In this issue

Update from COS President, Dr. Paul Rafuse
Sometimes it is difficult to know how much a national organization, such as ours, should get involved with the affairs of an individual province. The COS Council on Provincial Affairs brings together representatives from the boards of the provincial associations to compare notes on the activities on their domestic fronts. This has proved a fertile forum for good ideas and cautionary tales. With a board of full time ophthalmologists and a small administration, it is impossible and improper to tackle all the problem issues. Nonetheless, when something comes along with the potential to impact the entire country, we need to dig in.

And dig in is what we did recently in response to a proposal by the Alberta College of Optometry (ACO) to expand its scope of practice enormously. Requested changes to the Alberta Health Professions Act would allow optometrists to:

  • independently manage glaucoma medically
  • prescribe all Schedule 1 drugs pertinent to their profession
  • perform some eyelid surgery
  • do intraocular laser surgery
  • order any imaging (including CT, MRI and ultrasound) or laboratory tests felt necessary to investigate systemic diseases with ocular involvement

Added together, this goes far beyond the scope of practice of optometry in any Canadian province or US state. This same issue arose two years ago and, thanks to the efforts of COS Past-President, Dr. Lorne Bellan, the Eye Physicians and Surgeons Association of Alberta and the American Academy of Ophthalmology, Alberta Health and Wellness decided not to allow any of these regulatory changes to take place.

This time around, working once again with the Eye Physicians and Surgeons Association of Alberta (EPSAA), the COS has responded in a clear and detailed fashion to explain why we feel this application is poorly conceived, has lacked the proper consultation with the affected stakeholders in the medical profession and (quite bluntly) would put the health of Albertans at risk. We have respectfully implored Alberta Health and Wellness to carefully examine and validate the appended claims of education and training purported by the ACO. We don't think they are accurate.

With the leadership of EPSAA President-Elect, Ken Romanchuk, and COS Council on Provincial Affairs Chair, Andrew Budning, the COS board and administration is continuing to help the Alberta government appreciate the protean implications of the proposed changes for patient safety and health care costs. We will be recruiting help from the Royal College of Physicians and Surgeons of Canada, as well as the Alberta Medical Association, the Canadian Medical Association and the Canadian Medical Protective Association. The American Academy of Ophthalmology has written a strong objection, and its experience and recommendations have been greatly appreciated. We will meet directly with the president and CEO of the Canadian Association of Optometry to determine its level of support for this proposal as well.

It is clear that we need to work with optometry in a constructive and coordinated fashion to best serve the needs of our patients. Many of us have good working relations already. The scopes of our professions will evolve, and it is critical that we all regularly convene with the provincial health ministries to develop and deliver eye care in the best and most cost effective ways. The Eye Health Council of Ontario is an excellent model for doing just that, and the COS board encourages Alberta and other provinces to consider setting up a similar panel of expert representatives from the medical and optometric groups.

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Update from COS CEO, Jennifer Brunet-Colvey

Bill C-313 receives royal assent

On December 14, 2012, an Act to amend the Food and Drugs Act (non-corrective contact lenses) gained royal assent (see Governor General grants...). Once enacted, this private member's bill, introduced by Pat Davidson MP for Sarnia-Lambton, will bring non-corrective contact lenses into the Class II medical device category, bringing them in line with the regulations for prescription contact lenses. Bill C-313 was unanimously endorsed by members of the House of Commons at each stage of debate and passed easily through the Senate.

The COS was among the stakeholders who supported Bill C-313. Other key eye care stakeholders included the Canadian Association of Optometrists and the Opticians Association of Canada. In February 2012, the COS testified before the House of Commons Standing Committee on Health on the dangers of improperly used cosmetic/decorative contact lenses, including corneal injury, such as microbial keratitis, corneal abrasions and neovascularization from hypoxia to the cornea.

The Medical Devices Bureau of the Therapeutic Products Directorate (TPD) is the national authority that monitors and evaluates the safety, effectiveness and quality of diagnostic and therapeutic medical devices in Canada. To determine which devices need a license, all medical devices are categorized based on the risk associated with their use (see Safe Medical Devices in Canada, Health Canada). Class I devices present the lowest potential risk (e.g., a thermometer) and Class IV devices present the greatest potential risk (e.g., pacemakers). Classifying cosmetic contact lenses as Class II medical devices will require the products sold in Canada to be licensed through Health Canada. In addition, distributors of the products will require a medical device establishment license and must provide assurance to the TPD that regulatory requirements related to post-production activities have been met.

