Indigenous and First Nation Canadians, particularly those living in rural and remote areas, are facing major gaps in eye care. Persistent inequities have resulted from limited access to care, financial constraints, lack of sensitivity to Indigenous culture, and mistrust of healthcare providers based on negative past experiences and the legacy of colonialism.
Research commissioned by the Canadian National Institute for the Blind found that one third of Indigenous patients haven’t had an eye exam in the last 2 years.
According to research by the Canadian Association of Optometrists, Canada is behind the US and Australia in developing eye health and vision care services for its Indigenous population. The organization stated that addressing the lack of equitable access to eye health and vision care for Indigenous Canadians should be a public health imperative.
Barriers to Care
The lack of a national eye care strategy and the implications of this gap for Indigenous and First Nations communities have been the focus of leaders in the field. “These challenges lead to delayed diagnosis, preventable vision loss, and poorer quality of life for patients, particularly those with uncorrected refractive errors,” Helen Dimaras, PhD, scientist and director of global eye health research at The Hospital for Sick Children in Toronto, told Medscape News Canada. “The lack of accessible and culturally safe services undermines trust in the health system and reduces engagement with care. For eye care professionals, fragmented infrastructure, limited local capacity, and absence of coordinated national support make it difficult to deliver consistent and equitable eye care across regions.”
The current funding model for eye care is flawed, Dimaras added. “A lot of Indigenous programs are charity-based…and it doesn’t help you sustain any long-term outcomes. I think an eye care strategy could help us figure out where the greatest needs are. We would then be able to design ways to deliver solutions without the fear of funding being taken away. We need a mix of training and implementation, which would be strengthened by a strategy.”
Logistical challenges play an important role in the limited access to quality eye care. The consensus among healthcare advocates is that eye care and other health services should travel to the patients in need, rather than expecting patients in remote areas to journey long distances, miss work, find childcare, and pay out of pocket for the related expenses.
There is a major discrepancy between the healthcare services that White Canadians in urban centers receive and those available to Indigenous patients in northern Ontario and Saskatchewan. “We have almost two countries,” Kourosh Sabri, MBChB, professor of surgery at McMaster University in Hamilton, Ontario, told Medscape News Canada. “We have the affluent part of Canada and, by contrast, we have the Indigenous community. There are almost 500,000 Indigenous children living either on reserves or off reserves in the remote parts of Canada, and most of these communities have no healthcare. These people live in a third-world society, which we have normalized.”
Myopia, high degrees of astigmatism, and age-related macular degeneration are common in Canada’s Indigenous population. Untreated diabetes, a long-standing and worsening problem in this demographic, can result in diabetic retinopathy, vision loss, and blindness. Seventy-five percent of the 1000 children in northern Ontario and Saskatchewan wear glasses, which is a much higher percentage than in non-Indigenous children, said Sabri. Fifty-one of these children have blindness that had gone undetected.
Filling in the Gaps
“Successful programs mean we have to go out into the communities, have screening programs, and invest in training local people to undertake certain aspects of screening and healthcare. The problem right now with the way the federal government runs the healthcare for these communities is that we’re expecting a child in a remote community who has eye disease to get on a plane or a train and come to a city to receive care. It’s just not happening,” said Sabri.
Sabri’s approach to eye care is based on the four pillars of in-person visits, telemedicine, training of local youth in eye care technology for early screening, and delivering additional healthcare services to communities (for example, cardiac clinics and plastic surgery).
“Without an overarching plan to bring doctors, communities, and the government together, it’s very difficult to deliver the level of care that patients deserve,” said Cody van Dijk, OD, a Winnipeg-based optometrist and co-chair of the Manitoba Association of Optometrists. “Developing a national eye care strategy for Canada would ensure the various stakeholders know what their responsibilities are and [ensure] the development of a plan for the execution of adequate vision care across Canada.”
Van Dijk stressed the importance of early detection of eye and vision changes that can only be identified through a comprehensive eye exam. A care plan to help preserve a patient’s vision also is essential. “A lack of early detection can lead to poor outcomes in the long run and represent a high burden on the healthcare system.”
“What we want, what we have to strive for, is a vision care system that provides the same level of care regardless of where you are, to ensure we’re providing the same standard of care across Canada,” van Dijk continued. He underscored the importance of investing in optometry equipment in local Indigenous communities to allow optometrists who travel to these regions to practice the same way they do in the city.
Like Sabri, van Dijk stressed that forming relationships and engaging in conversations with key players is essential to developing a cohesive vision care strategy for Indigenous patients in Canada. “We need to learn how Indigenous communities want their care delivered, and we all have to work together to use our various professional strengths to achieve that goal,” he said.
Dimaras, Sabri, and van Dijk reported having no relevant financial relationships.
Evra Taylor is a freelance medical writer and reporter with 20 years’ experience covering a broad range of therapeutic sectors, including family health, cardiology, psychiatry, ophthalmology, and dermatology.
