A. PREFACE

The Ethics Committee of the North American Neuro-Ophthalmology Society (NANOS) developed the North American Neuro-Ophthalmology Society Code of Ethics (the Code) to formalize the standards of professional behavior for all members of NANOS, regardless of the class of membership. The primary goal of the Code is to promote the highest quality of neuro-ophthalmologic research and patient care. The Code outlines the professional standards that NANOS requires its membership to observe in the advancement of their clinical and scientific activities. All references in the Code to neuro-ophthalmology and neuro-ophthalmologist refer and apply with equal force and affect to all members of NANOS irrespective of their individual field, training or licensure status.

The Code embodies traditional medical ethical standards dating from the time of Hippocrates as well as more contemporary standards. It includes general principles of medical ethics and provides for their application to the specific demands of neuro-ophthalmologic practice. The basic ethical principles and objectives outlined in the Code are intended to be interpreted in such a manner as to be consistent with the ethics codes of the American Medical Association Code of Medical Ethics, the American Medical Association Current Opinions of the Council on Ethical and Judicial Affairs, and the ethics committees of the American Academy of Neurology and the American Academy of Ophthalmology.  Any inconsistencies which currently exist or which may hereafter develop between these third party codes of ethics and this Code shall be submitted to the Ethics Committee for review and interpretation, as provided for in Section C of this Code.

While ethical principles are generally considered constant, developments in science, technology, and clinical practice may require the application of these ethical principles to be modified. Therefore, the Code is designed to be a dynamic instrument that can grow and adapt to future developments in the practice and science of neuro-ophthalmology.

The Code outlines the standards of professional conduct required of all NANOS members and applies to all categories of membership. Violations of the Code may serve as the basis for disciplinary action as provided for in the Code and the NANOS Bylaws.

B. RULES

1.0 The Neuro-ophthalmologist-Patient Relationship

1.1 The Practice of Neuro-ophthalmology

The profession of neuro-ophthalmology exists primarily to study, diagnose and treat disorders of the nervous system and the eye. The neuro-ophthalmologist should be dedicated to the ideals and obligations of the profession and must be educated and trained to provide neuro-ophthalmologic medical treatment and care.  The neuro-ophthalmologist should only perform those procedures in which the neuro-ophthalmologist is competent by virtue of specific training or experience or ensure that he/she is properly assisted by a physician who is competent.  The neuro-ophthalmologist-patient relationship forms the foundation for neuro-ophthalmologic care and should be carefully safeguarded.

1.2 Fiduciary and Contractual Obligations

The neuro-ophthalmologist owes the patient both fiduciary duties and contractual obligations. The neuro-ophthalmologist has a duty to consider the interests of the patient, to practice competently and to respect the patient’s autonomy, confidentiality, and welfare.

1.3 Beginning and Ending the Relationship

The neuro-ophthalmologist is free to determine to undertake the medical treatment or care of any person. However, the neuro-ophthalmologist must not decline a patient on the basis of race, religion, nationality, or gender.  Nor should a neuro-ophthalmologist refuse treatment to any patient solely because of any real or perceived health risks which the patient or his/her condition may pose to the physician. The neuro-ophthalmologist should take appropriate precautions to minimize any associated health risks to the physician and the physician’s staff which may arise from the treatment of any such patient.  Once the relationship has begun, the neuro-ophthalmologist must continue to provide adequate care to the patient until such time as the treatment is complete, the patient ends the relationship, or the neuro-ophthalmologist appropriately ends the relationship. If the neuro-ophthalmologist desires to end the relationship prior to the completion of treatment, he/she should provide the patient with adequate advanced notice and must assist in arranging for the patient to receive continued care from another qualified physician.

1.4 Communication

The neuro-ophthalmologist has a duty to communicate openly and effectively with the patient. The neuro-ophthalmologist should convey relevant information using language and terms which the patient can understand and allow adequate opportunity for the patient to raise questions and discuss matters related to the treatment. Patient confidentiality must be safeguarded by the physician in compliance with all state and federal laws, rules, and regulations.

1.5 Informed Consent

 The neuro-ophthalmologist whenever feasible must obtain the patient's informed consent prior to initiating neuro-ophthalmologic treatment. The neuro-ophthalmologist should provide the patient with information related to the treatment in such a way that an average adult would be able to understand the explanation and be able to formulate an informed decision. If the patient lacks medical decision-making capacity, the neuro-ophthalmologist whenever feasible must obtain informed consent from the patient’s legal guardian or the duly appointed power of attorney prior to beginning treatment when informed consent is required.

1.6 Emergency Care

While obtaining prior informed consent is desirable before beginning treatment, the neuro-ophthalmologist should not delay urgently needed treatment because of concerns about informed consent. When a neuro-ophthalmologist is presented, in his/her professional opinion, with an emergency situation, the neuro-ophthalmologist should render the necessary emergent neuro-ophthalmologic care to the patient to the best of his/her ability.

1.7 Medical Decision-Making

Treatment shall be recommended for a patient only after a careful consideration of the patient’s physical, social, emotional and occupational needs. The neuro-ophthalmologist must evaluate the patient and assure that the evaluation accurately supports the physician’s treatment plan. Recommendation of unnecessary treatment or withholding of necessary treatment is unethical.  The physician must communicate the treatment plan to the patient. The patient has the ultimate right to accept or reject the neuro-ophthalmologist's recommendation for medical treatment. The neuro-ophthalmologist should respect decisions made by the patient or when appropriate by the patient’s legal guardian or duly appointed power of attorney. If the neuro-ophthalmologist determines that he/she cannot honor the patient's or, where appropriate, the guardian’s decision, the neuro-ophthalmologist should notify the patient and seek to arrange for the transfer of the patient's treatment to another qualified physician.

2.0 General Principles of Neuro-ophthalmology

2.1 Professional Competence

The neuro-ophthalmologist must practice only within the scope of his/her training, experience, and competence. The neuro-ophthalmologist should provide care that represents the prevailing standards of neuro-ophthalmologic practice. To maintain this level of competency, neuro-ophthalmologists should participate in a regular program of continuing education. The neuro-ophthalmologist must not misrepresent credentials, training, experience, ability or results.

2.2 Medical Consultation

The neuro-ophthalmologist should obtain consultations when appropriate with other physicians or health care practitioners. The neuro-ophthalmologist should ensure that adequate medical information is conveyed to the consulting physician to enable him/her to make an informed recommendation. Any differences of opinion between the neuro-ophthalmologist and any medical consultant or between the neuro-ophthalmologist and the referring physician should be resolved in the best interest of the patient.

2.3 Patient Confidentiality

The neuro-ophthalmologist must maintain the patient’s privacy and confidentiality and must comply with all applicable state and federal confidentiality rules and regulations. 

2.4 Patient Records

The neuro-ophthalmologist should prepare and maintain thorough and accurate patient records which should include a statement of all relevant history, neuro-ophthalmic findings, assessments, and the proposed plan of evaluation and treatment. Upon request, patients should be provided with copies of their medical records, pursuant to prevailing regulations.

2.5 Professional Fees

The neuro-ophthalmologist is entitled to reasonable compensation for medical services to or on behalf of patients. The neuro-ophthalmologist should receive compensation only for services actually rendered or supervised. The neuro-ophthalmologist must not receive a fee for making a referral ("fee-splitting") or receive a commission from anyone for an item or service he/she has ordered for a patient ("kickback") or from other fee arrangements which are barred by the then current local, State or Federal laws, rules or regulations.   A reasonably agreed upon division of practice income among members of an organized medical group which complies with all relevant laws, rules and regulations is acceptable.

2.6 Appropriate Services

The neuro-ophthalmologist should order only those tests and perform only those services which are medically necessary for the patient.

2.7 Special Categories of Neuro-ophthalmologic Care - The Dying Patient

The neuro-ophthalmologist should strive to relieve the suffering of patients. The neuro-ophthalmologist should respect the expressed wishes of dying patients regarding life-prolonging therapy, including all lawful advance directives.

3.0 Professional and Personal Conduct

3.1 Respect for the Patient

The neuro-ophthalmologist should provide care to the patient with compassion, respect for human dignity, honesty and integrity. The physician should treat every patient with respect, honesty and meticulous care. No physician should ever engage in activities which result in physical, psychological, emotional, or financial abuse or exploitation of a patient.

3.2 Lack of Capacity

When the neuro-ophthalmologist’s patient lacks the capacity to make informed decisions, the neuro-ophthalmologist should take reasonable steps to safeguard the interests and rights of that patient.  

3.3 Official Agencies

The neuro-ophthalmologist must observe all applicable government rules, regulations and laws. Because many government and quasi-government agencies decisions impact the patient’s welfare, the neuro-ophthalmologist should cooperate and comply with reasonable requests from any such agency while safeguarding the patient’s rights to privacy and confidentiality.

3.4 Assisting, Soliciting, or Inducing Violations

A neuro-ophthalmologist shall not knowingly violate, attempt to violate, assist in, solicit, or induce any violation of this Code or of any State, Federal or local laws, rules or regulations.  Nor shall the neuro-ophthalmologist engage in conduct involving dishonesty, fraud, deceit or misrepresentation. 

3.5 Maintenance of the Neuro-ophthalmologist's Personal Health

The neuro-ophthalmologist should strive to maintain his/her own physical and emotional health. The neuro-ophthalmologist should refrain from practices that may impair his/her capacity to provide adequate patient care. A physically, mentally or emotionally impaired neuro-ophthalmologist should withdraw from those aspects of his/her practice which are affected by the impairment. If an impaired neuro-ophthalmologist fails to withdraw from those aspects of the practice which are affected by any impairment, it is the duty of other neuro-ophthalmologists who are aware of the impairment to take action to correct the situation including, but not limited to, the duty to report the impairment to the Ethics Committee and, when required by any law governing such physician’s practice the duty to report the impairment to the appropriate regulating authority.   