A coming-into-force provision has been built into the legislation to allow a grace period for Health Canada to allow those who will be affected by the new regulatory oversight to bring themselves in line with the new provisions. This will include a public consultation, resulting in publication of draft regulations for the new Act in the Canada Gazette, Part I (see Consultation). Interested groups and individuals, as well as Canadians in general, have a final opportunity to review and comment on a proposed regulation at the last stages of the regulation-making process, before it is enacted ("comes into force") and is published in Part II of the Canada Gazette. The process is expected to take approximately 18 months.

As the right to sell non-corrective lenses and the requirements for a prescription are regulated at the provincial level, each province will need to adjust the language of their current contact lens regulations to include non-corrective contact lenses. The new Federal regulation will provide a solid foundation for updating wording at the provincial level. The COS will work with its Council on Provincial Affairs to determine next steps.

CMA recognizes need for physician human resource data and planning

In March 2013, the Board of Directors of the Canadian Medical Association held a strategic discussion on the growing issue of physician under-employment in certain specialties. There was consensus about CMA playing a leading role in bringing stakeholders together and being more vocal on the topic and the need for a national planning body, possibly similar to what exists in the United Kingdom, to ensure that the proper number and types of physicians are being trained.

Royal College - national specialty societies human resources for health dialogue and specialty medicine summit

On December 3 and 4, 2012, the COS was represented at this summit, which focused on physician employment.

Key points and trends

  • delayed retirement (due to the economic downturn)
  • shortage of hospital resources
  • lack of a national job bank
  • some medical specialists disciplines experiencing difficulties finding employment
  • possibility of oversupply or surplus of physicians

The Royal College Medical Specialists Employability Study is researching whether medical specialists are having difficulties finding employment in Canada because there are too many physicians in their specialty to meet the population needs, or whether these difficulties are a by-product or consequence of other factors. The drivers behind unemployment and underemployment are multifactorial and complex, but key factors include economics (e.g., hospital cutbacks, delayed retirements, prolonged fellowships), health system issues (e.g., increased use of residents and the physician remuneration system), individual factors (e.g., job preference and family obligations), and models of inter-professional care.

The Canadian Association of Interns and Residents (CAIR) 2012 National Resident Survey revealed that 19% of the residents who were looking for a job could not find one, and almost 50% were not satisfied with the counseling they had received. CAIR recommendations include the better alignment of resident positions and societal needs, support for a pan-Canadian workforce observatory, support for a coordinated needs-based projection approach to inform workforce decision-making, and support for the Future of Medical Education Post Graduate Project recommendations to ensure the right mix, number and distribution of physicians. CAIR recently established a Standing Committee on Health Human Resources; it also provides residents with a Transition into Practice Service (TIPS), in order to help and to advise residents having difficulties finding employment.

Stakeholder consultation on the future of medical education in Canada (FMEC): continuing professional development (CPD)

This December 12, 2012 meeting brought together a number of key stakeholders, including provincial colleges of family physicians, provincial medical associations, national societies and universities. An environmental scan of CPD activities shows that while the mission statements of many stakeholders are similar, there is fragmentation, duplication, competition and lack of synergy in the present system.

A successful FMEC-CPD initiative would need to be carefully constructed to ensure a future system that would attract collaboration and the effective and efficient use of resources. There are several growing fields and organizations, outside of the traditional CPD organizations, that could make important contributions to the evolution of CPD in Canada including knowledge translation and implementation science, performance improvement and other quality improvement initiatives.

CMA Specialist Forum

The CMA Specialist Forum, held February 8, 2013, brought together senior leaders from all 60 national specialty societies to discuss issues of common concern. COS Board member, Dr. Yvonne Buys, and CEO, Jennifer Brunet-Colvey, serve as the official representatives on this group.

Choosing Wisely - Participants explored specialties' interest/capacity to participate in a Canadian version of an American program, Choosing Wisely. The Choosing Wisely program is currently led by the American Board of Internal Medicine along with 10 specialty society partners and Consumers Reports. The goal is cost control through consumer education about appropriateness by physicians.

