The Toronto Star, November 25, 2011
Leslie Hughes is a self-employed mom on the go who, like half of all adults in Canada, has not had an eye exam in five years or more.
For Hughes, 41, it’s been 10 years, despite the fact that she wears corrective lenses — contacts she orders online using her decade-old prescription.
“I’m an ‘If it ain’t broke, don’t fix it’ kind of gal,” she admits, in a telephone interview from her home in Newcastle, Ont. “It’s just one of those things that’s not on my to-do list, with all the other appointments we have going on. I force myself to go to my annual physical. I do go to a dentist. I did, at one point, put that off and it caught up with me.”
That attitude toward eye-care is catching up with an increasing number of Canadians. A survey by the Canadian Ophthalmological Society in 2005 found that 50 per cent of Canadians have not had an eye exam in five years or more. A study by the Canadian National Institute for the Blind in 2008 shows the number of Canadians with vision loss is expected to double in 20 years from glaucoma, cataracts and age-related macular degeneration.
“Studies have shown that the fear of going blind is only second to the fear of developing cancer,” says Dr. John Mastronardi, past-president of the Ontario Association of Optometrists. Yet we take our eyesight for granted.
Going to the eye doctor is just not a conscious issue for many people, especially if they don’t wear glasses. We wake up and, if we can see, we figure all is well.
But that’s a faulty assumption, says Mastronardi. “All the sight-threatening conditions out there happen within the eyes, before the patients develop symptoms.”
A Canada-wide study led by Dr. Yvonne Buys, an ophthalmology professor at the University of Toronto, and co-director of the University Health Network’s glaucoma unit, found that half of newly diagnosed glaucoma patients are already at moderate to advanced stages, with irreversible and often devastating damage. The disease has no noticeable symptoms in early stages.
The study, which included 404 patients recently diagnosed with ocular hypertension, glaucoma’s precursor, or full-blown glaucoma, was published in the June issue of the Journal of Ophthalmology.
“Everything usually does better if you treat it sooner than later,” says Buys.
Keith Gordon, vice-president of research for the CNIB, agrees.
“The impact of eye diseases such as glaucoma, cataracts and macular degeneration can usually be minimized if caught early enough.”
The CNIB estimates the cost of vision loss in Canada at $15.8 billion each year; $8.6 billion in direct health costs and $7.2 billion from indirect causes such as productivity loss from lower unemployment, higher absenteeism and premature death, care and disability support programs.
But because of a casual approach toward eye care, patients are coming in with serious, significant and unnecessary vision loss, optometrists say.
A dearth of Canadian data exacerbates the problem.
Until 2007, Statistics Canada asked Canadians about eye health in the annual health survey. The questions were general — Are you able to see? Are you able to read ordinary newsprint? Do you wear contact lenses? — but provided policy-makers and researchers with a sense of vision health in the country. The survey no longer asks those questions.
In 2004, Ontario delisted routine eye exams from provincial health insurance coverage for people aged 20 to 64. Since then, individuals have to pay for the exam, which typically costs about $100.
Exams are still covered for children, seniors, people on social assistance and those with medical conditions including diabetes, glaucoma, optic nerve pathway disease, visual field defects, strabismus, amblyopia, cataracts, recurrent uveitis, retinal disease and corneal disease.
That new cost is a factor for Hughes, who had exams every other year before they were delisted. At that time, it was the only way she could get contact lenses.
“My husband doesn’t have insurance, either, so everything comes out of my pocket,” Hughes says. “The less money I have to shell out, the better.”
Health Ministry spokesperson David Jensen said in an email that delisting eye exams wasn’t a means to save money, but rather to divert it to where it has the greatest positive effect, in increased coverage for patients with medical conditions affecting the eyes.
The decline in people getting eye exams isn’t significant overall, but a study by Yaping Jin, a biostatistician at the University of Toronto’s Dalla Lana School of Public Health, showed that the biggest drop in visits came among people in lower socio-economic brackets.
Gleaning information from the Canadian Community Health Study, Jin found that the overall drop in eye exams after they were delisted was less than 2 per cent.
But among people lacking a high school diploma, the proportion who failed to get an eye exam rose from 4.7 per cent to 11.2 per cent. Among those in the lowest income bracket, the percentage rose from 4.5 to 12 per cent.
Jin concluded that taking eye exams out of OHIP coverage led to reduced access to care for the socially disadvantaged.
Toronto optometrist Dr. Bernard Fresco suggests that anyone who cannot afford the $100 for an exam should ask their optometrist for a break. Eye doctors should not turn people away for lack of funds, he says.
By the numbers
$15.8 billion: Cost of vision loss in Canada annually
$8.6 billion: Direct health care costs annually
$7.2 billion: Indirect costs (lost earnings, care and rehabilitation, special equipment etc.)
$30.3 billion: Annual cost of vision loss in Canada by 2032
44.5 per cent: Canadians with vision loss who live in Ontario
$7 billion: Ontario’s burden of vision loss each year.
$108.3 million: Ontario government’s outlay for eye exams in 2010 and 2011.
What if you have no coverage and can’t afford exams?
The Ontario government delisted eye exams in 2004 for adults 20 to 64, other than for people on social assistance or with conditions such as diabetes. Others must rely on extra insurance or pay out of pocket. Many can’t afford the cost of exams. Toronto optometrist Dr. Bernard Fresco says optometrists should not turn people away for lack of funds and advises asking for a break in price.
New program for children
A new program called Eye See … Eye Learn will provide eye exams to junior kindergarten students in participating regions. The exams are covered under OHIP and children requiring a pair of glasses may receive them free, courtesy of participating sponsors.
The program is active in Hamilton and is being expanded into London, Sault Ste. Marie and the Niagara Region. It’s expected to be rolled out across the rest of the province within five years. For more information: eyeseeeyelearn.com.
And one more for good measure:
Compared to people who are sighted, people with blindness or partial sight experience:
Two to five times as much difficulty with daily living
Three times as much clinical depression
Twice as much social dependence
A greater number of medication errors
Twice the risk of falls and premature death
Four times the risk of serious hip fractures
Premature admission to nursing homes — three years earlier on average
CNIB and the Canadian Ophthalmological Society
The three most important ways to maintain your eyesight:
have regular exams
avoid smoking. Smokers have four times the risk of macular degeneration.
wear sunglasses, even children.
Keith Gordon, vice-president of research for the Canadian National Institute for the Blind.