When Emergency Strikes: Are You Prepared?

EmergencyBy Evra Taylor

With the increase in natural and man-made disasters over the past several years, emergency preparedness has become more essential than ever – and has moved from the back to the front burner for businesses and individuals in high-risk geographical zones and cosmopolitan areas alike.

The ice storm that hit Quebec in 1998, the 9/11 tragedy in 2001 and the floods that deluged Alberta in 2013 all highlighted the need for enhanced and more comprehensive emergency and post-emergency measures for citizens and their businesses.


As part of preparation for a forced shut-in, adequate supplies of food and water for several weeks should be maintained. Fire drills, knowledge of first aid, including CPR, and business insurance for natural disasters are also a must.

The United States Federal Emergency Management Agency (FEMA) highlights the fact that, “how quickly your company is back in business following a disaster will depend on emergency planning done today.”

The following are some of the recommendations FEMA makes in its ‘Ready Business’ plan, which involves protecting your employees and your facility:

  • Obtain emergency contact information from your employees.
  • Designate a telephone number at a location away from your primary facility where employees can call in and leave an“I’m okay” message and receive instructions.
  • If you have employees with disabilities or special needs, ask them what assistance they would need in the event of a disaster occurrence.
  • Make an Evacuation Plan, as well as a Shelter-in-Place plan. In the event of a transportation accident that releases chemicals into the air, for instance, individuals should shelter-in-place within the building. This requires shutdown of heating, ventilation and air conditioning (HVAC) systems, and the closure of air intakes.

In March 2011, a magnitude-9 earthquake shook northeastern Japan, unleashing a savage tsunami and killing more than 230,000 people. Ophthalmologists used a customized ‘Mission Vision Van’ – a clinic on wheels – to provide survivors with eye exams and medications, and treat a large number of eye infections as the result of contaminated water.

However, a new study has shown that the items most needed in post-disaster relief are replacement eyeglasses, contact lenses and eye drops, underlining the crucial role ECPs can play in post-disaster aid and recovery.

In the wake of Hurricane Sandy, which struck New York and New Jersey in 2012, power outages had an obvious effect on the level of foot traffic as optical retailers and labs scrambled to conduct business. But the greatest concern was how to assist customers with damaged or lost eyewear. Numerous optical firms, some as far away as Texas, rallied to provide much-needed help through replacement eyewear, financial aid and feet on the ground.

In July 2013, a train derailment in the town of Lac-Mégantic in Quebec’s Eastern Townships resulted in the explosion of multiple tank cars carrying crude oil. Forty-two people were confirmed dead and more than 30 buildings in the town centre were destroyed, including two optical stores. Six months after the tragedy, a report published by the Canadian Red Cross noted that, “People affected by the disaster can also receive assistance from the Red Cross for purchasing dental prostheses, hearing aids, glasses and home support equipment. All expenses are covered by the Red Cross.”

One of the things ECPs can do proactively is to recommend that patients who are able to do so keep a back-up pair of eyeglasses or contact lenses on hand, in addition to an extra month’s supply of medications, if possible.

While shelter and food remain at the top of most people’s lists of essentials, re-tracing your daily activities, including your healthcare regimen, can serve as a helpful reminder of health-related items, such as eyewear, that are easily overlooked.

Focus on Ebola: Managing the Ocular Effects of the Disease

EbolaBy Evra Taylor

With the continuing Ebola Virus Disease (EVD) crisis in West Africa, all eyes are focused on survival, as they should be. As of October 2014, the disease had already claimed the lives of more than 3,000 citizens, according to the World Health Organization.

EVD was first identified in 1976 but there have been more cases and deaths in this outbreak than in all the others combined. In fact, the Ebola crisis is reported to be the worst the world has ever seen. “The average case fatality rate is 50 per cent, which is significantly higher than the lowest level of previous outbreaks, which ranged from approximately 25 to 90 per cent.”

Some of the symptoms of EVD, such as body aches, fever, vomiting and cough, are the same as those of the flu. However, patients may present with more serious symptoms like chest pain and bleeding, both internally and externally, including bleeding from the eyes.

Moreover, optometrists travelling abroad to provide healthcare support for those afflicted face the possibility of contracting the disease. In terms of transmission through tears or contact lenses, the information is inconclusive. It is not yet known whether tears or tear fluid on a contact lens can carry the EVD virus.