The Council of the Federation (CoF) Working Group on Clinical Practice Guidelines, of which CMA is a member, has had its mandate expanded for 2013 to include work on appropriateness; specifically, it is charged with developing a list of five clinical activities/procedures that are generally viewed as problematic. The government representatives have suggested in future developing an approach to appropriateness that could include a program similar to Choosing Wisely. The purpose behind Choosing Wisely is primarily to assist the physician-patient communication process in those clinical situations in which the benefits of some actions may be marginal or negative. As a by-product of reducing the consumption of marginally useful care, the overall quality of care will increase and costs will decrease.

Other highlights

  • An excellent presentation by Dr. Shoo Lee on clinical practice variation
  • Discussion regarding physician manpower issues and underemployment and results from the RCPSC survey
  • Anesthesia in cataract surgery
  • Prescription renewals by pharmacists

New Canada Not-for-Profit Corporations Act

Compliance with the new Act will require COS to review and revise its existing documents including its bylaws. A committee has been created consisting of Dr. Paul Rafuse, Dr. Mona Harissi-Dagher, Susan Gemmell and Jennifer Brunet-Colvey to review and revise the COS bylaws in time to present them for ratification at the COS Annual General Meeting in 2014.

National Physician Survey

Calling on Canadian physicians! Add your voice to Canada's largest physician workforce survey!

The National Physician Survey was launched in April 2013, and we encourage all physicians in Canada to participate. This is your chance to provided important information that will help shape the future of healthcare in Canada, and earn CPD credits quickly and conveniently. The survey will take only 10-15 minutes to complete, and all responses will remain confidential. Complete the survey and you could win $1,000. Visit to learn more and to complete the survey.

Strategic planning

To ensure that COS continues to remain member-centric and relevant to its membership, COS will be undertaking a strategic planning process. More details to follow later this year.

RCPSC re-accreditation due this spring

COS must apply to maintain its status as an accredited education provider every five years through the Royal College of Physicians and Surgeons of Canada. Our re-accreditation application is due later this spring. COS received very high marks during its last round of accreditation and we are working towards a successful outcome again this year.

Cornea donation

Canadian Blood Services has been working diligently over the past three years around the design of an integrated interprovincial system for cornea and tissue donation and transplantation in Canada. COS and CNIB have partnered with Canadian Blood Services to raise awareness about the importance of cornea donations. Full-page ads appeared in Metro newspapers across the country on March 26 and in the Toronto Star on March 30, 2013.

CORS partners with the AAO's Young Ophthalmologists (YO) International Subcommittee

The Canadian Ophthalmological Residents Society (CORS) collaborated with the Academy's YO International Subcommittee on a pilot networking event at the 2012 Academy "YO Neighbor! Cross Border Conversations with Canada". The event was well attended. Special thanks to Dr. Mona Harissi-Dagher, COS Board member, and Drs. Mike Brennan, Michael Price and Dan Rootman (photos).

Canadian Retina Society inaugural meeting a huge success

From March 7 to 10, 2013, over 100 delegates attended the inaugural Canadian Retina Society (CRS) meeting in Banff, Alberta. International guest speakers included Dr. Philip J. Ferrone, Dr. Daniel F. Martin, Dr. H. Richard McDonald and Dr. Srinivas R. Sadda. Special thanks as well to our Canadian guest speakers and to industry partners for supporting this meeting.

COS Board of Directors proposes small increase in membership fees

At their Sunday, February 24, 2013 meeting, the COS Board proposed that membership fees be amended as follows: fees for Life Member (Retired) will be raised to $85 to cover the cost of the CJO subscription for these members, and membership fees will increase annually to keep pace with inflation. It had been nine years since the last fee increase, and it was felt that regular incremental increases to cover rising costs are preferable to less frequent but larger increases. These proposed fee changes will be brought to a membership vote at the June Annual General Meeting in Montreal.

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Nominations for the 2014 COS Lifetime Achievement Award

Several years ago, the COS introduced its Lifetime Achievement Award to honour members who have made significant contributions to eye and vision care during their lifelong career in medicine.

The COS is soliciting nominations from its membership for the 2014 award. Nominees must be COS members who have "made a sustained impact nationally and internationally to the growth of the profession and who have maintained the highest standards of patient care in their practice. Recipients of this award have also been strong and positive role models in the community and exemplary mentors and educators."