4.0 Conflicts of Interest

4.1 The Patient's Interest is Paramount

A conflict of interest exists when professional judgment concerning the well-being of the patient has a reasonable chance of being influenced by other interests of the physician providing treatment. When a conflict of interest occurs or when one becomes apparent the treating physician has a duty to disclose such conflict to the patient.  The neuro-ophthalmologist must attempt to resolve any conflict of interest which arises to ensure that the patient’s treatment plan continues to service the best interest of the patient. If the conflict cannot be eliminated, the neuro-ophthalmologist must notify the patient of the specific conflict and, if the patient requires, terminate the physician/patient relationship.

4.2 Conflicting Ethical Duties   

A neuro-ophthalmologist ordinarily must maintain the patient's confidentiality; however, if the neuro-ophthalmologist becomes aware that the patient intends to injure an identifiable third party, then the neuro-ophthalmologist must take reasonable steps to warn the third party or notify the appropriate authorities. Similarly, when the neuro-ophthalmologist becomes aware of the patient’s intent to injure members of the general public, the neuro-ophthalmologist must take reasonable steps to advise the appropriate public officials or agencies of the danger.  If the physician is uncertain of his/her duties he/she should immediately consult with the Ethics Committee.
 
5.0 Relationships with other Professionals

5.1 Cooperation with Health Care Professionals

The neuro-ophthalmologist should cooperate and appropriately communicate with other health care professionals, including other physicians, nurses, and therapists, in order to provide the best care possible to the patient.

5.2 Peer Review

The neuro-ophthalmologist should participate in peer review activities in order to promote the best care possible of patients.

5.3 Criticism of a Colleague

The neuro-ophthalmologist should avoid criticizing a colleague's judgment, training, knowledge, or skills. However, when a member of NANOS becomes aware of another  NANOS member’s incompetence or professional misconduct, then that NANOS member should report such concerns to the Ethics Committee.    

5.4 Expert Testimony

The neuro-ophthalmologist who elects to provide or who is otherwise called upon to provide expert medical testimony should provide such testimony in an objective manner using medical knowledge to form his/her expert medical opinions. He/She should testify only about those subjects for which he/she is qualified to provide as an expert by training and experience. Before giving testimony the neuro-ophthalmologist must carefully review the relevant records and facts of the case and the prevailing standards of practice.  Non-medical factors should not bias the testimony.  Compensation for testimony should be reasonable and commensurate with time and effort spent, and must not be contingent upon the outcome of the litigation.  Knowingly providing false testimony is a breach of this Code.

5.5 Health Care Organizations

The neuro-ophthalmologist may enter into contractual agreements with managed health care organizations, prepaid practice plans, and hospitals. The neuro-ophthalmologist must retain control of his/her ability to independently determine the medical treatment or other medical decisions for patients without undue interference from the organization, program, or hospital. 

6.0 Relationships with the Public and Community

6.1 Public Communication

The neuro-ophthalmologist must represent himself/herself to the public accurately. He/She must not convey false, untruthful, misleading, or deceptive statements.  The physician must not omit material information without which the communication could be deemed to be deceptive. Communications must not appeal to an individual’s anxiety in an excessive or unfair manner and they must not create unjustified expectations of results. The neuro-ophthalmologist’s credentials, training, experience or ability must be accurately represented.  In no event should a neuro-ophthalmologist publicly use or otherwise disclose any patient's medical condition or treatment without the patient's prior written consent.

6.2 Obligation to Community

Neuro-ophthalmologists should work toward improving the health of all members of their community and society. To achieve this goal, the neuro-ophthalmologist should strive to participate in continuing educational programs, research, public health activities, and to allocate a percentage of his/her practice to patients who would otherwise be economically unable to obtain such medical services. The neuro-ophthalmologist should be aware of the limitation of society's health care resources and should not squander those finite resources by ordering unnecessary tests and implementing known ineffective treatment plans.

6.3 Disclosure of Potential Conflicts

Neuro-ophthalmologists who make written or oral public statements in support of a product of a company from which they receive compensation or support, or in which they hold a significant equity position, have a duty to disclose their financial relationship with the company in that public statement.

6.4 Communications with Colleagues

Communications between colleagues must be accurate and truthful and must be conducted in a manner that, when pertaining to the treatment of a patient, advances that patient’s best interests. All communications between colleagues related in any way to the science or practice of medicine generally and more particularly of neuro-ophthalmology shall be conducted in a professional and collegial manner.

7.0 Research

7.1 Institutional Review

The neuro-ophthalmologist who elects to participate in any clinical research or study must first confirm that the research has been approved by an Institutional Review Board (IRB) or other comparable regulatory authority and must observe and comply with the requirements of the approved protocol.

7.2 Disclosure of Potential Conflicts

The neuro-ophthalmologist who is paid for treating patients in a clinical research project must inform the patient/subject of any additional compensation the neuro-ophthalmologist is entitled to receive as a result of the subject’s participation in the study. The compensation for research subject treatment should be reasonable in amount. The neuro-ophthalmologist should not bill the subject or their insurer for services which the physician has already received compensation for from the study sponsor.

7.3 Experimental Treatment

Any neuro-ophthalmologist who proposes to provide a patient with an experimental medical treatment program which has not received approval as a valid clinical study by an IRB or similar regulator agency should obtain prior written informed consent from the patient for all such experimental treatment.  Employment of experimental treatment must comply with all applicable institutional, local, State or Federal law.

7.4 Reporting Research Results

The neuro-ophthalmologist who publishes his/her research results must do so professionally, truthfully, completely, and without distortion. In reporting research results to the news media, the neuro-ophthalmologist should make statements that are clear, understandable, and supportable by the facts.  The neuro-ophthalmologist should not publicize results of any research project until after the data has been subjected to appropriate peer review and is determined to be accurate.

7.5 Scientific Misconduct

Members engaged in scientific research shall abide by the highest professional, ethical and scientific standards as determined by the National Academy of Sciences.  Scientific misconduct may include but is not limited to deception, plagiarism, fabrication, or falsification of data, and, is a breach of this Code. 

C. ADMINISTRATIVE PROCEDURES

The Administrative Procedures form the third part of this Code. They provide for the structure and operation of the Ethics Committee; they provide detailed procedures which must be followed by the Committee when handling Inquiries or Challenges raised under the Code. All members of NANOS are required to comply with these Procedures; failure to cooperate with the Ethics Committee in a proceeding on a Challenge may be considered by the Committee according to the same procedures and with the same sanctions as failure to observe the Code.

1. Ethics Committee.

1.1 The Committee. The President, with approval of the Board of Directors appoints at least five (5), but not more than nine (9), neuro-ophthalmologists who are active Voting Members of NANOS who are authorized pursuant to Article II, Section 11 of the Bylaws to hold office.  Article III, Section 7, Standing Rules, of the NANOS Bylaws and the Standing Rules of the North American Neuro-Ophthalmology Society, as they are from time to time amended, govern the formation, term, and termination of the Ethics Committee and its membership.  NANOS will provide the administrative resources, such as teleconferencing, necessary for Ethics Committee activities.  

The Ethics Committee is responsible for: (i) responding to each inquiry regarding ethics and, if appropriate, making a recommendation to the Board of Directors regarding action, such as the development of an advisory opinion interpreting the Rules of Ethics in this Code; (ii) investigating each challenge regarding ethics and recommending whether the Board of Directors should make a determination that a NANOS member, regardless of the class of membership, area of practice, type of practice or licensure, has failed to observe the Code, and recommending an appropriate sanction as outlined herein below and in the Bylaws; (iii) serving as a resource for NANOS, its members and its Board of Directors regarding professional ethics and ethical issues; and (iv) assessing the Principles of Ethics, Rules of Ethics and Administrative Procedures in this Code periodically and recommending any amendments to the Board of Directors.

1.2 The Chair of the Committee. The President of NANOS appoints one (1) member of the Ethics Committee as the Committee's Chair to serve, at the will of the President, as the principal administrative officer responsible for management of the promulgation, interpretation and enforcement of this Code. The Chair should be a distinguished neuro-ophthalmologist who possesses recognized integrity and broad experience.

The Chair of the Committee is responsible directly to the Board of Directors; and, upon the approval of the Board of Directors is provided, with staff, legal counsel and other resources necessary to fulfill the responsibilities of administering this Code. The Chair presides at, and participates in, all meetings and hearings of the Ethics Committee. The Chair is responsible for ensuring that these Administrative Procedures are followed. The Chair may maintain liaison with entities, both public and private, which are interested or involved in medical ethics, particularly as they relate to neuro-ophthalmology.

1.3 The Vice Chair of the Committee. The President of NANOS may appoint one (1) member of the Committee as the Committee's Vice Chair to serve, at the will of the President, in the place of the Chair when the Chair is unable to serve.

1.4 Meetings of the Committee. Meetings of the Ethics Committee are called upon issuing at least seven (7) days' advanced written notice to all Ethics Committee members which may include electronic mail notice, and which notice may include a copy of the agenda for the meeting. A quorum of members is required to conduct any meeting. A quorum consists of a majority of all the appointed Committee members. Voting is by a majority of those present at a meeting (or by a majority of those submitting votes in a mail or electronic mail vote). Mail including electronic mail voting without a meeting is permitted where all Committee members submit mail and/or electronic votes or abstentions. Voting by proxy is not permitted. Meeting by teleconference is permitted. 

