This form provides for the submission of Financial Disclosures and Conflict of Interest Resoluions for five distinct AGS activities / roles. In addition to information that is common, each role requires additional role specific information. In order for the form to present you with the correct form fields for your activity, the system must know which role your form applies to. Please select the role your submission will apply to and click "Submit Role".
Symposium Moderators
Symposium Speaker
SIG Presenter
Workshops Leader
Surgical Video Submittor
Breakfast Roundtable
Non-Specific Role
Poster/Paper Moderator

The American Glaucoma Society has determined that a financial relationship should not restrict expert scientific, clinical, or non-clinical presentation or publication, provided that appropriate disclosure of such relationship is made. Similarly, it should not restrict participation in AGS leadership or governance, so long as appropriate disclosure is made. As an ACCME accredited provider of CME, the AGS seeks to ensure balance, independence, objectivity, and scientific rigor in all individual or jointly sponsored CME activities.

All contributors to AGS educational and leadership activities must disclose significant financial relationships (defined below) to AGS annually. The ACCME requires AGS to disclose the following to participants prior to the activity:

• Any known financial relationships a meeting presenter, author, contributor or reviewer has reported with manufacturers of commercial ophthalmic products or providers of commercial ophthalmic services within the past 12 months
• Meeting presenters, authors, contributors or reviewers who report they have no known financial relationships to disclose

AGS will request disclosure information from meeting presenters, authors, contributors or reviewers, committee members, Board of Directors, and others involved in AGS leadership activities ("Contributors") annually. Disclosure information will be kept on file and used during the calendar year in which it was collected for all Academy activities. Updates to the disclosure information file should be made whenever there is a change. At the time of submission of a Journal article or materials for an educational activity or nomination to a leadership position, each Contributor should specifically review his/her statement on file and notify the AGS of any changes to his/her financial disclosures. These requirements apply to relationships that are in place at the time of or were in place 12 months preceding the presentation, publication submission, or nomination to a leadership position.

When individuals have financial relationships with commercial interests and are in a position to control the content of CME, there is also the potential for commercial bias. The American Glaucoma Society is in agreement with the ACCME that CME must be free of commercial bias. To that end, American Glaucoma Society proffers this mechanism to identify all relevant financial relationships with commercial interests and to set into action a series of steps to resolve any conflicts of interest that exist.

FINANCIAL RELATIONSHIP DISCLOSURE

For purposes of this disclosure, a known financial relationship is defined as any financial gain or expectancy of financial gain brought to the Contributor or the Contributor's immediate family (defined as spouse, domestic partner, parent, child or spouse of child, or sibling or spouse of sibling of the Contributor) by:

• Direct or indirect compensation;
• Ownership of stock in the producing company;
• Stock options and/or warrants in the producing company, even if they have not been exercised or they are not currently exercisable;
• Financial support or funding to the investigator, including research support from government agencies (e.g., NIH), device manufacturers, and\or pharmaceutical companies; or
• Involvement with any for-profit corporation that is likely to become involved in activities directly impacting the Academy where the Contributor or the Contributor's family is a director or recipient of a grant from said entity, including consultant fees, honoraria, and funded travel.

Use the following categories to indicate the type of financial relationships you are disclosing either for yourself or for your immediate family as defined above. If an individual is uncertain about what might constitute a potential financial conflict of interest, they should err on the side of full disclosure.