To submit a nomination, please describe (in less than 500 words) how the nominee has:

  • Made an impact nationally and internationally on the growth of the profession
  • Maintained the highest standards of patient care in their practice
  • Been a positive role model in the community and an exemplary mentor and educator

Please submit your nominations in writing to [email protected] by September 13, 2013.

Lifetime Achievement Award recipients

Awards and distinctions

Dr. Cindy Hutnik honoured as a recipient of the 2013 YMCA of Western Ontario Women of Excellence Award in Health, Science and Technology.

Dr. Patricia-Ann Laughrea recently received the Royal College of Physicians and Surgeons of Canada Mentor Award.

Dr. Lorne Bellan and Dr. Graham Trope each received a Commemorative Medal for the Diamond Jubilee of Her Majesty Queen Elizabeth II for their tremendous achievements and contributions.

Please advise us if you know of any members who have received a special award or been appointed to a special position. Please send your comments to Susan Gemmell at [email protected]

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Membership news

Membership fees are now due! Any outstanding fees may be remitted by cheque through regular mail or online at through our secure server for the use of credit cards. You may also contact Rita Afeltra directly at 613-729-6779 ext. 300 or by email at [email protected].

Top 10 reasons to renew your COS membership

  1. Save by taking advantage of member rates for the COS Annual Meeting and Exhibition, the premiere ophthalmology event in Canada, including the opportunity for hands-on learning through surgical skills transfer courses
  2. Participate in great educational programs to earn CPD/CME credits
  3. Receive a free subscription to the Canadian Journal of Ophthalmology
  4. Access the latest CPGs
  5. Network with more than 1,200 Canadian ophthalmology professionals
  6. Gain access to COS's annual online membership directory - a complete listing of Canadian ophthalmologists and residents - and a complimentary subscription to Perspectives, the COS newsletter
  7. Get involved in helping to shape the future of health care policy in Canada
  8. Receive discounts on the purchase of patient information pamphlets
  9. Find your niche - the COS is affiliated with Canadian subspecialty societies
  10. Get the latest news and updates in ophthalmology

Notice to membership: Annual Business Meeting 2013

Notice is hereby given that the Annual Business Meeting of COS members will be held on Sunday, June 16, 2013 at 0700 in Le Castillon Restaurant, Montréal, Quebec, to approve audited financial statements, receive nominations for the Board of Directors and consider any other business.

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Dr. Jeffrey Sher
(May 30, 1953 to Feb. 22, 2013)

On Sunday, Feb. 24, 2013, along with numerous other Ontario ophthalmologists, I attended the funeral of an ophthalmologist who contributed eagerly, humbly, and consistently to numerous Ontario programs which have improved all of our lives: my colleague and dear friend, Jeff Sher.

Jeff was a graduate of the University of Toronto residency program in ophthalmology (1983) and subsequently did his cornea and external disease fellowship at the University of California in San Diego, becoming a fellow of the Royal College of Surgeons of Canada in 1984.

Jeff joined the OMA-CNIB Eye Van team just after receiving his fellowship in 1984, and was a prominent member of the Ontario Mobile Medical Eye Care Unit Advisory Committee since its inception in 1990 (and actually before that, when he helped design and build the first tractor trailer eye van). Jeff was involved with the eye van program for over 30 years, and became the word of reason for the MAC, the unofficial "Eye Van Photographer," and everybody's best friend. When Jeff became ill he requested that he be replaced on the MAC, because he felt he could not fulfill his responsibilities. The MAC members unanimously rejected his resignation, instead requesting that he continue to contribute his valuable advice for as long as he was well enough to do so.

Jeff was assistant clinical professor in the department of surgery (ophthalmology) at McMaster University, a member of numerous academic societies, and a critical member of the team that brought the residency program at McMaster back to life, after many years of hibernation, which was done with the typical Jeff optimism, drive and attention to detail, attracting among the best and brightest residents in Canada from day 1. He was a reviewer for the Canadian Journal of Ophthalmology, a member of the COS eye bank steering committee and an examiner for the Royal College.

Jeff was a past chairman of the ophthalmology section of the Ontario Medical Association, and forever after was a frequent contributor to OntEye about political issues, always with well thought out and clearly enunciated appraisals of our collective position, and useful suggestions.