A member of the Committee must decline to participate in the consideration of, or the decision in, any matter before the Committee in which the member has a personal interest.  In the event that there is a dispute between the Committee members as to whether or not such a conflict exists, the Chair of the Committee shall resolve such conflict. In the event that the Chair of the Committee is the member with a potential conflict, then the President shall resolve any such conflict issue.

1.5 Indemnification. All Ethics Committee members, staff, and other individuals engaged in investigations at the written request of the Chair, are indemnified and defended by NANOS against liability arising from Committee-related activities to the extent provided by Article IV Section 3 of NANOS’ Bylaws.

2. Inquiries and Challenges.

2.1 Inquiry and Challenge Defined

An Inquiry is a request for information on an ethical or educational issue related to NANOS.

A Challenge is a formal complaint alleging that a member of NANOS has violated this Code.  The Ethics Committee will only review those Challenges which are related to members of NANOS or to NANOS itself.

2.2 Submission

Any member, physician, patient or member of the general public may submit a Challenge to the Ethics Committee.  Inquiries may only be submitted by NANOS members to the Ethics Committee. All Challenges must be in writing, signed by the submitter and mailed by certified mail, return receipt requested, to the current NANOS President at the address listed on the NANOS website with a copy sent on the same date, by mail, to the NANOS Executive Director who will immediately provide a copy to the Chair of the Ethics Committee. Further, the submitter(s) must agree to have their name(s) disclosed to the party who is the subject of the Challenge.  Anonymous Challenges or Inquiries will not be considered.

2.3 Preliminary Review

The Chair preliminarily reviews each submission involving this Code of Ethics to consider whether it may be an Inquiry (e.g., a request for issuance by the Board of Directors of an advisory opinion interpreting the Rules of Ethics in this Code) or a Challenge (i.e., a request for a finding by the Board of Directors that a member of NANOS has failed to observe the Rules of Ethics in this Code). A submission involving this Code, whether or not it is designated or phrased as an Inquiry or Challenge, may be construed by the Chair or the Committee as either an Inquiry or a Challenge. Inquiries may be considered without regard to their means or form of submission.

The Chair, at his/her sole discretion, may impose such temporary interim actions as the Chair deems necessary under the circumstances. Temporary interim actions implemented pursuant to this section shall be ratified by the Ethics Committee within 10 days from the date of issuance. In no event shall the duration of any temporary interim action exceed 60 days from the date the member is notified of such measure. 

2.4 Investigation

The Chair shall review each submission to determine if it warrants investigation.  When the Chair determines that further review by the Ethics Committee is required, then the Ethics Committee shall conduct an investigation into the specific facts or circumstances of such submission to whatever extent the Committee deems is necessary in order to clarify, expand or corroborate the information provided by the submitter. The Chair may supervise each investigation or may conduct the investigation personally. The Chair may be assisted in the conducting of an investigation by other Ethics Committee members or by the NANOS Executive Office, or the Ethics Committee staff. With the prior written approval of the Committee and the Board of Directors, the Chair may also be assisted by any other individual: (i) whose location, professional position or expertise might facilitate the investigation; and (ii) whose assistance is requested in writing by the Committee Chair; and (iii) who agrees in writing to follow the Administrative Procedures of this Code; (iv) but, only when such individual meets all of these conditions.

A member of NANOS who is the subject of a valid and actionable Challenge is informed in writing, by certified mail sent to the last known address provided by such member to NANOS, at the beginning of the Committee's investigation as to: (i) the nature of the challenge; (ii) the member’s obligation to cooperate fully in the Committee's investigation of the Challenge; and (iii) the opportunity to request a hearing on the Challenge before the Ethics Committee. Investigations involving Challenges are conducted in confidence, with all written communications sealed and marked "Personal and Confidential." The investigation must be conducted objectively and without prejudgment.

An investigation may be directed toward any aspect of an Inquiry or Challenge which is relevant or potentially relevant. The investigation may include one (1) or more site visits and informal interviews with the member who is the subject of the Challenge.

3. Proceedings on Inquiries

3.1 Hearing

In the course of an investigation involving an inquiry, the Committee may conduct an administrative hearing to receive the views of those who are interested in, or may be affected by, any action taken by the Board of Directors related to this Code. Thirty (30) days' advanced written notice of the hearing must be provided to the member(s) subject to the investigation. 

The notice may, at the Committee’s discretion, include a tentative proposed advisory opinion. The hearing is conducted by three (3) or more members of the Committee. The Chair of the Committee serves as the Hearing Officer to preside at the hearing and assure that these Administrative Procedures are followed. The Hearing Officer may issue an appropriate procedural or evidentiary ruling in the course of the hearing and may be assisted by legal counsel. The Hearing Officer presents at the hearing the issues raised by the Inquiry, the results of the investigation up to the time of the hearing, and any tentative proposed Committee recommendation to the Board of Directors for an advisory opinion. Information is offered through witnesses who may be assisted by legal counsel and are subject to questioning by the Committee. Any information may be considered which is relevant or potentially relevant. A written transcript or audio recording of the hearing will be created providing an official record of the hearing.

3.2 Recommendation

Upon completion of an investigation involving an Inquiry, the Ethics Committee must develop an advisory opinion which must be submitted to the Board of Directors for approval.

3.3 Advisory Opinion

The Board of Directors will issue an advisory opinion interpreting the Rules of Ethics in this Code: (i) upon receipt of a recommendation of the Ethics Committee arising from an Inquiry and following an investigation, or (ii) upon the recommendation of the Committee arising from its own initiative. Once issued by the Board of Directors, the advisory opinion may be promulgated by publication to the members of NANOS. Advisory opinions will also be maintained by the Ethics Committee and will be made available to any NANOS member upon request.

4. Proceedings on Challenges.

4.1 Hearing

In the course of an investigation involving a Challenge, the Committee may conduct a private adjudicative hearing, if one is requested by the NANOS member who is the subject of the Challenge, or the Committee may conduct a hearing on its own initiative.

The member who is the subject of the Challenge shall be given at least thirty (30) days advanced written notice of the Challenge and of his/her right to request a hearing on the Challenge. In the event that the party does elect to exercise his/her right to a hearing on the Challenge, then he/she shall be provided with an additional thirty (30) days advanced written notice of the hearing. The notice shall include the date, time and location of the hearing. The hearing shall be conducted by the Committee with at least three (3) Committee members participating. The hearing shall not be conducted by the original investigator or any Committee member who assisted substantially in the investigation of the Challenge. The Chair of the Ethics Committee may be one (1) of the three (3) or more Committee members conducting the hearing unless the individual is otherwise disqualified.

The Committee members participating in the hearing elect from their number a Hearing Officer to preside at the hearing and assure that these Administrative Procedures are followed. The Hearing Officer may issue any appropriate procedural or evidentiary rulings in the course of the hearing and may be assisted by legal counsel. The Hearing Officer, or a person or persons designated by the Hearing Officer, shall summarize for the Ethics Committee the results of the investigation up to the date of the hearing which are believed to support a finding that the member has failed to observe the Rules of Ethics, and may make such other introductory factual remarks as the Hearing Officer or the Hearing Officer's designate deems appropriate. A person designated by the Ethics Committee shall present the facts indicating that the member has failed to observe the Rules of Ethics, including documentary evidence and the testimony of witnesses. Those witnesses shall be available in person or by telephone for questioning by the members of the Ethics Committee and its legal counsel and by the member or the member's legal counsel.

The member subject to the Challenge may be assisted at the hearing, at their sole cost and expense, by legal counsel. The member or member’s legal counsel may present documentary evidence and the testimony of witnesses in the member's defense. Those witnesses shall be available in person or by telephone for questioning by the member or the member’s legal counsel and by the Ethics Committee and its legal counsel. Any information may be considered which is relevant or potentially relevant. The member may submit a written statement at the close of the hearing.  There shall be created a transcript or audio recording of the hearing. The hearing is closed to all except the Committee, the Chair, the member who is the subject of the Challenge, the respective witnesses (when testifying and at other times as determined by the Hearing Officer), legal counsel, and the official reporter. The official record of the hearing becomes a part of the record of the investigation of the Challenge.

4.2  Recommendation

Upon completion of an investigation involving a Challenge, the Ethics Committee recommends to the Board of Directors whether it should make a determination that the member who is the subject of the Challenge has failed to observe the Rules of Ethics in this Code. When the Committee recommends a determination by the Board of Directors of non-observance, the Committee also recommends imposition by the Board of Directors of an appropriate sanction. A copy of the Ethics Committee’s recommendation and when appropriate its statement of the basis for the recommendation shall be provided to the member. If the Committee recommends against a determination of non-observance, the Challenge is dismissed, with notice to the member who is the subject of the Challenge and to the submitter of the Challenge, and a summary report is made to the Board of Directors. In the sole discretion of the Ethics Committee and with the written consent of the member who was the subject of the Challenge, the Committee may recommend to the Board of Directors that the fact of the dismissal of the Challenge (and, in appropriate cases, the reasons for the dismissal) be publicized, and the Board of Directors may, in its sole discretion, determine the nature, extent and manner of such publicity.

