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  • A primary goal of the American Academy of Ophthalmology is to provide accredited CE (CE) to enhance the ophthalmologist's ability to furnish the highest possible quality of eye care for patients. Therefore, relationships with other organizations must not jeopardize the Academy's standing as a respected organization.

    1. Policy

    When appropriate and desirable, the American Academy of Ophthalmology may solicit or accept financial or other support from both for-profit and not-for-profit organizations in order to develop and/or improve activities and programs that are consistent with the Academy's mission statement. All arrangements for financial or other support must adhere to the guidelines of this policy statement or be reviewed by the Board of Trustees or the Executive Committee acting on behalf of the Board of Trustees. Support for all accredited CE programs and activities must adhere to the Standards for Integrity and Independence in Accredited Continuing Education of the Accreditation Council for Continuing Medical Education (ACCME) as described below. In addition, with respect to gifts to physicians and the conflicts inherent in such gifts, the Board of Trustees has adopted the American Medical Association's (AMA) guidelines as outlined in its publication entitled Gifts to Physicians from Industry.

    2. Background

    Financial and other support from corporations, foundations, and other organizations can contribute significantly to both the quality and scope of Academy programs, activities, and services. The Academy shares many common goals with other organizations, including corporations in ophthalmic industry, and it is appropriate for the Academy to cultivate and maintain appropriate and ethical relationships with these organizations. Such relationships must not pose conflicts of interest for the Academy, its officers, staff, members, or the sponsoring organizations, and they must be consistent with the goals and objectives of the Academy's strategic plan.

    3. Definitions

    The Academy may enter into different types of relationships or arrangements with other organizations as defined below.

    1. Sponsorship: A financial donation to the Academy to support an Academy product or service with appropriate recognition for the donor.
    2. Joint Sponsorship: A joint effort in which both (or all) organizations or institutions are integrally involved in planning and developing an Academy program.
    3. Joint Providership for CME: The ACCME accredits the Academy to provide CME to physicians. The ACCME Joint Providership policy includes definitions and requirements specific to the joint providership of CME. These are supported by the Academy's Joint Providership Agreement for Continuing Medical Education Activity. All joint-providership CME efforts must conform to these ACCME requirements and Academy guidelines.
    4. Joint Providership for accredited continuing education: The ACCME accredits the Academy to provide accredited continuing education to physicians. The ACCME Joint Providership policy includes definitions and requirements specific to the joint providership of accredited continuing education. These are supported by the Academy's Joint Providership Agreement for Continuing Medical Education Activities. All joint-providership accredited CE efforts must conform to these ACCME requirements and Academy guidelines. In accordance with the ACCME’s requirements, the Academy will engage in joint providership only with entities that are eligible to be accredited themselves, namely those whose mission and function are: (1) providing clinical services directly to patients; or (2) the education of healthcare professionals; or (3) serving as fiduciary to patients, the public, or population health; and other organizations that are not otherwise ineligible.
    5. Cooperative Relationship: A relationship in which the degree of involvement of one organization or institution in the planning, developing, or implementing of a program or service is less than that of the primary sponsoring organization or institution. The terms "in cooperation with" or "cooperating organizations" are used to describe such relationships.
    6. Companies: Called “ineligible companies” by the ACCME and defined as those whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.  In accordance with the CMSS Code for Interactions with Companies, this definition shall also include for‐profit entities that develop, produce, market or distribute drugs, devices, services or therapies used to diagnose, treat, monitor, manage, and alleviate health conditions.
    7. Endorsement: Approval by the Academy of, or the loan of the Academy name to, a program or service developed by another organization. Endorsements must be approved by the Board of Trustees.
    8. Alliance or Collaboration: A joint effort of two entities that benefit from sharing profit, cost-savings, service, royalties, license, or name recognition.
    9. Joint Policy Statements: Statements developed by one organization to which that organization requests Academy co-signature. These should be consistent with mission and scope of operations of the Academy.

