Indigenous Access to Eye Health and Vision Care in Canada

Indigenous access to eye health and vision care in Canada:  A public health imperative

Indigenous Canadians, particularly those living in rural and remote areas, experience a number of barriers to accessing optometric care. These access issues are the result of many factors, including inadequate transportation, financial constraints, and a lack of on-reserve care. (1) Research commissioned by the CNIB found one-third of Indigenous people have not had an eye examination within the last two years. (2)  The lack of equitable access to eye health and vision care for Indigenous Canadians should be a public health imperative.

Impact of inequitable access to eye health and vision care

  • Canada is behind the United States and Australia in developing eye health and vision care services for Indigenous peoples.(3)
  • Research shows that Indigenous children experience high levels of astigmatism along with high levels of uncorrected refractive error and poor compliance with wearing glasses.(4) 
  • Over the last two decades, the percentage of Canada’s Indigenous population living with diabetes increased to 20%, (5) putting them at increased risk of diabetic retinopathy leading to vision loss.
  • Indigenous Canadians with permanent and severe vision loss lack access to rehabilitation services in their communities.

There is a growing public health crisis in the delivery of vision care services to Indigenous communities. Barriers to care must be reduced, and new models of in-community services developed with engagement of Indigenous peoples. Optometrists practice across Canada and are well-positioned to provide care to Indigenous peoples close to where they live.

Swift action required to address eye health and vision care for Canada’s Indigenous People

  • Improve access to care by:
    • Establishing community-based and culturally appropriate prevention strategies that include a diabetic retinopathy program
    • Providing timely access to quality, in-person optometric care for all Indigenous Canadians, particularly those living in rural and remote areas.
    • Considering new approaches and enhanced care components to address vision care needs of those impacted by Health Canada’s Non-Insured Health Benefits Program (NIHB)
  • Build a pan-Canadian Framework for Action, coordinated by a Vision Desk at PHAC, that:
    • Is patient-centered and ensures access to the right eye health provider at the right time
    • Promotes national vision health guidelines including regular, comprehensive in-person eye exams
    • Approaches eye health as a population health priority and encourages its integration into the preventive health care routine.
  • Educate the public by:
  • Promoting the value of comprehensive eye exams to prevent vision loss and promote eye health through a public awareness campaign
  • Fund research on Indigenous peoples’ eye health, notably diabetes and models for access to care

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(1) Brise LS, de Leeuw S. Seeing Clearly: A Community-Based Inquiry into Vision Care Access for a Rural Northern First Nation. Can J Optom 2015; 77
(2):34-43 (2) CNIB. 2015. Vision Health and Eye care: The Canadian Perspective, page 18. Accessed October 14, 2016 at: http:// www.cnib.ca/en/get-involved/join-an-event/Vision-Health-Month/Documents/Vision-Health-Report-2015-English.pdf
(3) Dyck R, et al. Epidemiology of diabetes mellitus among First Nations and non-First Nations adults.  CMAJ February 23, 2010 182(3)
(4) Chiarelli C, Chris AP. Visual status of First Nations children: The Sagamok First Nation Vision Care Project. Can J Optom 2013; 75(4):6-10
(5) Young TK, et al. Type 2 diabetes mellitus in Canada's First Nations: status of an epidemic in progress. CMAJ; September 5, 2000; 163(5)