4.3 Determination of Non-Observance

The Board of Directors makes the determination whether a member has failed to observe the Rules of Ethics in this Code and imposes an appropriate sanction upon the recommendation of the Ethics Committee arising from a Challenge. The Board of Directors shall review the recommendation of the Committee based upon the record of the investigation. The Board of Directors may accept, reject or modify the Committee's recommendation, either with respect to the determination of non-observance or with respect to the sanction. When the sanction involves termination of a member from NANOS the Board of Directors must approve the sanction by a 2/3 supermajority vote; failure to achieve the 2/3 supermajority vote for termination, will result in the imposition of a five (5) year suspension for the member unless the Board of Directors agrees by 2/3 supermajority vote to impose an alternative sanction.  If the Board of Directors makes a determination of non-observance, this determination and the imposition of a sanction are promulgated by written notice to the affected member. The individual or entity who submitted the Challenge may be provided with this notice at the Board of Directors’ discretion, but this notice will only be provided if the submitter has previously provided the Board of Directors with his/her written statement agreeing to maintain all confidential information contained in the notice. Additional publication occurs only to the extent provided in the sanctions themselves. If the Board of Directors does not make a determination of non-observance, the Challenge is dismissed with notice to the affected member and to the submitter of the Challenge.

4.4 Alternative Disposition

Before the Committee makes any recommendation to the Board of Directors as to a determination that a member has failed to observe the Rules of Ethics in this Code, the Committee may extend to the member an opportunity to submit a proposed alternative disposition of the matter in whole or in part upon terms and conditions suggested by the Ethics Committee. The terms and conditions may include sanctions and restrictions which are the same as, different from, or more or less restrictive than the sanctions contained in the paragraph 4.5 herein below or in the Bylaws, but shall in all cases include a written assurance by the member that the possible non-observance has been terminated and will not recur.

The decision of the Ethics Committee on whether to extend such an opportunity is entirely within the Committee's own discretion, based upon its investigation of the Challenge.  The Committee will also assess the nature and severity of the possible non-observance when viewed from the point of view of what is in the best interests of patients of the member who is the subject of the Challenge, when applicable. If an opportunity to submit a proposed alternative disposition is extended by the Ethics Committee, an alternative disposition will be considered only if the member submits in writing to the Chair of the Ethics Committee his/her proposed alternative disposition within thirty (30) days from the date of the Ethics Committee's notice to the member that it has extended this opportunity to the member. Such alternative disposition must substantially comply with the Ethics Committee’s proposed recommendations. If the member timely submits his/her proposed alternative disposition and it is approved by the Ethics Committee then the Ethics Committee shall present the alternative disposition to the Board of Directors for review and approval.   If it is accepted by a majority of the Board of Directors then the matter shall be resolved on the basis of the alternative disposition. 

If the member who submitted the Challenge has provided an advanced signed writing to the Ethics Committee wherein he/she has agreed to maintain all information related to the Challenge in confidence, then notice of the Board of Directors’ acceptance of an alternative disposition resolving the matter shall be given to the submitter.

4.5  Sanctions

Any of the following sanctions may be imposed by the Board of Directors upon a member who the Board of Directors has determined by a majority or in the event of a sanction involving permanent termination of membership by a supermajority 2/3 vote, has failed to observe the Rules of Ethics in this Code, although the sanction applied must reasonably relate to the nature and severity of the non-observance. The focus in assessing sanctions is on correcting the misconduct and deterrence of similar conduct in others:

(i) Censure or reprimand of the member, with publication of the violating activity which publication may or may not, at the discretion of the Board of Directors, include the violating individual’s name;
(ii) Suspension of the member from NANOS for a designated period of time, with publication of the determination and with or without publication, at the discretion of the Board of Directors, of the member's name; or
(iii) Expulsion or permanent termination of the member from NANOS, with or without publication of the determination and of the member's name.

In addition to and not in limitation of the foregoing, in any case in which the Board of Directors determines that a member has failed to observe the Rules of Ethics, the Board of Directors may impose the further sanction that the member shall not be entitled to sponsor, present, or participate in a lecture, poster, film, instruction course, panel, or exhibit booth at any meeting or program of, or sponsored by, NANOS: (A) for a period of up to five (5) calendar years from and after the effective date a sanction described in clause (i) or (ii) of this paragraph 4.5 is imposed for the first time upon the member; or (B) at any time from and after the effective date a sanction described in clause (i) or (ii) of this paragraph 4.5 is imposed for a second time upon the member; or (C) at any time from and after the effective date a sanction described in clause (iii) of this paragraph 4.5 is imposed upon the member.

Members who are suspended are deprived of all benefits and incidents of membership during the period of suspension.   In no case shall dues be refunded in the case of suspension or termination.  In the event that a suspended or terminated member is eligible for re-admittance to NANOS, such suspended or terminated member must pay all applicable dues and fees in full when re-applying for membership status in NANOS.

In the event that the member is suspended or if his or her membership in NANOS is permanently terminated, and the appeal, if any, sustains the determination on which the sanction is based, the Board of Directors may at its discretion authorize the Ethics Committee to communicate the determination and transfer a summary or the entire record of the proceeding on the Challenge to an appropriate entity engaged in the administration of law, a governmental program, or the regulation of the conduct of physicians.  The Chair of the Ethics Committee may appear, if requested by such agency or program, as a witness to that determination and record. Except in the instance of communication of the determination and transferal of the record, or in the instance of request of the record by the member who was the subject of the Challenge, the entire record, including the record of any appeal, is sealed by the Ethics Committee and the Board of Directors and no part of it is communicated by the members of the Board of Directors, the members of any appellate body, the members of the Ethics Committee, the staff or any others who assisted in the proceeding on the Challenge to any third parties. Members whose membership has been terminated as provided in this paragraph 4.5 may not reapply for membership in any class.

4.6 Appeal

Within thirty (30) days of receipt of notice of a determination by the Board of Directors that a Member has failed to observe the Rules of Ethics in this Code and of imposition of a sanction, the affected Member may submit to the Board of Directors in writing a request for an appeal. The Board of Directors shall establish an appellate body consisting of at least three (3), but not more than five (5), neuro-ophthalmologists who are members of NANOS and who did not participate in the Ethics Committee's investigation or in the Board of Directors determination. The appellate body conducts and completes the appeal within ninety (90) days after receipt of the request for an appeal. The purpose of the appeal is to provide an objective review of the original Challenge, the investigation and recommendation of the Ethics Committee, and the determination of the Ethics Committee, and the determination of the Board of Directors, but not of the sanction imposed. The appeal is limited to a review of the Ethics Committee’s and the Board of Directors’ application of the Rules of Ethics in this Code to the facts established in the investigation of the Challenge and to a review of the procedures followed to ascertain whether they were consistent with those detailed in these Administrative Procedures.

An appeal may not take into consideration any matters not included as part of the record of the Ethics Committee's investigation and the Board of Directors’ determination. The appeal consists of a review by the appellate body of the entire record of the proceeding on the Challenge and written appellate submission of the member who was the subject of the Challenge. Written appellate submissions and any reply submissions may be made by authorized representatives of the member and of the Board of Directors. Submissions are made according to the schedule established by the appellate body.  The decision of the appeal will be communicated to the Board of Directors for final disposition, requiring a supermajority vote as defined in section 4.5 above.   The decision of the appellate body either affirms or overrules the initial determination of the Board of Directors. The decision does not address the sanction imposed by the Board of Directors. The decision of the appellate body, including a statement of the reasons for the decision, is reported to the Board of Directors and is binding upon the Board of Directors, the member who is subject of the Challenge, and the Ethics Committee. 

4.7 Resignation

If a member who is the subject of a Challenge resigns from NANOS at any time during the pendency of the proceeding of the Challenge, the Challenge is dismissed without any further action by the Ethics Committee, the Board of Directors, or an appellate body established after an appeal; the entire record is sealed; and the member is barred from reapplying for membership in NANOS. The Board of Directors may authorize the Ethics Committee to communicate the fact and date of resignation, the name and address of the member who resigned and the fact that a Challenge pursuant to the Code of Ethics was pending at the time of the resignation to the NANOS membership. Such communications shall not reveal the nature of the Challenge. In addition, the Board of Directors may authorize the Ethics Committee to communicate the fact and date of resignation, and the fact and general nature of the Challenge on which a proceeding was pending at the time of the resignation, to an appropriate entity engaged in the administration of law or the regulation of the conduct of physicians, in a proceeding that relates to the subject matter of the Challenge.

4.8 Overriding Reporting Requirement

Notwithstanding anything expressly or apparently to the contrary contained in this Code, NANOS shall report such information, to such agency or agencies, and in such form and manner and frequency as may from time to time be prescribed by the Health Care Quality Improvement Act of 1986 and by regulations promulgated thereunder, all as from time to time may be amended, as a condition to the continued availability to NANOS of the protection from liability for damages afforded by such Act.

References

Portions of this Code were modified from the following codes of professional ethics and professional conduct:

1.American Academy of Orthopedic Surgeons: Guide to the Ethical Practice of Orthopedic Surgery, 1990.

2. American Association of Neurological Surgeons: American Association of Neurological Surgeons Code of Ethics.

3. American Academy of Ophthalmology: Code of Ethics of the American Academy of Ophthalmology, Inc., 1991.
4. American College of Physicians: American College of Physicians Ethics Manual. Part I: history; the patient; other physicians; Annals of Internal Medicine; 1989; 111:245-252.

5. American College of Physicians: American College of Physicians Ethics Manual. Part II: the physician and society; research; life-sustaining treatment; other issues. Annals of Internal Medicine; 1989; 111:327-335.

6. American College of Surgeons: American College of Surgeons Statements on Principles, 1989.

7. American Psychiatric Association: The Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry, 1989.

8. American Medical Association: Code of Medical Ethics and Current Opinions of the American Medical Association Council on Ethical and Judicial Affairs, 1992. American Academy of Neurology Code of Professional Conduct.1993

Ethics Subcommittee

Approved by the Ethics Subcommittee: Roy J. Meckler, MD - Chair, T. Goodglick, MD, M. Seybold, MD, H. S. Thompson , MD, and E. Fitzgibbon, MD (Copyright 2007 North American Neuro-Ophthalmology Society).