Reasonable and Responsible Precautions

One mode of transmission is direct contact with the body or bodily fluids of an infected person, whether living or deceased. Additionally, EVD can be transmitted through indirect contact, through objects, surfaces, clothing or bedding contaminated by the body fluids of a live or deceased infected person.

Healthcare workers have frequently been infected while treating patients with suspected or confirmed EVD. This has occurred through close contact with patients when infection control precautions are not strictly practiced. Careful adherence to health guidelines is essential in addressing the challenges posed by Ebola and helping to minimize the spread of the virus. The World Health Organization’s guidance for care of patients with Ebola, published in September 2014, states: “Strengthen and carefully apply standard precautions when providing care to ALL patients, regardless of the signs and symptoms they present with. This is especially important because the initial manifestations of hemorrhagic fever may be non-specific. Hand hygiene is the most important measure. Gloves should be worn for any contact with blood or body fluid. Medical mask and goggles or a face shield should be used if there is any potential for splashes of blood or body fluids to the face, and cleaning of contaminated surfaces is paramount.”

The federal government reports that there have been no cases of Ebola in Canada and that the risk to Canadians remains very low. Canada’s new Chief Public Health Officer, Dr. Gregory Taylor, has stated that this country has been preparing for the possibility of Ebola cases emerging as the result of overseas travel.

“Canada is well prepared with a number of systems in place to identify and prevent the spread of serious infectious diseases like Ebola, such as working closely with our international partners to gather and assess information and administering the Quarantine Act at all points of entry into Canada,” Dr. Taylor said in a statement.

“The Public Health Agency of Canada is working closely with its provincial and territorial partners and the agency’s National Microbiology Laboratory is well connected with its network of provincial labs to ensure Canada is ready to detect and respond quickly.”

Canadian ECPs are justified in reassuring their patients about the low risk of contracting Ebola. However, in light of the disease’s 21-day incubation period, the importance of high-level precautions cannot be overestimated.

Protecting Online Healthcare Records: Is it Possible?

By Evra Taylor


“They’re vacuuming up your data.” That’s how a cyber protection expert recently described the growing phenomenon of health records being stolen and patient charts being hacked from web sites and sold on the black market. While the Internet used to be viewed as an impenetrable fortress guarding health data and other private information, it has now become a gateway to cybercrime.

Electronic health records (EHRs) may contain a range of administrative and personal health information, such as names, provincial health card numbers, diagnostic codes, diagnoses and test results. And from 2006 to 2012, medical and health care providers in the U.S. experienced 767 security breaches resulting in the compromised confidential health information of more than 23 million patients.

In December 2013, the St. Joseph Health System in Texas confirmed a security breach affecting the records of up to 405,000 past and current patients, employees and their beneficiaries. The attackers may have gained access to records including names, Social Security numbers and possibly addresses, along with patients’ medical information and employees’ bank account data.
One of the most egregious examples of cyberhacking occurred in 2013 when a laptop containing the personal health information of 650,000 Albertans was stolen.
Pros and Cons for Canadians

In a document drafted in 2012, entitled Protecting Privacy in an Era of Electronic Health Records, Ann Cavoukian, Ph.D., Information and Privacy Commissioner of Ontario, contrasted the promise and perils of EHRs. It included the following:

On the positive side, EHRs:

• Can facilitate the provision of more efficient and effective health care and improve the quality of care provided.

• Require less space and fewer administrative resources to maintain than hard copies.

• Can be designed to enhance privacy through access controls, audit logs, strong encryption and authentication.

• May be more complete and readily accessible by all healthcare providers involved in the health care of a patient, regardless of location.

On the negative side:

• If privacy is not embedded in the design of EHRs, they pose unique risks to privacy and the security of personal health information.

• They allow for massive amounts of personal health information from diverse sources to be collected, used and disclosed.

• Unauthorized uses attract hackers and others with malicious intent, including authorized healthcare providers who access the information for purposes other than providing health care.
Moving from bad to worse, the FBI’s Cyber Division is issuing warnings about patient charts being hacked from websites or stolen from computers and sold on the black market. Patient health information has more value to hackers on the black market than credit card numbers because it may contain prescription information for controlled substances. In addition, it potentially contains details that can be used to access bank accounts.
Looking for Answers

Regarding the Alberta breach, IT World Canada reported that according to Tony Busseri, CEO of the Toronto-based security and ID management company Route 1 Inc., the incident could have been avoided if the parties concerned had been following proper privacy and data protection policies.
Busseri cited a lack of safeguards by the Ministry of Health around its sharing of health records with other organizations such as private health centres. He also said that Medicentres, the Edmonton health clinics involved in the 2012 breach, should have a policy that prevents employees and contractors from carrying sensitive information and patient data on their electronic devices.