Jeff suffered over the past two years, relentlessly fighting metastatic carcinoma, enduring painful and sapping chemotherapy and then radiotherapy. But throughout this time, he continued to practise, perform surgery and teach, believing that care of patients and teaching were critical parts of who he was, and wanted to remain, for as long as he possibly could. One of the last communications I received from Jeff was an email in which he wanted to be sure that the McMaster residents would not lose out on their rotations if he was unable to continue. So I called him, and he told me that he was going through "a rough patch" and could not talk for long, but wanted reassurance that his residents were taken care of. That little "rough patch" was the last time I spoke with him, as it took his life.

Jeff will be missed by his wife, Vicky, and his sons, Jason and Trevor. Jeff requested donations, if desired, be given to the CNIB Eye Van. To make a gift in memory of Jeff, please call the CNIB Helpline number 1-800-563-2642.

Dr. Steve Arshinoff

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Continuing Professional Development (CPD) update

2013 COS Annual Meeting in Montréal

Join us June 14-17 in the vibrant city of Montréal. The 2013 educational program focuses on innovation in medicine and science, with skills transfer courses demonstrating the latest advances in surgery, interactive symposia discussing evidence-based updates, and more than 30 exhibitors at the vanguard of ophthalmological technology.

We've planned a robust scientific program with high calibre international faculty, including:

  • Robert H. Osher, MD, from the University of Cincinnati delivering the COS Lecture: Management of cataract complications.
  • William F. Mieler, MD, from the Illinois Eye and Ear Infirmary, delivering the Canadian Journal of Ophthalmology Lecture: Update on age-related macular degeneration.

We've also scheduled specialized symposia and workshops, including:

  • Ocular oncology symposium
  • Refractive cornea surgery symposium
  • Workshop on ophthalmic viscosurgical devices
  • Uveitis symposium on treatment
  • Glaucoma workshop on visual fields
  • Skills transfer course on special implant lenses
  • Skills transfer course on novel techniques and devices in glaucoma

It all takes place at the Hilton Montréal Bonaventure, right in the heart of Montréal. Accommodation is filling up quickly, so make your hotel reservation now.

You won't want to miss the COS Celebration, an evening of elegance and mystery on Sunday, June 16, 2013 at the Marriott Château Champlain Hotel. You will be entertained in the opulent atmosphere of a masquerade ball and dance. Buy your tickets in advance with your annual meeting registration and save money.

Check the website often for program updates.

Registration is now open! Register before May 12 for the early-bird rate.

Annual meeting chairmanship
COS wishes to acknowledge the tremendous leadership of Dr. Allan Slomovic who has chaired the Annual Meeting and the Council on Continuing Professional Development since 2009. Dr. Slomovic will be stepping down this June to pursue other opportunities. We are grateful for his educational guidance, vision and dedication to the Annual Meeting and the COS.

CPD activities

Upcoming: COS is working with the Canadian Glaucoma Society to develop online education modules based on the Clinical Practice Guidelines on Glaucoma. This self-assessment program is in development and we hope to have it up and running on the COS website shortly.


  • APOS: Atlantic Provinces Ophthalmology Society
    Update in Ophthalmology: Retinal, Paediatric Eye Disease and Systemic Diease
    May 24-25, 2013
    Crowbush, PEI
    Contact Kim MacLellan [email protected]
  • VIOS: Vancouver Island Ophthalmological Society Annual Spring Meeting
    June 1, 2013
    Westin Bear Mountain Resort, Victoria BC
    Contact Andrew Burnett [email protected]
  • COS recently co-developed the Annual Glaucoma Meeting, January 31-February 2 with Alcon. This marked the first time this meeting was approved for credit.
  • The Canadian Retina Society recently held its inaugural meeting in Banff, March 7-10. Co-developed with COS, this physician-led meeting was extremely well attended and offered a robust scientific program.

