Uninsured services: COS has struck an advisory committee to create a reference document on fees for uninsured services. This will not be a guideline but rather a statement of principles on establishing fees for uninsured services and will include an appendix with sample reference ranges. Previous disproportionate charges for premium lenses in Ontario led to a temporary government ban on their use. Multiple governments have contacted us since then suggesting that this type of document would be helpful to avoid similar problems in the future.

Cigarette package warnings: COS is working with Health Canada to create warnings on cigarette packages to stress the link between smoking and macular degeneration. An appropriate visual message is currently being researched.

Corneal transplant regulations: I will be meeting with the head of the Canadian Blood Services (CBS) to discuss regulations pertaining to corneal transplants now that the federal government has given CBS authority over solid organ transplantation in Canada.

Wait Time Alliance: COS continues to be an active member of the Wait Time Alliance (WTA). This group continues to keep the cross-specialty problem of long wait times in the public eye by issuing press releases and report cards. The Canadian Association of Pediatric Surgeons recently joined the group. WTA recently received a letter of praise from the Health Council of Canada encouraging it to keep up its work. The feeling amongst WTA members is that it is critical to continue to publicly raise this issue even if there hasn't been any new money for this over the last few years - otherwise governments will be happy to let the whole issue slide off the table. For example, the situation has recently deteriorated in Alberta because of the government's 15% cut back on surgical volumes.

COS presence on EMR working group: Thank you to Dr. Paul Harasymowycz, who has agreed to represent COS on a new Canadian Medical Association (CMA) Electronic Medical Records (EMR) working group. CMA formed this committee because they realized that various provincial government EMR planning committees and Canada Infoway were exclusively planning the regulations about EMR based on the needs of primary care and not looking at the needs of specialists. We were quick to volunteer on this small working group to ensure strong representation for ophthalmology.

Integration of CPGs: Thank you to Dr. Yvonne Buys for suggesting COS contact the Royal College Examining Committee for Ophthalmology in order to incorporate material from the various COS Clinical Practice Guidelines into the Fellowship examination. The Royal College has agreed and we have notified the program directors about this new initiative.

COS representation at AAO: Finally, I represented COS at the recent American Academy of Ophthalmology (AAO) meeting in San Francisco, October 2009. It was quite an eye opener to hear the discussions between the State representatives and the AAO Board about adversarial relationships between ophthalmology and optometry in the US. I hope that we will continue to have better relationships with our optometry colleagues in Canada, though recent developments make this much less certain.

Recently, in Alberta, the Optometry Association has proposed an overhaul of their regulatory statutes to

1. allow them to administer all drugs by all routes,
2. order X-rays, CT, and MRI scans and ultrasounds,
3. eliminate co-management restrictions for glaucoma and allow them to manage this condition independently, and
4. to perform minor surgery around the eyes including mass and chalazion excisions and suturing as needed.

COS will be working with the Ophthalmological Society of Alberta to challenge these proposed changes, with the focus on what we perceive to be in patients' best interest.

I look forward to providing progress reports to you on all of these initiatives when we meet at the COS Annual Meeting in Qu�bec City. Au plaisir de vous y revoir en juin!

• More consultation required with our membership: A membership survey is being developed and will be sent to you this spring. We want to hear from you: what you like about COS and, conversely, where we need to improve. One of our key strategic priorities will be to provide greater value and transparency to our membership.
• Increased continuing professional development (CPD) opportunities for members: Given the geographical vastness of our country, we need to make multiple resources (such as e-learning/web-based learning) for CPD credit available. Increasing the number of codeveloped programs should also be considered a priority for the organization, as well as linking journal content to CPD for credit.
• Improvements to the Annual Scientific Meeting: It was recommended that, this year, we add a Current Concepts session (bringing the total number to 3) to allow delegates to fully benefit from our speakers' expertise. We also heard that delegates want increased networking opportunities and, with that in mind, we have revamped our annual reception (please see below for more details).
• Increased advocacy: This, too, will become a stronger focus for COS. Already, Past-President Dr. Sherif El- Defrawy and I met with the Health Professions Regulatory Advisory Council (HPRAC) on January 11, 2010 to outline a proposed plan for eye care services for the province of Ontario. Based on a shared management model that is currently in place in Nova Scotia and Qu�bec, the plan calls for the development of an Ontario Eye Health Council where ophthalmology, optometry, family physicians, and government would collaborate in order to best meet patient needs. This would allow for ongoing dialogue between key stakeholders and would be a model of best practices. Enhanced patient care, improved patient access, improved efficiencies, better utilization of resources, and significant cost savings to the system would result. This model could also be expanded nationally. Thank you to those COS members with whom we consulted in order to prepare for this meeting.
• Ongoing work on clinical practice guidelines: Postevaluation of the impact of guidelines is an important consideration. To date, we have developed guidelines on vision screening, cataract, glaucoma, and retinoblastoma. We are in the process of developing diabetic retinopathy guidelines. And, as our President Dr. Lorne Bellan mentioned in his report, content from our guidelines will be integrated in upcoming Royal College exams.
• Supporting residents: Developing a strong residents program to provide support through training and into practice was identified as another key recommendation. See below for more details on our Young Ophthalmologist Program at the COS Annual Meeting this June.

Partnership development will be a major focus for COS as we move forward. The COS is grateful to all of its partners for their ongoing generosity and would like to develop partnerships with other key stakeholders in order to increase overall support to the organization.

Your feedback would be greatly appreciated as we work together to take COS to its next level of development. Contact me at [email protected]