As often occurs, the remedies to the problem seem obvious after the fact. But until the security of electronic health records is buttressed, Canadians and Americans have reason to be concerned about sharing their personal health information.

3D Printing: New Dimensions for the Optical Industry

By Evra Taylor

LegalAngleAt the 2013 Vision Expo West, ClearVision Optical presented cutting-edge 3D printing technology as one of the optical industry’s newest innovations. Some pundits refer to it as the 3D industrial revolution.

ClearVision Optical is one of the first optical companies to openly discuss its implementation of 3D printing in the eyewear production process. Its president, David Friedfeld, spoke with Bruce Bradshaw, director of marketing with Stratasys, a leading 3D printing firm, at a special Vision Expo event, during which Friedfeld noted, “Our product is entry-level but we think there’s a big opportunity going forward.”

Three-dimensional printing is not new to eyewear. In the 1940s it was called additive manufacturing and the process involved building by layers. But as the old slogan goes, “You’ve come a long way, baby.” The types of printers exhibited at Vision Expo West range in price from roughly $100,000 to $300,000.

ClearVision Optical demonstrated their new 3D printer and talked extensively about the process and possibilities. Company executives believe that the technology to “print” ophthalmic lenses is only a few years away. And they don’t see why – in just a few years – ECPs couldn’t be “printing” their own frames.

The company is currently using the technology to produce prototypes – 3D models – of eyeglass frames. What’s more, industries such as jewellery manufacturing, interior design and fashion are using this latest technological advance to produce one-offs, such as $10,000 dresses, for fashion shows and the like.

In the 3D printing process, instead of producing an image made up of one layer of ink as in traditional printing, multiple layers are stacked upon one another to create complex 3D structures. One of the chief benefits of this process is the ability to move away from generic forms and styles to highly personalized objects made on demand to fit custom requirements.

In the past, explained Friedfeld, a hand-made prototype of an eyeglass frame, for instance, was manufactured overseas, which compromised product control to some degree. Furthermore, it took weeks or months for any necessary corrections to be made. Now the process can be reduced to one day. With 3D printing, ClearVision Optical can discuss its products with customers or vendors, interpret the data they provide and print out a template on site in 30-40 minutes.

As with all technology, the flip side of the coin may be tarnished. The protection of patents, intellectual property, trademarks and copyright will rear its head as a new challenge. In addition, this equipment facilitates the work of counterfeiters and could encourage a larger number of people to engage in such activity.

Moving back to the positive, the most exciting part of this innovation, said Friedfeld, is that a lot of patents are expiring, therefore allowing new engineering and innovative designs. “A lot of people want to get into this field and these expirations will lower barriers to entry.”

Friedfeld holds that in the optical space, buzz about the process will make people increasingly comfortable with it. Custom frames represent a good opportunity for ClearVision Optical down the road. Three-dimensional printing technology is ideally suited for, among others, African American and Asian consumers, who have bridge-fitting challenges; or for professional athletes with money to burn.

According to Friedfeld, 2014 will bring a more advanced printer that will print faster and require less prototype finishing. “We see ourselves as keeping the conversation going. In the future, we may be installing software or printers in peoples’ offices to make eyewear, or we may be involved in making eyewear designs available to people,” he stated.

A New Approach to Working With Blind Children

By Evra Taylor 

LegalAngleWith growing numbers of women giving birth later in life, there is an increasing awareness of the risk of birth defects. Yet few of us give much thought to children who are born blind. A synergistic partnership between the MUHC (McGill University Health Centre) and the MAB-Mackay Rehabilitation Centre aims to change that.

The MAB (Montreal Association for the Blind) provides family-centered adaptation, rehabilitation and social integration services for children with motor or language impairments and to persons of all ages who are blind or visually impaired and/or deaf or hard of hearing.

In many cases, the MAB is the first resource families consult regarding vision defects and the challenges faced by the child and the parents. Its Early Intervention Program is a rehabilitation service that addresses the needs of children from birth to kindergarten. The service also provides parents with a better understanding of the essential role vision plays in child development. Early intervention is offered for children and adolescents with vision loss up to age 17 (or to age 21, if still attending high school). The program uses a comprehensive, multi-disciplinary approach that involves professionals from the optometry, occupational therapy and vision rehabilitation sectors, among others.

