• Uninsured services: The COS Board recently approved a policy statement on fair market value for uninsured services. The policy statement and full report are available on the COS website and were sent out to the membership by email. The policy is also being distributed widely to key stakeholders. This document is a landmark achievement thanks to the efforts of many people, including those of you who responded to our multiple surveys and the members of the COS Council on Provincial Affairs. The principle endorsed in the policy statement, that the public has a right to access new medical technology at a fair price when it is not provided by provincial health plans, is important for us to champion. This will serve us well in the future as research brings exciting new options to better help our patients.

• Canadian Blood Services partnership: COS has now started to work with Canadian Blood Services (CBS), who has been given responsibility by both the federal and provincial governments to oversee organ and tissue transplantation. It is very encouraging to see how receptive CBS has been to our initiatives. Some of their staff will be attending our meeting in Qu�bec City in order to have more dialogue with our corneal transplant surgeons. Dr. Guillermo Rocha has been appointed by the Board as the new chair of the COS Eye Bank Committee, succeeding Dr. Chris Seamone who provided years of great leadership. Dr. Rocha, who is also chair of the Canadian Cornea Society, will act as our principle liaison with CBS.

• Provincial news:

  Alberta - optometry scope of practice: In the last newsletter, I informed you that the Alberta Optometry Association formally requested an expansion to their scope of practice including the right to prescribe all drugs by all routes, order CT/MRI/ultrasound scans, manage glaucoma independently, and to perform surgery around the eye. The COS has worked closely with the Ophthalmological Society of Alberta (OSA) to stop this initiative; both the COS and the OSA wrote strong submissions to the provincial government. The OSA was very effective in getting written support from key local groups such as the Alberta Medical Association, the Alberta College of Physicians and Surgeons, and the University Deans. The COS contacted national groups such as the Association of Canadian University Professors of Ophthalmology (ACUPO) (the committee of all university ophthalmology department heads) and the Canadian Society of Oculoplastic and Reconstructive Surgery, each of whom contributed submissions. COS contacted the American Academy of Ophthalmology (AAO) who provided valuable advice. COS subsequently contacted the Alberta government and enabled the AAO to make a separate submission on this issue after the deadline. At the moment, the government is sitting on all of these submissions and has not yet indicated when a decision will be made.

  British Columbia - optician's scope of practice: The BC government has announced that it intends to allow opticians to refract healthy patients between 19-65 years of age. This will essentially eliminate screening for glaucoma and other conditions because patients will only have to be seen by an ophthalmologist or optometrist once every 20-25 years. The proposals will also allow the public to directly order their contact lenses online from a BC company. The new legislation would require patients ordering contact lenses to have been seen only once in their life by an optometrist or ophthalmologist to get their initial fitting. The COS has written a strongly worded letter to the Minister condemning this change and pointing out that our guideline for periodic eye examination in adults states that screening should occur every 3-5 years depending on a person's age.

• Post-evaluation of glaucoma guidelines: As we learned from the BC issue about optician's scope of practice, it is very helpful for the Society to have current guidelines about appropriate care when controversial issues arise. But do the guidelines actually lead to change in practice? This is a question that was raised by some the authors of the COS evidence-based clinical practice guidelines for the management of glaucoma in the adult eye. To find the answer, COS has agreed to fund a study to determine the impact the glaucoma guidelines have had in modifying clinical practice.

• Medical use of marijuana: Recently, COS was asked to provide an opinion on the medical use of marijuana for the treatment of glaucoma. Drs. Yvonne Buys and Paul Rafuse kindly agreed to update our old policy statement. Following a thorough review of the literature, a revised statement has now been endorsed by the COS Board and is available online.

Although challenging at times, I have immensely enjoyed serving as your president. I don't think that we would have been able to accomplish so much this year without our new CEO, Jennifer Brunet-Colvey, and the COS staff, who work tirelessly on our behalf. I look forward to seeing you all in Qu�bec City and will be happy to update you then.

As stated in the February 2010 e-newsletter, we are committed to ensuring consultation with our membership. We would like to know what you like about COS and, conversely, where we need to improve. The COS membership survey is now underway; as of May 12th, 254 of you have responded - thank you! Your input and feedback are critical to ensure the Society develops a plan to meet your vision and needs.

If you have not yet completed the survey (it takes only a few minutes!), please do so by June 1, 2010. Survey results will be collated and reported to the membership in the fall.

Notice is hereby given that the Annual Business Meeting of COS members will be held on Sunday, June 27th at 0700 in the De Tourny Room of the Hilton Qu�bec, Qu�bec City, to approve audited financial statements, receive nominations for the Board of Directors, and consider any other business. Dr. Fran�ois Cod�re will be installed as President to succeed Dr. Lorne Bellan who completes his two-year term.

June 26-29, 2010, Centre des congr�s, Qu�bec QC

The COS 2010 Qu�bec City program is now online! The website is continually updated as new information comes in; be sure to check back often. NOTE: we will not be mailing the program in advance, but will provide you with a hard copy of the program on site. This allows us to provide you with the most accurate and up-to-date information, while also helping the environment and our budget.

Meeting highlights include:

• Clinical updates: ocular surface disease, uveitis, ocular allergies, and age-related macular degeneration
• Discussion forums: optometry and ophthalmology, and ophthalmic medical personnel
• Workshops: electronic medical records systems, cognitive errors in medicine, starting a medical practice

Social events:

• Welcome reception: "Le Cinq � Sept" featuring Qu�bec beers and cheeses, Saturday, June 26, 1700-1900
• COS Celebration: "La grande f�te" at the Ch�teau Frontenac featuring La Famille Painchaud, Sunday, June 27, 1900-2300
• Fun Run: new, quick-dry COS t-shirt for participants! Monday, June 28, 0630-0730

If you have not already done so, be sure to register before May 21 to avoid paying additional late fees.

See you in Qu�bec City!

Inika Anderson, Manager, Continuing Professional Development, Email: [email protected]

Economic systematic review of AMD treatment
Researchers undertook a systematic review of economic literature and primary economic evaluation to examine the economic implications for the Canadian health system of pharmacologic treatment of neovascular AMD. It was found that although ranibizumab is effective for wet AMD, its cost/QALY is higher than what is usually considered acceptable based on cost-utility theory. Read the full article and editorial comment in June's issue of Can J Ophthalmol.

Safety signals following intravitreal bevacizumab
As the off-label use of intravitreal bevacizumab continues for an increasing number of ocular conditions, a systematic review of the literature and the Canadian Adverse Drug Reaction Information System Database was undertaken to detect systemic adverse events temporally associated with intravitreal bevacizumab. Events were found to be mainly of cardiovascular and neurological origin. Health Canada's spontaneous drug reporting system is an underutilized resource and a more active surveillance system, such as a patient registry, may be better suited to establish the low rates of systemic adverse events following bevacizumab use in ophthalmology. Read the full article and editorial comment in June's issue of Can J Ophthalmol.