Re-Approved by the Ethics Subcommittee 2013: B. Frishberg, MD - Chair, E. FitzGibbon, MD, K. Kubis, MD, and P. McNussen, MD.

Re-Approved by NANOS Board 2021.

(modeled after https://www.arvo.org/annual-meeting/meeting-info/anti-harassment-policy/)

Membership of the North American Neuro-Ophthalmology Society consists of physicians, scientists, and trainees who seek to advance the field of neuro-ophthalmology through education, research, and developing clinical expertise.

Through our annual scientific meeting, support of professional seminars, publication of the Journal of Neuro-Ophthalmology, distribution of research grants in neuro-ophthalmology, and provision of e-mail discussions for lively clinical exchanges, we promote the free exchange of ideas as well as critical discourse and evaluation. This freedom of ideas and discussion is accompanied by a critical responsibility of professional conduct as well as personal, individual responsibilities to maintain an environment free from harassment.

A harassment-free environment is one in which conduct is based on respect for others and which does not in any way exploit power and/or status differences, such as those that exist between (but not limited to) faculty and students, senior and junior colleagues, employers and those seeking employment, or those who grant access to publication, presentation, or other NANOS activities and those who seek such access. It also includes conduct based on respect in peer-to-peer relationships.

Harassment may be defined as offensive or inappropriate comments or nonverbal conduct in relation to a person or group of persons on the basis of personal characteristics which (i) has the effect or purpose of creating a hostile or intimidating environment; or (ii) has the effect or purpose of offending or demeaning a person or group of persons; or (iii) functions implicitly or explicitly to limit participation in a professional program, activity or opportunity. It is also the case that the victim of harassment can be anyone affected by the offensive conduct, not just the individual at whom the conduct is directed. In other words, what one or two persons may consider "joking around" may be unwelcome to or offensive to a bystander. Sexual harassment includes unwelcome sexual advances, requests for sexual favors, and other verbal comment or physical conduct of a sexual nature by a person who knows or ought reasonably to know that such conduct is unwanted, including situations in which (i) the request or conduct involves any implied or expressed promise of professional reward for complying; or (ii) the request or conduct involves any implied or expressed threat of reprisal or denial of opportunity for refusing to comply; or (iii) the request or conduct results in what reasonably may be perceived as a hostile or intimidating environment. Such examples are illustrative, not exhaustive.

Sexual harassment does not refer to occasional compliments of a socially acceptable nature, or consensual personal and social relationships without a discriminatory effect. It refers to behavior that reasonably situated persons would regard as not welcome and as personally intimidating, hostile, or offensive.

NANOS is committed to the creation and maintenance of a harassment-free environment in all of its activities, meetings and events. The professional conduct of all members and non-members who participate in such activities, meetings and events is essential for preserving this standard. NANOS is also committed to preventing harassment by or toward its employees and third parties involved in its activities, including contractors, vendors, volunteers, or guests.

Any person who has experienced a serious verbal threat or any physical assault should contact law enforcement officials immediately.

Any person who desires to report a possible violation of the NANOS Anti-harassment Policy should promptly contact the NANOS Executive Office through this form. If the incident occurs during any event organized by NANOS, then the Executive Office should be directly contacted as soon as possible. The matter will be discussed by either the President, President Elect or Executive Vice President of NANOS or the Ethics committee depending on the content of the incident. NANOS has established procedures to address complaints under this Policy that provide guidelines for gathering information, maintaining confidentiality to the extent possible, reaching a determination, and determining the consequences. The investigation of a complaint shall include discussing the complaint with the individual(s) against which the complaint has been directed. Once determination is made, all parties will be apprised of the resolution. No individual will be retaliated against for making a complaint or assisting with the investigation of a complaint. Anyone who is found to have engaged in harassment will be subject to disciplinary action, which may include, but is not limited to, reprimand and/or suspension or termination of the individual's membership and/or participation in current or future NANOS operated, sponsored, or affiliated events.

Procedures

The procedures for investigation and redress are split into two categories: allegations of harassment against members and allegations against non-members. If the person against whom the allegation of harassment is made falls into two categories, for example, the person is both a vendor and a member, they will be treated as a member.

1. Allegations Against Members
   1. NANOS receives a report of harassment by a member during or in association with a NANOS-sponsored event, meeting or social gathering.
   2. The Executive Vice President, President, or President Elect may request any or all of the parties to leave the event, meeting, or gathering immediately upon receipt of the report, depending on the circumstances.
   3. Any allegation which appears to be potentially criminal in nature will be promptly reported to appropriate authorities.
   4. The President, Executive Vice President, and President Elect will convene a three-person panel, including one member from the NANOS Ethics Committee and at least one from the Board of Directors. This panel will be convened as soon as possible after the receipt of the report, but no later than ten business days following its receipt.
   5. The panel will conduct a confidential investigation, with both parties having the choice to submit in-person or written statements. Third party witness statements may only be in writing.
   6. The panel will decide the consequences, if any, including, but not limited to dismissal of the allegation, apology, reprimand, suspension, or termination of membership in the Society, with loss of any rights and privileges afforded to NANOS members.
   7. The party receiving the consequences may appeal to a new three-person panel also convened by the President, President Elect, and Executive Vice President , at his or her option The recommendation of this panel is final.
2. Allegations Against Non-Members
   1. NANOS receives a report of harassment by a non-member during or in association with a NANOS-sponsored event, meeting or social gathering.
   2. The President, Executive Vice President or President Elect may request any or all of the parties to leave the event, meeting, or gathering immediately upon receipt of the report, depending on the circumstances.
   3. Any allegation which appears to be potentially criminal in nature will be promptly reported to appropriate authorities.
   4. The President, Executive Vice President or President Elect will convene a three-person panel including one member from the Ethics Committee. This panel will be convened as soon as possible after receipt of the report, but no later than ten business days following its receipt.
   5. The panel will conduct a confidential investigation, with both parties having the choice to submit in-person or written statements. Third party witness statements may only be in writing.
   6. The panel will decide the consequences, if any, including, but not limited to dismissal of the allegation, apology, withdrawal of vendor privileges for a specific time or permanently, or other consequences.
   7. The party receiving the consequences may appeal to a new three-person panel and, at his or her option. The recommendation of this panel is final.

To fill out a Reporting Form, or to contact us directly, click here

The North American Neuro-Ophthalmology Society (NANOS) provides NANOS members with networking and collaborative opportunities through online communities that are powered by Higher Logic, a member engagement platform for associations. NANOS has more than forty online committee communities, Officer and Board communities, as well as several open member-only communities that cater to various needs of our membership. By participating in any or all of  the NANOS online communication platforms members agree to adhere to the NANOS Online Communication Platforms Rules and Terms and reserve discussions for appropriate topics. NANOS reserves the right to modify these Online Communication Platforms Rules and Terms at any time without notice and to suspend or terminate access to any NANOS online communication platforms for users who violate these rules and terms. 

NANOS does not undertake editorial control of postings. Posted messages contained within the NANOS online communication platforms express the views of their author, not necessarily the views of the online community, or of NANOS, its administrative office/agents, or its Executive Board. Any user who feels that a posted message is objectionable is encouraged to contact us immediately by email. Such content will be reviewed by Senior NANOS members familiar with these platforms and rules, and if the content is felt to be inappropriate, sanctioning of the person posting the inappropriate content may occur without further warning.

Online Communication Rules: 

• Commercial Messages: Any communication that contains spam is prohibited. Advertising or any form of commercial solicitation, including job postings and links to promote and/or purchase products or services is not allowed (unless prior approval has been granted by the NANOS Board). Contact individual members directly with products and services that you believe would help them. Visit the NANOS's Career Center to submit a job posting. 
• No content that would allow identification of a patient is permitted.
• The posting of private communications (including, but not limited to e-mail, private messages, letters, faxes) without the consent of all parties to said communication is strictly prohibited.
• Copyright: You agree not to post any copyrighted material unless the copyright is owned by you or by the community, or you can provide NANOS with evidence that you have been granted permission to use the copyrighted material by the person/entity owning the copyright 
• Courtesy: Participation in NANOS online communication platforms assumes that authors will not be rude to other members, and will remember the basic tenet that the purpose of the platforms is to further the missions of NANOS and its members, and to improve neuro-ophthalmic care.
• Use caution: Communicating on an online communication platform is different from face-to-face communication. Only the words are seen, not facial expressions or tone of voice. Please pay careful attention to how words are used. Remember, words entered in a burst of passion or anger will be there for everyone to see, sometimes long after those intense feelings have passed. This is not meant to discourage spontaneity, but a reminder of the long-term existence and ramifications of posting to an online communication platform.
  Do not post any material that is defamatory, abusive, profane, threatening, offensive, illegal, or violates any third party’s rights.
• Privacy Laws: Comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and applicable state and federal privacy laws. Confidentiality of patient information must be maintained. No names, initials, or other readily identifying information may be included in clinical resumes placed on the online communication platforms
• Antitrust: NANOS complies with all antitrust laws and reminds all users to guard against activity that could be construed as a violation of the antitrust laws. As a professional organization, we must also be careful not to compare fees for services we provide, in order to avoid even the appearance of collusion, coordination or price fixing. General discussions about CPT and ICD coding are acceptable, as well as reporting of aggregate fee and coding data for the subspecialty. Your using the NANOS communication platform(s) indicates that you have reviewed and agree to abide by the complete Avoidance of Anticompetitive Behavior Guidelines. Click here to review the complete Avoidance of Anticompetitive Behavior Guidelines. 
  1. Do not discuss or share fees or prices.
  2. Do not discuss or share salaries or terms of employment.
  3. Do not propose to allocate or restrict patient markets.
  4. Do not propose to collectively refuse to do business with one or more providers, third-party payers, hospitals, suppliers, purchasers, or patients.
  5. Do not propose conduct that would restrict free trade in providing health care services.
• Surveys: Do not post surveys to NANOS online communication platforms that have not been reviewed and approved by the NANOS Executive Board or its designated committee for dissemination to specific audiences. Please click here to learn how to request an announcement of clinical surveys and investigations to NANOS membership. 