The thinking behind early intervention is that people with limited ability to interact with their environment – through sight, for example – are prevented from growing and developing at a normal rate. The MAB offers an assessment of functional vision, visual skills training and an ocular health appraisal using a specialized optometric evaluation and equipment designed to determine the child’s developmental level; it also offers psychosocial support and counseling for the child and the family and consultation as well as support with respect to integration into daycare, school and leisure activities. Importantly, the MAB’s services extend to lifestyle training including selfcare skills, food preparation and cooking, environmental modifications, and mobility skills such as safe travel and navigating one’s neighbourhood. It also provides an adapted computer service that teaches visually impaired people how to use adapted technology and software.

In recent years, the MUHC has been trying to further develop its relationship with the MAB within the framework of the RUIS, the Quebec Ministry of Health and Social Services’ four integrated university health networks across the province. The teaming of the MUHC and the MAB was initiated by the MUHC as a way of promoting the services of the two organizations in a symbiotic relationship. They have agreed to seek ways to sensitize and educate professionals within the MUHC about the services provided by the MAB as well as to promote access to educational opportunities for MAB staff.

“This is an excellent opportunity for us,” said Jim Gates, acting director of the McGill Health Network Office. “With this relationship our blind and visually impaired patients – from newborns to elderly – will benefit.”

“We are happy to be teaming up with the MUHC,” said Gisèle Hall, director of Professional Services at the MAB and at Mackay Rehabilitation Centre. “I know our services can help a lot of people and we can certainly benefit from the wealth of knowledge the MUHC can provide us with in the many areas related to blindness and visual impairment.”

AMI: Accessible Media for One and All

By Evra Taylor

Accessibility has become a popular watchword in disability circles, but Accessible Media Inc. (AMI) has ventured beyond clichés, proving itself as a true advocate and pioneer in providing broadcast accessibility services to a growing number of vision-impaired and blind Canadians.

The devoted professionals at AMI provide programming over multiple platforms, including described video for television, audio programs and original media content.

Now in its 21st year, AMI’s mission is to ensure that media content is accessible to persons of all abilities and disabilities. As the organization’s website states, “Inclusion can be achieved when a universal user experience can be provided to the widest possible audience that may wish to consume the media being provided.”

AMI President and CEO David Errington, highlights the fact that AMI is the only television network in the world with open description for television 24 hours a day, seven days a week. Most sight-impaired people need to use the Second Audio Programming (SAP) channel in order to access described video, whereas on AMI, access to described video is automatic. Other stations are mandated by the CRTC to have accessible content for a mere four hours per week. “The majority exceed that, but not by a huge amount,” he states.

All of AMI’s television programming is captioned. In addition to television, the organization provides extensive audio services such as audio files – essentially, an audio “transcript” – on CBC Newsworld’s SAP channels. The AMI website (www.AMI.ca) hosts audio services, and video programming is being planned.

Researchers estimate that more than one million Canadians are living with blindness or a significant loss of vision. What’s more, the total number of visually impaired and blind Canadians is projected to double over the next 25 years, due to a combination of increasing rates of age-related macular degeneration and the greying of the population. “We’re outliving our eyes,” said Errington, a haunting phrase that makes one appreciate the ability to see.

This spirit of inclusiveness is so strong at AMI that it insists on providing meaningful content to individuals without a disability: good content is good for everyone, it maintains. AMI bases its programming choices on carefully thought-out feedback mechanisms like consumer panels, surveys and focus groups, which keep it connected to the public and spark conversations about media-related issues.

The CRTC, which regularly raises the ire of a dissatisfied public, is a friend to AMI. “The CRTC is the reason for our existence,” stated Errington. “Its broadcasting act stipulates that all Canadian cable and satellite companies must pay a monthly fee for accessible television programming. It’s a way of guaranteeing access to media, and this mandate exists only in Canada.”

What does the future hold for AMI? The group has applied for a license for French TV service, and hopes for a response soon. If the license is granted, AMI TV Français would launch in January 2015.

Errington has nothing but praise for the way in which accessibility has been embraced in this country. “The Canadian broadcast system is definitely a world leader in this regard.” As he travels abroad in search of new programming, his continued efforts elevate broadcasting to a level that meets the intellectual and creative expectations of a discerning media-consuming public.