    4. Independence

    1. In general, the Academy will proactively choose its priorities for entering into relationships and arrangements with other organizations; however, the Academy will also consider opportunities presented by other organizations.
    2. All proposed arrangements and relationships must fit the guidelines outlined here or be reviewed by the Academy Board of Trustees or the Executive Committee acting on behalf of the Board of Trustees, in order to ensure that acceptance of funds or use of Academy funds would not have a negative influence on Academy programs or policy or be inconsistent with the Academy's mission and goals.
    3. Proposed arrangements and relationships must not compromise the Academy’s reputation, the privacy of its members, the existence or identity of the Academy, its adherence to the ACCME accreditation criteria or Standards for Integrity and Independence in Accredited Continuing Education, its tax status, or its trademarks.
    4. In accordance with the ACCME’s Standards for Integrity and Independence in Accredited Continuing Education (SII), The American Academy of Ophthalmology (“Academy”) develops its accredited CE activities independent of any commercial interest. Specifically, a commercial interest or Company can have no involvement in the following:
      1. Identification of practice gaps and needs 
      2. Preparation of or input into the learning objectives
      3. Selection and presentation of content
      4. Recommendation of persons that will be in the position to control the content of credit-bearing CME
      5. Influence over the selection of the educational design for the activity
      6. Selection of vendors or methods for the evaluation of the activity 
      7. Requests for “technical review” of the content of the credit-bearing CME activity by the Company will not be accepted. 
    5. Participation in a specific arrangement or relationship does not in any way imply Academy approval of an organization's general policies, nor does it imply that the Academy will exert any influence to advance the organization's interests outside the substance of the arrangement itself. 
    6. The Academy's name and logo may not be used in a manner that would express or imply Academy endorsement of the organization or its policies. As a general rule, the Academy does not endorse companies, organizations, products, or services of third parties. 
    7. The Academy's name or logo will not be used to promote or endorse a medical product for consumers produced by others without approval of the Board of Trustees, which will be granted only in exceptional circumstances.
    8. The Academy can support joint policy statements and recommendations with other organizations for harmonization purposes, given that these policy statements and recommendations do not carry financial or other liability to the Academy, and given appropriate review by relevant Academy committee (s) and approval by the Board of Trustees. Subsequent to approval, before the sponsoring organization makes any changes to the statements and recommendations, the organization must notify the Academy so that the Academy can determine if it will continue its support.
    9. The Academy does not endorse programs developed by other organizations or institutions, except as determined by the Board of Trustees.
    10. The Academy does not actively seek endorsements of Academy programs or services from other organizations or institutions except as determined by the Board of Trustees.