Violations of these rules will be subject to a ZERO TOLERANCE policy, and may lead to reprimand, or other sanctions up to and including temporary or permanent ban from participation in NANOS online communication platforms. Any grievances with the enforcement of these policies should not be expressed via public online forum, but rather by personal message to the senior NANOS member(s) responsible for the monitoring of the content. In any case, the decision of the Board and its agents shall be final. NANOS reserves the right to immediately terminate access to any user who does not abide by these rules and terms. 

NANOS accepts no responsibility for the opinions and information posted on any NANOS online communication platform except if posted by the NANOS Executive office or assigned community moderators. NANOS disclaims all warranties regarding information posted on any NANOS online communication platform whether posted by NANOS or any third party; this disclaimer includes all implied warranties of merchantability and fitness. 

IN NO EVENT WILL THE NORTH AMERICAN NEURO-OPHTHALMOLOGY SOCIETY (NANOS), ITS OFFICERS, EXECUTIVE BOARD, EXECUTIVE STAFF OR WEBMASTER/MODERATOR BE LIABLE FOR ANY DAMAGES WHATSOEVER (INCLUDING WITHOUT LIMITATION DAMAGES RELATING TO LOST REVENUES OR PROFITS, LOST DATA, WORK STOPPAGE, COMPUTER FAILURE OR MALFUNCTION) RESULTING FROM OR IN ANY WAY RELATED TO THE USE OR PERFORMANCE OF ANY MATERIALS POSTED ON OR MADE AVAILABLE ON THE NANOS COMMUNICATION PLATFORMSOR ANY OTHER WEBSITE TO WHICH A LINK IS PROVIDED OR ON WHICH A LINK IS PROVIDED TO THESE COMMUNICATION PLATFORMS, EVEN IF NANOS HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES AND REGARDLESS OF THE LEGAL THEORY ON WHICH SUCH DAMAGES ARE BASED. You agree, through your use of this service, that you will not use NANOS online communication platforms to post any material which is knowingly false and/or defamatory, inaccurate, abusive, vulgar, hateful, harassing, obscene, profane, sexually oriented, threatening, invasive of a person's privacy, or otherwise violative of any law. Material that advocates illegal activity or discusses illegal activities with the intent to commit them is forbidden.

We respect your privacy

Any personal information you provide to us including and similar to your name, address, telephone number and e-mail address will not be released, sold, or rented to any entities or individuals outside of our organization except as noted below.

With Whom Do We Share the Personal Information We Collect Through This Site?

Our Service Providers. 
We may share your personal information with companies (including our affiliates) that perform services on our behalf, for example, companies that help process credit card payments. Our service providers are required by contract to protect the confidentiality of the personal information we share with them and to use it only to provide specific services on our behalf.

Business Transfers. 
Your personal information may be transferred to another entity (either an affiliated entity or an unrelated third party) in connection with a merger, reorganization, dissolution or similar corporate event. If such a transfer were ever to occur, the acquiring entity’s use of your personal information will still be subject to this Privacy Policy.

Government and Legal Disclosures.
We may disclose the personal information we collect through this Site, when we, in good faith, believe disclosure is appropriate to comply with the law (or a court order or subpoena); to prevent or investigate a possible crime, such as fraud or identity theft; to enforce our Terms and Rules or other agreements that govern your use of this Site; or to protect the rights, property or safety of our company, our users, or others.

External Sites

We are not responsible for the content of external internet sites. You are advised to read the privacy policy of external sites before disclosing any personal information.

Cookies

A "cookie" is a small data text file that is placed in your browser and allows us to recognize you each time you visit this site (personalization, etc). Cookies themselves do not contain any personal information, and we do not use cookies to collect personal information. Cookies may also be used by 3rd party content providers such as newsfeeds.

Remember The Risks Whenever You Use The Internet

While we do our best to protect your personal information, we cannot guarantee the security of any information that you transmit to us and you are solely responsible for maintaining the secrecy of any passwords or other account information. In addition, other Internet sites or services that may be accessible through our site have separate data and privacy practices independent of us, and therefore we disclaim any responsibility or liability for their policies or actions. Please contact those vendors and others directly if you have any questions about their privacy policies. For any other information please contact us by emailing info@nanosweb.org.

Meeting Security

Individual online communication platform participants as hosts are responsible for ensuring the security of any meetings arranged through invitations made on the NANOS online communications platforms.

For example, any Zoom meetings should be held with the use of in-meeting security options and the host or any co-host should be fully familiar with those options. The Security icon in the Zoom meeting controls allows the host or co-host of a meeting to enable or disable options during a meeting to secure the meeting and minimize disruption during the meeting. Available security options can enable the waiting room, remove participants, control screen sharing and lock meeting features.

Any security breach should be reported as necessary to the meeting platform security team, and to law enforcement if criminal activity is involved. The incident should also be reported to NANOS; however, NANOS is not responsible for the consequences of any security breach that occurs in a meeting hosted by an individual platform participant or participants.

These guidelines apply to all NANOS email discussion lists or listservs, meetings, or group e-mail.

1. Do not discuss or share fees or prices.
2. Do not discuss or share salaries or terms of employment.
3. Do not propose to allocate or restrict patient markets.
4. Do not propose to collectively refuse to do business with one or more providers, third-party payers, hospitals, suppliers, purchasers, or patients.
5. Do not propose conduct that would restrict free trade in providing health care services.

To review the complete Avoidance of Anticompetitive Behavior Guidelines, click here

Antitrust Compliance Training and Scenarios

To view the antitrust training video, click here (member log-in required)

To view the PDF of the training, click here (member log-in required)

This advisory opinion is an adaption of the American Academy of Ophthalmology Advisory Opinion and edited with their permission.

Subject
Social Media and Professionalism

Issues Raised
What are the ethical issues and risks to professionalism inherent in social media use?

Applicable Rules
Rule 2.1. Professional Competence
Rule 6.1. Public Communication
Rule 4.0. Conflicts of Interest
Rule 2.3. Patient Confidentiality

Background
Social media refers to the interactions among people in which they create, share, and exchange information and ideas in virtual communities and networks.1 In this Advisory Opinion, we use the term to include email, blogs and micro-blogs (such as Twitter), internet forums (such as doctors.net), content communities (such as YouTube and Flickr), and social networking sites (such as Facebook and LinkedIn). As a blend of technology, social interaction, and information sharing, social media is a new paradigm for society and has created an extraordinary transformation of cultural communication.

It has enabled the sharing of health information that is unprecedented in the medical profession’s long history. Due to the relative expansion of this form of communication, only recently have user-guidelines been published by various state boards of medicine and professional medical associations. These guidelines, however, appear to offer conflicting information for the social media user. The guidelines agree on strict adherence to privacy, the need to maximize one’s personal online privacy settings, and recommendations to separate personal and public personas. However, there is a lack of consensus on several points, including medical information posted by the patients themselves, anonymous physician postings, posting patient information with consent even after a patient posts it publicly, and managing conflicts of interest. 2

Although incomplete or imperfect, published guidelines may be helpful for the user because, lacking precedent for this sort of cultural shift, the medical profession has few role models for physicians regarding appropriate social media behavior. Social media has changed traditional physician-patient communication by decreasing the knowledge gap between physician and patient thus equalizing access to many types of health-related information. For patient-users, it has also changed the sanctity of the confidential physician – patient relationship primarily by patients’ purposeful online sharing of confidential information and the inadvertent online disclosure of confidential information by friends and family. There is also a new term to add to our professional parlance, “medical surveillance,” that describes physician-trolling of patient communications on blogs, web sites, and other platforms to gather information about existing patients or for research purposes.

Ethical concerns related to professionalism and the use of social media include the physician’s competence to serve as an online expert, appropriate use of social media in research studies, use of appropriate communication standards, disclosures of relevant conflicts of interests, and adherence to the confidentiality of the physician-patient relationship. All communications with patients, the public, and colleagues, whether via social media or in more traditional frameworks, must adhere to appropriate standards of ethics and professionalism to maintain the public’s trust in the medical profession.

General Discussion
In the face of conflicting guidelines, the following general recommendations for the use of social media, based on the North American Neuro-Ophthalmology Society's Code of Ethics, are made to educate the physician and to protect patients and the profession. Ultimately, it is the responsibility of the physician to act in the best interest of the patient, regardless of what type of communication medium is used.

Rule 2.1. Professional Competence. The physician should be competent by virtue of specific training or experience to act as an online expert and should have a legitimate reason for adding to an ongoing online dialogue. Social media provides a very low bar for declaring yourself an expert, thus a true medical expert should make his or her identify and qualifications known.

Rule 6.1. Public Communication. As in all professional communications to the public, promotions or information provided on social media should be offered in a manner that is not false, deceptive or misleading, including information about the participating physician’s skills, training, or experience. Ideally, physicians should offer evidence-based, scientifically valid information that is 1) useful to the intended audience, 2) understandable to the intended audience, and 3) in an appropriate, shareable format. The physician should identify him or herself and his/her institutional or representative affiliations. If a communication via social media results from payment by or on behalf of a physician, this must be disclosed unless the nature, format or medium makes it apparent.