Making Vision Care Less Remote for Canada’s Aboriginal Population

By Evra Taylor

While Canada is facing a health crisis, the country’s First Nations and Inuit population have a much steeper mountain to climb than the rest of us in order to overcome its insufficiencies.

It has long been known that Canada’s aboriginal population suffers from an immediate hypersensitivity to drugs and alcohol, and an astoundingly high suicide rate. The problems, however, don’t stop there. Ocular health and the needs of this sector have become a growing concern among government and community groups which recognize the urgency of stemming diseases that can result in tragic vision loss.

The National Collaborating Centre for Aboriginal Health (NCCAH) is an advocacy organization based in British Columbia, whose mandate is to foster “a holistic, coordinated and strength-based approach to health” for First Nations, Inuit and Métis peoples. The Government of Canada established the group, which is funded by the Public Health Agency of Canada, as a vehicle to help improve healthcare in various sectors, including environmental health and infectious diseases.

In 2011, the Vision Institute of Canada launched its first-ever campaign, “Aboriginal Vision Health Awareness Year,” which was designed to promote eye healthcare for the aboriginal population. More specifically, the campaign focused on educating the public about the ocular effects of the skyrocketing incidence of diabetes in the general population, and particularly among native groups in which obesity is a rampant problem.

The campaign promoted yearly comprehensive eye examinations for aboriginal people with diabetes, particularly children. First Nations individuals have a disproportionate incidence of diabetes, and it occurs at a much earlier age than in the general population.  In fact, those with diabetes are 25 times more likely to experience vision loss and blindness than other populations.

A team of optometrists has made it its mission to provide practical, “on the ground” eyecare services to Quebec’s aboriginal population to help ensure that their eye health needs are met. At Donnelly Optical in Montreal, all of the optometrists on staff spend considerable time servicing the vision health needs of roughly 10,000 inhabitants in 14 communities in Nunavik – the Arctic territory flanked to the west by Hudson Bay and to the east by Ungava Bay.

This group of optometrists, which has been serving the needs of this population for roughly seven years, rotates trips up north every four weeks for two weeks at a time. The staff sees a lot of elderly patients, along with people in their twenties. “We see very high astigmatic corrections, which we don’t see in the general population. They seem to be fairly myopic as well.  Their eye health, however, is very good,” explained practice founder James Donnelly.

Through his years of experience, Donnelly has an informed perspective on the preponderance of diabetes in these communities. “The people have gone through a generation in the villages for the past roughly 60 years. The children are no longer hunting or fishing as much as before. Now they’re into processed foods like chips and colas. We’ve tried to help them through education, which is probably the only way we’ll make any inroads.”

Donnelly has developed a diabetic retinopathy screening program in which he examines patients once a year, evaluates their condition, and arranges follow-up care with an ophthalmologist or other eyecare specialist, as needed.

One of the efforts at encouraging better nutrition in Canada’s north was a program that gave diabetic patients food coupons strictly for healthy foods. Unfortunately, the initiative has been cancelled.

Canada’s eye and vision care benefits for aboriginal people can be reviewed at: www.hc-sc.gc.ca/fniah-spnia/pubs/nihb-ssna/index-eng.php#eye-yeux.

With the help of those government initiatives that remain in place and dedicated eyecare professionals like Donnelly’s group, the hope is that our native population will see a noticeable improvement in the eye health of its communities.

University of Waterloo: Bridging the Gap for Foreign ODs

By Evra Taylor

One of the problems facing the medical sector in North America is the tremendous number of individuals trained as physicians in their home country but unable to work in Canada and the U.S. because of differing credentials and language requirements.

The University of Waterloo has taken an important step in this regard with its International Optometric Bridging Program (IOBP). The program is designed to bring new optometric talent “home” to Canada, easing the process along the way by preparing applicants for the Canadian Assessment of Competence in Optometry (CACO), the examination required to be able to practice optometry in Canada. Bridging programs are developed through collaboration between employers, colleges and universities, occupational regulatory bodies, and community organizations.

The University Of Montreal School of Optometry also offers a bridging program, along with several other Canadian universities that do the same for family physicians and specialists, including University of Ottawa and University of Toronto. These practitioners are sometimes referred to as International Medical Doctors (IMD) or International Medical Graduates (IMGs). The various initiatives fall under the umbrella of the provincial Ministries of Citizenship and Immigration, and Citizenship and Immigration Canada.