Earn CPD credits

Did you know...
You can claim Section 2 Self-Learning credits for:
Reading a journal article - 1 credit
Viewing a podcast - 0.5 credit
Participating in a committee - 15 credits per year per committee

For more information about CPD opportunities, please contact Inika Anderson, Manager, Continuing Professional Development [email protected]

New COS patient brochure on diabetic retinopathy

As part of the dissemination strategy around the COS Evidence-based Clinical Practice Guidelines for the Management of Diabetic Retinopathy, the COS has updated its patient brochure on diabetic retinopathy. This project was partially funded by a CIHR Meetings Grant to develop strategic dissemination activities around clinical practice guidelines. Written in lay language, this brochure summarizes the key points from the guidelines from a patient perspective. French or English brochures can be ordered by contacting Rita Afeltra, Executive Assistant & Membership Services ([email protected] or 613.729.6779, ext. 300).

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Canadian Journal of Ophthalmology


Upcoming issues
So far 2013 has been a banner year for the CJO. The February 2013 issue contained a selection of articles that had been presented at the 2012 COS Annual Meeting. We hope to continue this tradition with another "Best of the COS" issue in February 2014. If you are presenting at this year's Annual Meeting, please consider submitting an article to the CJO. Submissions are always welcome at

We are also looking forward to October 2013 and the much-anticipated special issue on microperimetry. This issue will cover many in-depth this new technique and its ever-growing application to clinical practice. The issue is guest edited for the CJO by Dr. Samuel N. Markowitz.

Finally, please see below for highlights of the April 2013 issue of the CJO.

New Editorial Board and International Advisory Board members
We are happy to report that we have recruited three new section editors to the journal in recent months. Dr. Kathy Cao (medical education), Dr. Clara Chan (cornea) and Dr. Joseph Ma (cornea) are the newest members of the Editorial Board and welcome additions to the editorial team.

Our International Advisory Board has also been revised and we welcomed Dr. Sathish Srinivasan (cornea), Dr. Keith Barton (glaucoma), Dr. Dimitrios Kourkoutas (glaucoma), Dr. Brian Marr (ocular oncology), Dr. Kevin Blinder (retina), and Dr. Sunir J. Garg (retina) as new members in 2012/2013. We are very grateful for the assistance of all of the members of the CJO International Advisory Board.

CJO seeks reviewers and editors
Due to increasing submissions to the journal, the CJO continues to need individuals interested in reviewing and/or in editing for the journal in all sections. In particular, we are presently actively recruiting a section rditor in the cataract and optics section as well as associate editors who would assist the editor-in-chief. If you are interested in these positions, please contact the editorial office ([email protected]) for further details.

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April 2013 issue highlights

Practice patterns of Canadian Ophthalmological Society members in cataract surgery - 2012 survey
This annual survey of the practice patterns of the members of the Canadian Ophthalmological Society (COS) who had indicated a practice focus on cataract surgery has been performed since 2009.

Socioeconomic status as a risk factor for late presentation of glaucoma in Canada
This prospective, multi-center, cross-sectional Canadian study provides evidence that socioeconomic deprivation is associated with greater severity of glaucoma at presentation, specifically for those aged 65 years or older.

Analysis of reasons for noncompliance with laser treatment in patients of diabetic retinopathy
Resarchers found that lack of awareness of the necessity for and need to complete treatment were two main reasons leading to noncompliance in Chinese patients with diabetic retinopathy.

Congenital ptosis repair - surgical, cosmetic and functional outcome: a report of 162 cases
The clinical records of 162 children with congenital ptosis that had been surgically repaired were reviewed and analyzed for surgical and functional outcome. Congenital ptosis repair yields good functional and cosmetic outcome, although the reoperation rate is relatively high (19.8%).

Retinal function assessment of the impact of trypan blue versus indocyanine green assisted internal limiting membrane peeling during macular hole surgery
This study compared the multifocal ERG retinal function and the anatomical and visual outcomes of macular hole surgery performed with indocyanine green (ICG) or trypan blue (TB). The use of TB or ICG appears to yield similar improvement in terms of BCVA, CS, mfERG amplitude and implicit time changes.

Cytomegalovirus retinitis in the absence of AIDS
The diagnosis of CMV retinitis in clinically immunocompetent patients should initiate an evaluation to identify systemic and local factors which could cause subclinical immunosuppression.

The Canadian Journal of Ophthalmology is your journal. Its content reflects the submissions received. We welcome the submission of research from COS members and we are also always on the lookout for expert reviewers and potential section editors. If you have questions or need more information, please feel free to contact the Editorial Office at [email protected].
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