Rule 4.0. Conflicts of Interest. A conflict of interest exists when professional judgment concerning the well-being of a patient, or the information provided to a patient population via social media, has a reasonable chance of being influenced by other interests of the provider. In a 2008 study, 31% of physician blogs contained product endorsements lacking disclosure3 and in a 2011-2012 survey, 20% of state medical boards noted failed online disclosures on the part of physicians.4 If a physician is compensated in any manner for his/her participation in a social media setting or if a posting contains a relevant product endorsement, the payment and/or the potential conflict of interest should be disclosed as part of the posting. The brevity of social media posts complicates disclosure, thus the physician must make a concerted effort to assure appropriate disclosure. Disclosure of a conflict of interest is required in communications to patients, the public, and colleagues.

Rule 2.3. Patient Confidentiality. Special consideration should be taken when using social media to safeguard confidential health information consistent with the law. As in all public communications, physicians should refrain from using patient identifiers in order to maintain confidentially and to protect patient privacy. Interestingly, social media has engendered a social willingness to share private health information far beyond the boundaries of traditionally-held norms of confidentiality, which may complicate the physician’s efforts to maintain patient confidences.

The HIPAA Privacy Rule5 allows physicians and other health care entities to rely on “professional ethics and best judgments” when determining whether to disclose confidential information in certain permitted circumstances. However, even if a patient has revealed confidential information about themselves on a social media platform, the physician should consider obtaining express permission from the patient before following suit. The federal Office of Civil Rights, which is responsible for HIPAA regulations and enforcement, defines a breach of confidentially under HIPAA as, “… an impermissible use or disclosure under the Privacy Rule that compromises the security or privacy of the protected health information such that the use or disclosure poses a significant risk of financial, reputational, or other harm to the affected individual.”6 There are no restrictions on the use or disclosure of de-identified health information.

When queried directly, physicians may be tempted to offer online medical advice; however, issues of confidentiality and potential liability complicate this practice. The Ophthalmic Mutual Insurance Company (OMIC) notes that online medical opinions may be considered “direct patient treatment” and recommends that interested physicians contact risk-management specialists for advice about “properly document(ing) your decision-making process and differential diagnosis, including the use of appropriate disclaimers’, as well as the applicability of state licensing requirements and whether they would be waived “when consultations are not delivered ‘live’”.7

Summary
These general recommendations are offered to guide physicians in the appropriate use of social media and may be used to fill gaps in state medical boards’ published guidelines. Physicians should adhere to appropriate standards of ethics and professionalism to maintain confidentiality and honesty and the public’s trust in our profession.

NANOS offers the following recommendations for how to be a positive influence in social media settings and to maintain professionalism:

a. Identify yourself and your qualifications
b. Identify why you are offering information and how it is substantiated
c. Be trustworthy, honest, and reliable
d. Provide knowledge and information that is useful and desirable
e. Share appropriately

Notes
1 Ahlqvist, T, et al. "Social media road maps: Exploring the futures triggered by social media". VTT Tiedotteita - Valtion Teknillinen Tutkimuskeskus (2454):13, 2008.
2 DeCamp, M. Social Media and Medical Professionalism: Toward an Expanded Program Arch Intern Med. 2012;172(18):1418-1419.
3 Laqu T, et al. Content of weblogs written by health professionals. J Gen Intern Med. 2008 Oct:23(10): 1642-1646.
4 Greyson, SR, et al. Physician Violations of Online Professionalism and Disciplinary Actions: A National Survey of State Medical Boards. JAMA. 2012;307(11):1141-1142
5 Summary of the HIPAA Privacy Rule
6 HIPAA Breach Notification Rule
7 OMIC: Policy Holder Services

Applicable Rules (from NANOS Code of Ethics)
“Rule 2.1. Professional Competence. The neuro-ophthalmologist must practice only within the scope of his/her training, experience, and competence. The neuro-ophthalmologist should provide care that represents the prevailing standards of neuro-ophthalmologic practice. To maintain this level of competency, neuro-ophthalmologists should participate in a regular program of continuing education. The neuro-ophthalmologist must not misrepresent credentials, training, experience, ability or results.”

“Rule 6.1. Public Communication. The neuro-ophthalmologist must represent himself/herself to the public accurately. He/She must not convey false, untruthful, misleading, or deceptive statements.  The physician must not omit material information without which the communication could be deemed to be deceptive. Communications must not appeal to an individual’s anxiety in an excessive or unfair manner and they must not create unjustified expectations of results. The neuro-ophthalmologist’s credentials, training, experience or ability must be accurately represented.  In no event should a neuro-ophthalmologist publicly use or otherwise disclose any patient's medical condition or treatment without the patient's prior written consent.”

“Rule 4.0. Conflicts of Interest. 4.1 The Patient's Interest is Paramount. A conflict of interest exists when professional judgment concerning the well-being of the patient has a reasonable chance of being influenced by other interests of the physician providing treatment. When a conflict of interest occurs or when one becomes apparent the treating physician has a duty to disclose such conflict to the patient.  The neuro-ophthalmologist must attempt to resolve any conflict of interest which arises to ensure that the patient’s treatment plan continues to service the best interest of the patient. If the conflict cannot be eliminated, the neuro-ophthalmologist must notify the patient of the specific conflict and, if the patient requires, terminate the physician/patient relationship. 4.2 Conflicting Ethical Duties. A neuro-ophthalmologist ordinarily must maintain the patient's confidentiality; however, if the neuro-ophthalmologist becomes aware that the patient intends to injure an identifiable third party, then the neuro-ophthalmologist must take reasonable steps to warn the third party or notify the appropriate authorities. Similarly, when the neuro-ophthalmologist becomes aware of the patient’s intent to injure members of the general public, the neuro-ophthalmologist must take reasonable steps to advise the appropriate public officials or agencies of the danger.  If the physician is uncertain of his/her duties he/she should immediately consult with the Ethics Committee.”

“Rule 2.3. Patient Confidentiality. The neuro-ophthalmologist must maintain the patient’s privacy and confidentiality and must comply with all applicable state and federal confidentiality rules and regulations.”

Other References
The HIPAA Privacy Rule, subsection on Research (45 CFR 164.501, 164.508, 164.512(i)) The Privacy Rule both permits important research and, at the same time, encourages patients to participate in research by providing much needed assurances about the privacy of their health information. For specific information visit the FTC’s Office of Civil Rights’ website (https://www.hhs.gov/hipaa/for-professionals/special-topics/research/index.html and/or consult your IRB.

“Principle 1. Ethics in Ophthalmology. Ethics are moral values. An issue of ethics in ophthalmology is resolved by the determination that the best interest of the patient is served.”

“Principle 7. An Ophthalmologist's Responsibility. It is the responsibility of the ophthalmologist to act in the best interest of the patient.”

American Academy of Ophthalmology Advisory Opinions of the Code of Ethics, Communications to the Public, Disclosure of Professionally Related Commercial Interests, Release and Confidentiality of Patient Records.

The Ethics Committee of the North American Neuro-Ophthalmology Society (NANOS) developed the North American Neuro-Ophthalmology Society Code of Ethics (the Code) to formalize the standards of professional behavior for all members of NANOS, regardless of the class of membership. The primary goal of the Code is to promote the highest quality of neuro-ophthalmologic research and patient care.

American Medical Association, Council on Ethical and Judicial Affairs Opinion 9.124 - Professionalism in the Use of Social Media. Issued June 2011 based on the report "Professionalism in the Use of Social Media," adopted November 2010. http://www.ama-assn.org/ama/pub/physician-resources/ medical-ethics/code-medical-ethics/opinion9124.page?
Accessed January 23, 2017.

The Federation of State Medical Boards, Model Policy Guidelines for the Appropriate Use of Social Media and Social Networking in Medical Practice, adopted April 28, 2012.

Bosslet, GT, et al. The patient-doctor relationship and online social networks: results of a national survey. J Gen Intern Med. 2011 Oct;26(10):1168-74.

Budd, L. Physician tweet thyself: A guide for integrating social media into medical practice. BCMJ. Jan/Feb 2013; 55(1):38-40.

Chretien KC, Azar J, Kind T. Physicians on Twitter. JAMA. 2011 Feb 9;305(6):566–8.

Collier, R. Professionalism: Social Media Mishaps. CMAJ. 2012 Sept; 184(12).

DeCamp, M. Social Media and Medical Professionalism: Toward an Expanded Program. Arch Intern Med. 2012;172(18):1418-1419.

Farnan JM, Snyder Sulmasy L, Worster BK, et al. Online medical professionalism: patient and public relationships: policy statement from the American College of Physicians and the Federation of State Medical Boards. Ann Intern Med. 2013;158(8):620-627.

Greyson, SR, et al. Physician Violations of Online Professionalism and Disciplinary Actions: A National Survey of State Medical Boards. JAMA. 2012;307(11):1141-1142.

Greyson, SR, et al. Online professionalism investigations by state medical boards: first, do no harm. Ann Intern Med. 2013 Jan 15;158(2).

Laqu T, et al. Content of weblogs written by health professionals. J Gen Intern Med. 2008 Oct:23(10): 1642-1646.

McGowan, BS, et al. Understanding the Factors That Influence the Adoption and Meaningful Use of Social Media by Physicians to Share Medical Information. J Med Internet Res. 2012 Sep-Oct; 14(5).

Moorhead, SA, et al. A New Dimension of Health Care: Systematic Review of the Uses, Benefits, and Limitations of Social Media for Health Communication. J Med Internet Res. 2013 April; 15(4).

Mostaghimi A. et al. Professionalism in the Digital Age. Ann Intern Med. 2011; 154(8): 560-562.