For healthcare professionals in the ocular sector who wish to emigrate and practice here, the issue of determining whether or not an individual’s foreign credentials correlate with Canadian requirements is key, and can represent a major stumbling block. Program participants are required to undergo a Prior Learning Assessment (PLA). A second common barrier facing overseas ODs face is the lack of English or other language training.

University of Waterloo program participants receive academic and occupation-specific language training, workplace culture and communication training, and they may have the opportunity for clinical placements through two bridging programs. Both programs receive funding from the governments of Canada and Ontario.

In terms of curricula, both the Bridging One and Bridging Two streams include classroom lectures, clinical instruction and externship rotations. Bridging One covers such topics as case analysis, diagnosis and management of ocular disease, review of optics, ophthalmic equipment commonly used in Canada, contact lens practice, and jurisprudence. In addition to more than 200 hours of lectures and clinical instruction, Bridging One students are required to complete a four-week externship involving real-life patient care.

Bridging Two students receive roughly 22 weeks of academic and clinical instruction, followed by practical hands-on training in the patient clinic at the university’s School of Optometry and Vision Science under the supervision of professional optometrists. The Bridging Two content includes extensive study of English language-related topics, such as disease description, written documentation and academic reading strategies. Some of the clinical instruction overlaps with that of Bridging One; however, the second stream encompasses advanced optometric subjects, including ocular pharmacology, ophthalmic and geometric optics, ocular pathology/disease, and neurophysiology.

Academically, clinically, culturally and linguistically, the process of emigrating to any foreign country with a view toward practicing medicine can be daunting, to say the least. Ontario’s optometric bridging programs were developed in conjunction with the College of Optometrists of Ontario as a way of standardizing training for prospective immigrants, and helping them gain the knowledge and practical experience required to attain success in their new environment.

TheUniversityofWaterloo IOBPis an example of an optometric initiative that combines stringent professional requirements to ensure that patients are managed competently with the sensitivity required to address cultural bridge-building.


The next Bridging One session of the University of Waterloo’s International Optometric Bridging Program begins on June 3rd, 2013. Students will be assigned to one of two externship periods starting on August 6 th or September 3 rd, 2013.

The Bridging Two program date is still to be confirmed.



A Promising Future for Ophthalmics

By Evra Taylor

Canada is a major contributor to pharmaceutical and biotechnology research and development (R&D), investing close to $92 million in 2011. According to Andrea Gilpin, director, corporate communications, Novartis Canada, this separates us from many of our counterparts worldwide. “There are over 100 clinical studies going on now in Canada. They encompass such areas as primary care, established medicines, and Phase III and Phase IV studies,” explains Gilpin. “This year, we’re investing in three main areas – protein-protein interaction, biologics, and drug delivery,” she says.

Of the $92 million, 76 per cent was allocated to clinical research and a portion was earmarked for pre-clinical research. In a major R&D initiative in Quebec, Novartis Pharmaceuticals Canada has become the latest pharmaceutical company to partner in the Explore program of the Québec Consortium for Drug Discovery (CQDM), which funds small, unconventional and highly innovative research projects that may have an impact on the drug discovery process. Projects funded by Explore must have the potential for a breakthrough discovery that could lead to an important change in the current drug discovery paradigm or conventional wisdom.

Novartis has invested $300,000 in the Explore program, joining several other pharmaceutical companies, including AstraZeneca, Eli Lilly Canada, Merck and Pfizer Canada.

Diane Gosselin, president and CEO of CQDM, states, “We’re trying to fund and impact biopharmaceutical research where the most crucial needs are. For example, an antibody for macular degeneration or other conditions at the back of the eye would be of great interest for pharma members. Drug delivery for these types of conditions – anything that can improve the efficiency of the drug for the back of the eye – is important to us.”

While ophthalmic-related projects are not part of this year’s Explore line-up, they form a significant part of Novartis Canada’s business. “Lucentis is considered to be a key business driver for us. It was one of our biggest products in Canada in 2012,” notes Gilpin.

The current indications for Lucentis in Canada are age-related macular degeneration (AMD), visual impairment due to diabetic macular edema (DME), and visual impairment due to macular edema secondary to retinal vein occlusion (RVO). The importance of treating AMD, which typically affects older adults, should not be underestimated in light of Canada’s aging population. Another indication being sought in Canada for Lucentis is pathological myopia, an extremely high amount of nearsightedness that causes an alteration of the shape or globe of the eye and may lead to profound vision loss.

