presented with the inaugural "Friend of Canadian Ophthalmology" award in recognition of the significant impact she has had on COS and ophthalmology in Canada. It is expected that a new Executive Director/CEO will be announced in early September.

COS could not fulfill its mandate without its dedicated staff and the tireless efforts of the many volunteers who give their valuable time to improve eye care for all Canadians and to advocate for the profession. Thank you to all who have volunteered for the COS to advance ophthalmology and patient care in Canada. For those wishing to volunteer, please contact the COS office and look for regular announcements of opportunities.