Peregrin T. Time to tweet: social networking for surgeons. Bull Am Coll Surg. 2011 Feb;96(2):46–8.

Proposed by: NANOS Ethics Committee, January 2021
Approved by: NANOS Board of Directors, January 2021

a. Encouragement of Reporting. NANOS encourages the reporting of suspected illegal practices or serious violations of NANOS’s adopted policies, including illegal or financially improper conduct by NANOS itself, by its leadership, or by others on its behalf. Appropriate subjects to raise under this policy include financial improprieties, accounting or audit matters, and ethical violations.  

b. Protection from Retaliation. NANOS prohibits retaliation for the making of good faith reports under this policy or for participating in a review or investigation under this policy. This protection extends to those whose allegations are made in good faith but prove to be mistaken.  

c. Format and Content. A report under this policy must be in writing and must sufficiently describe the suspected conduct that is the basis for the report. Reports should identify the person who prepared and is submitting the report, though anonymous reports may be considered if sufficiently detailed.  

d. Submission. A report must be submitted to the President and Executive Vice President. If both of those persons are implicated in the report, it may be directed to the President-Elect, or Secretary or Treasurer.

To request an announcement of clinical surveys and investigations to NANOS membership, please click here.

Research Mentorship Program

NANOS is now offering research mentorship to members who have questions or issues about specific projects. Researchers can potentially receive assistance or direction in identifying and understanding basic issues surrounding study design, bias, confounding, and biostatistics in their studies.  It should be noted that these efforts are not intended to provide a comprehensive review of the project but rather give guidance.  Studies can be submitted for advice at any stage, but we strongly recommend consultation be sought prior to starting the study. Please note that the mentor is not acting in the role of a collaborator. Mentor authorship is not anticipated if a publication results from this type of research consultation. Mentors are experienced in funded research and generally come from the research committee or their delegates.

To learn more about the research mentorship program, please click here.

Click here to learn about the NORDIC Clinical Trials.

Speaker Agreement on Terms of Ownership of Content
These Speaker Agreement Terms on Ownership of Content (the “Terms”) apply to the content of the presentation, including hand-outs, slide content, graphics, syllabus materials, and audiovisual or audio clips (the “Presentation”), at any NANOS-sponsored event, whether in-person, virtual, or hybrid (the “Event”), and to any individual speaker or group of speakers, whether NANOS member or non-member and whether volunteer or paid (the “Speaker”). These Terms supersede any other agreement about the content of the Presentation by the Speaker at the NANOS Event and are deemed incorporated into any later agreement about the Presentation, unless expressly modified in writing by NANOS and the Speaker.

The Terms are divided into two sections:
(A)    the Speaker’s obligation to respect the ownership of content from others; and
(B)    allocation of rights in the Presentation at the NANOS Event.

The parties agree that these Terms do not create an obligation for NANOS to use the Presentation at a NANOS-sponsored event, and that NANOS may cancel or decline to use the Presentation at any time in its sole discretion, including if it determines that use of the Presentation may be harmful to its reputation, does not further its mission, may create the appearance of a conflict of interest, or for any other reason.

A.    Respecting the Ownership of Content from Others
A-1. NANOS encourages the Speaker to be professional, authoritative, and accurate -- but also creative, passionate, and engaging -- in the Speaker’s Presentation. At the same time, the Speaker is legally obligated to respect the ownership of content from others that the Speaker incorporates into the Presentation. Not only the Speaker, but also NANOS, are put at legal risk if the Speaker fails to do that.
A-2. The Speaker therefore warrants that the Presentation will not include any content that violates, or infringes upon, any copyrights, trademarks, trade secrets, patents, personal privacy rights, data privacy rights, or any other intellectual property rights of any kind of any third parties, that the Presentation is factually accurate, to the best of the Speaker’s knowledge, and that the Presentation contains no content that is defamatory, harassing, or otherwise violates other rights of any third parties. The Speaker understands that there is no educational-setting exemption from infringement applicable to the NANOS-sponsored Event.
A-3. Accordingly, the Speaker warrants that all text, graphics, charts, photos, drawings, video, audio, including music, or any other content incorporated into the Presentation will be: (a) created by, and owned by, the Speaker, (b) subject to written permission from the owner to the Speaker authorizing its use in the Presentation, or (c) in the public domain (as defined in the US 2 Copyright Act), unless use of the content does not constitute infringement because it is a fair use under the US Copyright Act.
A-4. If the Speaker believes any content is protected under the fair use exemption (such as quoting briefly from another’s work for the purpose of criticism), the Speaker will specify the part of the content at issue when providing it for NANOS review, including the Speaker’s basis for
 
characterizing it as within the fair use exemption. The Speaker agrees not to use that content in the Presentation if NANOS requests that it not be used.
A-5. In particular, and without limitation, the Speaker will not use video, music, or other audio content in the Presentation unless: (a) the Speaker has obtained written permission from the owner of the video, music, or other audio content to the Speaker authorizing use of the video, music, or other audio content in the Presentation, or (b) the video, music, or other audio content is in the public domain.
A-6. Where the Speaker has obtained permission to use content owned by others, the Speaker warrants that the use of that content in the Presentation will not exceed the scope of the permission, or violate any conditions, or exceed any limits, incorporated into the permission.
A-7. The Speaker understands that it is the Speaker’s own responsibility to obtain any required permission or authorization to use the content of others; NANOS will not assist or advise in that effort. Each Speaker will be responsible to assure that they themselves, and all others in any group Presentation, comply with these terms on use of content owned by others.
A-8. The Speaker will provide the full content of the Presentation, including hand-outs, no later than the date indicated in the meeting timeline or other direction from NANOS. Failure by the Speaker to comply may result in the Speaker being removed from the program for the NANOS-sponsored event.

B.    Rights in the Presentation
B-1. The Speaker will own all rights, including but not limited to all intellectual property rights, in the Presentation except that the Speaker grants to NANOS an unlimited, permanent, nonexclusive, royalty-free license to all rights to the Presentation, including any hand-outs and syllabus materials, under which NANOS may, at its discretion, copy, record, transcribe, publicly perform, publicly display, translate and use all or any part of the Presentation in the form provided by the Speaker or in any derivative form and in any media and format, whether now known or later developed, including for commercial exploitation but, in any event, with attribution to the Speaker.
B-2. The Speaker authorizes NANOS to use the Speaker’s name, image, voice, credentials, and biographical information provided by the Speaker in connection with the use and promotion of any aspect of the Presentation and the marketing, publication, advertising, and related products and services of NANOS, including through social media tools. The Speaker warrants that the Speaker has full power and authority to grant this release and license.

NANOS is committed to promoting medical education and the exchange of scientific information to support our primary mission of achieving excellence in patient care through the support and promotion of education.  In addition, NANOS is committed to promoting collaboration between medical specialties, and between healthcare providers in different parts of the world who share our values.

To this end, NANOS will endorse medical meetings that are consistent with these goals and will partner with other medical societies and organizations to support scientific and educational meetings/sessions that pertain to neuro-ophthalmology.

NOTE: No presentation or program that cites NANOS as a sponsor or implies such sponsorship or involvement of NANOS in the activity, or uses the NANOS logo, may do so without advance review by and express written permission from the NANOS Board as outlined in the process below.  Failure to adhere to this requirement may lead to the NANOS Board applying sanctions against the offending member for this behaviour.

FORMAL ENDORSEMENT OF MEETINGS/SESSIONS

NANOS has agreed to host symposia at various international meetings. Examples of international meetings include but not limited to PAAO, SOE, MEACO, APAO, WOC and ASNOS. A few members of NANOS already attend these meetings and approaches have been made to individual members of NANOS by several conference organizers.

The arrangements are as follows:

1. Individual members of NANOS planning to attend a specific international meeting may contact organizers of local meetings to gauge interest in mounting a NANOS co-sponsored symposium, or vice versa.
2. The local meeting organizer would then formally request this individual to convene a symposium on behalf of NANOS.
3. If the Board approves the application, this convener will then draw up a proposed program of topics and speakers with help from the International Relations Committee (IRC),  if appropriate. The faculty would be selected from members of NANOS who were already planning to go (or were willing to go) to the meeting.
4. The IRC would review the proposal and make comments, as appropriate.
5. The proposed program would be submitted for approval to the Board of NANOS; if approved, the symposium could be “badged” as endorsed by NANOS.
6. All faculty members would expect to be self-funding. There would be no financial assistance from NANOS and most of the international meetings would be unlikely to offer financial support.
7. The convener would liaise with the local conference organizers as necessary and be responsible for coordinating any syllabus material, etc.  
8. The use of the NANOS logo and branding would be allowed with the formal endorsement only. The symposium should be promoted as a NANOS co-sponsored symposium in all marketing materials. 

This arrangement would have the benefit of furthering neuro-ophthalmological education around the world, and would “fly the flag” for NANOS, encouraging new people to attend NANOS meetings.

Only registered attendees are allowed to attend scientific sessions and meal functions (i.e. breakfasts, lunch, receptions and dinners). Guest tickets, including discounted children's tickets are available for purchase. 

• Children under age 18 may not attend scientific/educational sessions.
• Children may attend the Welcome Reception and Banquet when accompanied by a registered attendee.
• Tickets for all guests, including children, are required and can be purchased onsite. 
• It’s highly recommended that children under 10 should not attend the Award Ceremony or should be under close supervision to minimize distractions.

MEALS
Meals provided by NANOS are for NANOS registered attendees only. NANOS is a non-profit organization and meeting registration fees are not designed to subsidize guest meals. Additionally, we want to avoid running out of food for registered meeting attendees due to unplanned guests.