In 2011, Alcon merged with Novartis, uniting the strengths of Alcon, CIBA VISION and Novartis. The newly formed Alcon business became the second-largest division of Novartis.

Alcon has filed Jetrea™ (ocriplasmin) with Health Canada for the treatment of the sight-threatening eye conditions vitreomacular traction and macular hole. In October 2012, Jetrea was approved in the U.S. for the treatment of patients with symptomatic vitreomacular adhesion (VMA) and in January 2013, ThromboGenics launched Jetrea in the U.S.

Other big players on the Canadian eyecare scene include Bausch + Lomb, whose widely used Lotemax™ (loteprednol) reduces inflammation resulting from cataract and other types of eye surgery, as well as a number of eye conditions.

Allergan Canada markets Restasis®, cyclosporine eye drops used to treat dry eye disease, which is currently considered to be the most prevalent ocular condition in North America.

Eye diseases can have a devastating impact on quality of life. Fortunately, new pharmaceutical products are continually being developed to help those affected.

Biomedical Ethics and the Vision Industry: Shared Decision-Making is Key

Evra Taylor

Biomedical ethics is a relatively new field that is founded largely on dialogue and interpretation, rather than on the black and white conclusions that characterize other medical specialties. In biomedical ethics, the art of medicine meets the science of medicine.

Dr. Eugene Bereza, director of McGill University’s Biomedical Ethics Unit, teaches practicum courses in the Masters program, as well as medical school residents. According to Bereza, biomedical ethics emerged in order to find an alternative to an old-style model of medical paternalism.

Another impetus for the specialization was organ transplantation, which raises issues around how decisions are made about who receives organs. “As technology exploded, questions arose about how to use it,” explained Bereza. “For example, transplanting organs required a new definition of ‘brain dead’ and answers to questions like, ‘Who receives life support and what are the criteria for its cessation?’ The decisions being made weren’t keeping pace with the technologies at hand – and these issues came under the umbrella of medical ethics.”

Dr. Bereza is interested specifically in the doctor-patient relationship and how it has changed over the past 40 years. “Forty years ago, the doctor told the patient what to do. Now, doctors are supposed to listen to patients and take into account their preferences.” This is a newer model of care based on joint decision-making. How does this changing medical landscape affect the optical profession? “I would think that ophthalmologists and optometrists would have had to change like most other medical professions. Whether it’s diabetes or your eyes, the role of the physician is to properly diagnose and suggest appropriate treatments, and not to be perceived as the sole decision-maker.”

Dr. Bereza presented the following scenario: a 94-year-old woman visits her doctor’s office and says, “I’m having trouble with my vision.” The doctor says, “You have cataracts and we should remove them – then you’ll see better”. In the old days, the doctor would have said, “I’m scheduling surgery next month,” without considering the patient’s preferences and lifestyle. However, the patient might say, “I’m 94 years old. I’d rather not have the surgery. I’d rather stumble around the house.”

In another scenario, a 94-year-old woman asks her eyecare professional, “I can’t see. Can you do something?” She has arthritis and moderate dementia. The modern-day doctor ponders, “Am I going to do surgery on a 94-year-old woman with moderate dementia, who has limited mobility?” The doctor considers her likelihood of complying with treatment, plus her elevated risk of post-operative infection. “It’s quite appropriate for an eyecare professional to offer an opinion or advice, but ultimately the decision is going to lie with the patient. Two 94-year-olds might have two different preferences. Eyecare practitioners have to think about how this procedure fits into their patients’ lives,” explained Dr. Bereza.

In the above scenarios, the ocular professional shouldn’t be the only one making the decision, he said. Furthermore, it would be wrong for the practitioner to assume that because the patient has dementia, she doesn’t need to see. Naturally, the physician should want to improve the patient’s quality of life. “However, it’s valid for the ophthalmologist to say, ‘She’s in a nursing home with dementia. She has no visitors and no TV, and she stares at blank walls all day. What is the purpose of performing surgery, with the possibility that she’ll develop a post-operative infection, become septic and die?’”

“There has to be a shared exploration of the way the treatment fits into the patient’s life,” added Dr. Bereza. In this facet of biomedical ethics, the key point is shared decision-making, which must be integrated into a rapidly evolving healthcare landscape, and the unfortunate reality of shrinking human resources and budgets.