    5. Management of Funds

    1. The Academy accepts funds or royalties only if acceptance does not pose a conflict of interest and in no way impacts the objectivity of the Academy, its members, officers, or employees. If sponsorship funds are supplying all or part of an employee or independent contractor's compensation, each such employee or independent contractor must disclose any financial or fiduciary relationship with the sponsoring organization. This disclosure includes loans, gifts, or income from the organization; investments of $2,000 or more in the organization; and any position with the organization, such as a director, officer, partner, consultant, trustee, or employee.
    2. In accordance with ACCME Standards for Integrity and Independence in Accredited Continuing Education and the Academy’s “Identification and Mitigation of Conflicts of Interest” policy and the “Policy for Commercial Support for CME Activities”, the Academy will conduct all accredited CE programs independently and without influence of or control by other supporting organizations. Supporting organizations shall not influence or control the program planning, program content, or execution of the activity; the program must be free of commercial bias for or against any product; and any product discussion must be objective, balanced, and scientifically rigorous. Corporate supporters may not engage in promotional activities in the accredited CE program location or in the accredited CE materials, and no promotional materials may be disseminated during the accredited CE activities. 
    3. Written Letters of Agreement: For accredited CE activities, the Academy requires that a written letter of agreement (LOA) be signed by both the provider and the Company prior to the beginning of the activity. This document specifies terms and conditions in compliance with the SCS. Specifically, no language will be permitted in the LOA relating to any requirements for the Company’s involvement in content, faculty selection, and methods as described above. The LOA may be either AAO’s document or one produced by the Company, in which case the language is vetted for adherence to all required areas of the SCS. An LOA will be completed for both in-kind funds and educational grants. 
    4. Control of Funds: The Academy controls all aspects of the management of funds from a Company received for a accredited CE activity. Even in cases in which there is an educational partner or joint provider, The Academy is a signatory to the LOA and is full in control of all decisions and agreements relative to such funds.
    5. Additional Funds Provided to Those in Positions to Control Content: For accredited CE activities, the Academy ensures that Companies supporting an accredited CE activity are not providing additional funds to those in a position to control content relative to the specific accredited CE activity. This requirement is included both in the LOA as well as in faculty letters and agreements.
    6. For accredited CE activities, honoraria and expense support is provided only to faculty associated with an activity, and is given rarely.
    7. Provision of Funds to Learners: In accordance with the AMA's guidelines outlined in Gifts to Physicians from Industry (adopted and approved by the Academy's Board of Trustees), and the ACCME Standards for Integrity and Independence in Accredited Continuing Education (required under the Academy's accreditation to provide accredited CE activities), funding from industry to underwrite the costs of accredited CE conferences or professional meetings should be made to the Academy and not to individual physicians. Subsidies from industry should not be accepted by the Academy to pay for the costs of travel, lodging, or other personal expenses of the physicians who are attending accredited CE conferences or meetings. Industry support for the costs of travel and lodging for attendees who might otherwise not be able to participate in an Academy event (e.g., ophthalmologists from countries or regions with developing economies) may in limited circumstances be considered appropriate; such situations will be addressed on a case- by-case basis. 
    8. Social Events: Subsidies for hospitality should not be accepted except for modest meals or social events that are held as part of an accredited CE conference or meeting for the purpose of promoting interaction and exchange between faculty and learners. Social events that take place at an accredited CE activity, regardless of whether those events are provided with funds from a Company or not, may not compete with or overtake the accredited CE activity. 
    9. Transparency to Learners and other participants: Organizations that provide financial support to the Academy may be recognized. Such corporate or foundation recognition regularly occurs in Academy publications and other appropriate forums. Recognition does not include any reference to the organization’s products. For accredited CE activities, the Academy acknowledges the receipt of educational grants and in-kind donations from Companies. Such information is made transparent to learners by publishing this information for all in-kind and actual support grants in the general information pages located at the beginning of the activity, syllabus or handouts. Disclosure to learners of the relationships of Academy contributors to accredited CE activities is also required at the beginning of every accredited CE activity. The requirements for this process are described in the Policy for Identification and Resolution of Conflicts of Interest. 
    10. Institutional acknowledgment from non-Company entities for non-accredited CE activities may state the name mission, areas of involvement of the institution, and corporate logos and slogans, only if they do not promote a commercial product.

    6. Separation of Education from Promotion

    1. Promotion of Proprietary Interest of Companies: The Academy ensures that accredited CE activities do not promote the interests of product manufacturers through the following safeguards:
      1. Activities Linked to Analyses of Learner Gaps and Other Needs—accredited CE activities are planned based on clear gaps in knowledge and/or performance, the expert opinions of recognized experts in the field, national guidelines or authorities’ description of best practices.
      2. Content Validation Practices—The content of accredited CE activities is vetted by independent reviewers so as to ensure that commercial bias is not present and that the material is scientifically accurate, conforms to generally accepted experimental design, data collection, analysis, and interpretation, based on evidence acceptable to the profession, and that treatments discussed are appropriate. The Academy has a standard form for this purpose.
      3. Retrospective Learner Feedback—Evaluation mechanisms always contain questions that serve to demonstrate that learners did not perceive commercial bias in the materials from a specific teacher/author. If a bias is perceived, this information is provided to the planners, faculty and others to enable creation of an improvement plan and monitoring of improvement plan outcomes, so that an improvement plan can be determined and outcomes of the improvements monitored. 
    2. Commercial Exhibits
      1. The Academy occasionally permits exhibits to be presented in the context of a accredited CE activity. However, exhibit space is rented or otherwise provided to the commercial exhibitor in contrast to the provision of a marketing strategy. The Academy does not engage in any marketing practices or services-for-hire for a Company.
      2. Exhibits are not permitted in the educational room, in the obligate path to the educational room1, or in the case of enduring materials or Internet-based CME, within the space of educational content.
      3. Exhibits are never a condition for the receipt of an educational grant. Should an exhibit be requested, a separate agreement will be entered into with the appropriate party from the Company. A fee will be charged for securing exhibit space, and the fee will be consistent for any exhibitor regardless of the organization’s involvement in the provision of an educational grant for the accredited CE activity.
    3. Advertising
      1. Live Activities—A Company is not permitted to advertise its products within the confines of an accredited CE activity. Advertising or promotion cannot be displayed or distributed in the educational space immediately before, during, or after an accredited CE activity. The Academy does not permit subtle advertising by having book bags, pens, or other accoutrement that bears the name of the manufacturer and/or its products distributed within the educational space.
      2. Enduring Materials—Advertising is not permitted whatsoever in any enduring material, which by definition contains the course content for an accredited CE activity.
      3. Internet-Based Activities—Advertising may be present on general web pages, but in that case the learner must act to formally enter the educational space by knowingly click to enter that space. Messages informing the learner that they are entering an educational space shall be explicit, and thereafter no advertisements are permitted.
      4. Journal-Based Activities—The Academy currently does not offer journal-based accredited CE. If in the future it should it elect to offer this type of accredited CE, advertising would be permitted in journals containing articles certified for AMA PRA Category 1 Credit TM but those ads could not be within the confines of the certified article or on any partial page of that article. Furthermore, advertising would not be permitted in other parts of the official accredited CE activity, such as posttests, evaluations, and general accredited CE information pages.
    4. Appearance of Product Group Messages in Course Materials: No product group messages are permitted in any accredited CE activity certified by the Academy. Given the nature of how learners perceive such messages, steps taken to assure compliance with this policy include:
      1. Use of generic scientific names for product descriptions instead of product names.
      2. Insistence of fair balance in discussion of treatment options in which all drugs in a class are compared and contrasted, with treatment recommendations being reviewed by content reviewers to assure that recommendations made are based on verifiable studies and in the public interest.
      3. Logos from Companies are never permitted on any course materials including slides, syllabus materials, and other non-educational interventions.
      4. Corporate logos are not permitted when acknowledging the receipt of commercial support in Academy course materials of any kind.
    5. The Role of the Commercial Interest or Company in the Provision of accredited CE to Learners: The Company supporting an activity has no role in the provision of accredited CE to learners. They are acknowledged for their educational grant, and in addition, may provide promotional brochures or flyers to prospective learners as long as those materials clearly delineate AAO as the provider of the activity and the Company as provider of the educational grant. They may not distribute a link or other direct access to the activity.   

    7. Ensuring Academy Oversight and Control

    1. For all activities, the Academy retains editorial control over any information produced as part of relationships or arrangements with other organizations. All intellectual property resulting from sponsorship by another organization will be the property of the Academy unless the Board of Trustees has approved an agreement to the contrary. In every case, all materials in print, broadcast, or electronic media prepared by the supporting organization must be submitted to the Academy for written approval prior to release.
    2. In addition to normal reviews as needed by legal counsel, the chief financial officer and the appropriate divisional vice president, the chief executive officer shall be responsible for ensuring that arrangements and relationships with other organizations adhere to the guidelines adopted by the Board of Trustees.

    References:
    American Academy of Ophthalmology Policy Statement, “Identification and Resolution of Conflicts of Interest.”
    American Academy of Ophthalmology Policy Statement, “Gifts to Physicians from Industry.”
    American Academy of Ophthalmology Policy Statement, “Policy for Academy Leaders.”

    Approved by: Board of Trustees, June 1998
    Revised and Approved by: Board of Trustees, April 1999
    Revised and Approved by: Board of Trustees, February 2003
    Revised and Approved by: Board of Trustees, February 2007
    Revised and Approved by: Board of Trustees, February 2013
    Revised and Approved by: Board of Trustees, March 2016
    Revised and Approved by: Board of Trustees, December 2021

    ©2021 American Academy of Ophthalmology®
    P.O. Box 7424 / San Francisco, CA 94120-7424 / 415.561.8500

    1 CMSS Code for Interactions with Companies Section 5.4.3. ↩