There’s no question the pandemic has the health of our eyes under siege.
Endless Zoom calls, binge-watching Netflix to pass socially-distanced time and constantly following the news feed on your phone — all of it could mean trouble for your vision.
“I think the additional screen time is affecting my eyesight, I get dizzy,” says 84-year-old Toronto resident June Whitaker. “I’m watching a lot of Netflix, I’m on Facebook, I use a Kindle for reading at night.”
Now Whitaker is worried about getting her regular eye exam — something that saved her vision almost 20 years ago when her optometrist discovered two serious eye problems.
She is just one of millions of seniors, children, teens and adults with specific health conditions who have been unable to book eye appointments with their optometrists as OHIP funding negotiations between the Ontario Association of Optometrists (OAO) and the provincial government have stalled.
In 2002, Whitaker was diagnosed with cellophane maculopathy, a condition where fibrous tissue forms on the back of your eye making it harder to see. Compounding matters, at the same visit, she was also diagnosed with cataracts, common with aging. She was promptly referred to a specialist for assessment and surgery.
“I wouldn’t have known I had these conditions,” she says. “But I was operated on successfully and I have this gift of sight. Optometrists are the people who discover problems. I’m fighting for them.”
Decades of underfunding
Sheldon Salaba, head of OAO, says the job action — which has 2,300 of the 2,650 optometrists in Ontario participating — that began September 1 is sparked by three decades of underfunding.
In 1989, the government funded $39.15 toward an eye exam and now, in 2021, it funds, on average, $44 toward an eye exam. In 32 years, that’s a little less than a $5 increase.
His group’s members — about 1900 strong — are currently subsidizing around 45 per cent of the cost of every examination because funding has not kept pace with the realistic costs of running a clinic and the complexity of the services provided. Since the increase in scope of practice in 2010, Ontario optometrists have been prescribing medications and developing treatment plans to manage eye conditions.
“We are the family doctors of eyes,” Salaba explains. “And it’s a complex organ to examine. It is frequented by many different types of eye diseases when people age, very common ones like macular degeneration and glaucoma, and diseases like adult-onset diabetes — things that people have no idea are developing or starting without having an eye exam.”
Then, he says, you have to factor in the reality of an aging population with more seniors coming in for eye exams. About 70 per cent of people impacted by vision loss are over the age of 65, and the well-reported demographic shift puts one-quarter of the population at 65 and older by 2050.
“I don’t think anybody can argue that Ontario is the most expensive province to live in,” he adds. “It’s also the most expensive province to deliver services in. That’s just the bottom line. As for funding, we have the lowest rate in the entire country, compared to other provinces providing the exact same type of service.”
Salaba also cites the high cost of rent and real estate, along with the need to appropriately pay support staff who also live in Ontario.
To prove the point, the OAO commissioned an independent study by accounting firm BDO which determined that the average operating cost to provide an eye exam in Ontario is actually $75.51.
Ontario Health Minister Christine Elliott’s proposed funding increase of 8.49 per cent would still see an Ontario optometrist paying about $27 out of pocket to subsidize the cost to examine an OHIP-insured patient.
The Ontario government also offered a one-time $39 million payment in an effort to mitigate underfunding of the last decade. This averages out to just over $1 per exam for every optometry service performed over that period. OAO members say this does nothing to address Ontario’s unsustainable eye care system.
While the job action is ongoing, each day is a missed opportunity for patients to receive what can be critical early detection of eye disease.
“We are absolutely concerned about our patients and we want nothing more than to be able to start seeing them today,” says Salaba. “Good vision allows for independence, it’s important for driving, working, reading and learning. Vision is our most important external sense.”
The Ontario job action has caught the attention of eye experts and advocacy groups like Fighting Blindness Canada, the largest charitable funder of vision research with a mandate to make sure people have access to new treatments.
CEO Doug Earle echoes Salaba’s concerns about the critical role eye exams play to protect overall health.
“The eye is the window to the body,” he says. “There are so many things like cardiac disease and Alzheimer’s that can be diagnosed through the eye. The eye reflects what’s happening in the brain.”
The sooner innovative treatments get to market, the better, he says, for the 1.5 million Canadians who are living with vision disability. That number is expected to double by 2031. And the economic and human costs of delays in eye care are significant. His group has been compiling data for a new report on the effect of the pandemic on vision in Canada when eye care clinics had to close their doors for many services.
The Cost of Vision Loss and Blindness in Canada Report estimates 1,437 Canadians lost their vision because of delayed eye examinations and delayed treatment in 2020. The report documents eye disease impact and the amount of time and money that will be needed to clear the backlog of cataract surgeries.
Longer wait times for surgery will result in a $1.3 billion increase in the cost of vision loss over the next two-and-a-half years, with $253.3 million of these costs cited as direct healthcare system costs and $1.1 billion result from the loss of well-being, recognizing the impact of depression, isolation, family problems and financial stress.
“In March to December of 2020, there were 2.9 million Canadians who did not get a regular eye exam at an optometrist. We can stabilize their sight, they don’t have to go blind, but that only works if it’s diagnosed early enough,” Earle says.
On top of that, 143,000 Canadians had their surgical procedure canceled because of COVID-19 and the report has found that it will take at least two years to clear that backlog at $129 million per year.
How long can our eyes wait?
The fact that insured Ontario residents are now waiting for eye exams as we emerge from the pandemic is likely compounding the issue.
“It’s a highly unfortunate situation and it’s been long in getting to this point. Ontario is on the bottom of funding these types of services and has been for many, many years,” Earle says.
But how many people really understand the risk of missed checkups to their eyesight and overall health?
A survey released in August by the Canadian Ophthalmological Society found that while the majority of respondents are concerned about eye health, there are common misconceptions that could leave them more vulnerable to eye disease. According to the data, six in ten Canadians are unaware that many eye diseases, including glaucoma, won’t always present symptoms until they are at an advanced stage; one third (31 per cent) of respondents don’t know that eyesight can be impacted by different life stages affected by hormones, such as puberty, pregnancy and menopause; and while the majority agree to the contrary, as many as 16 per cent believe it is not important to get your vision checked frequently when you’re younger.
Patient outreach, education campaigns and access to services are top priorities for the Canadian Association of Optometrists (CAO), says president Harry Bohnsack, who practices optometry in New Brunswick.
People need to know that early detection of eye disease can change lives, he says.
“In cataracts for example, when a cataract progresses to a certain state, we’re talking about impairment of a person’s ability to see, to drive, to function, to work,” he says. “However, the effects are reversible with glaucoma. You’re dealing with something that really doesn’t show itself in the early stages, but if it has a chance to progress beyond a certain point, you never get that vision back.”
With more than 30 years in the field, Bohnsack has seen many technological advances for detecting eye issues earlier than ever before. Computerization and digital photography of the interior of the eye has led to real improvement in the ability to diagnose eye conditions earlier, to monitor them more closely and to help patients to preserve their vision.
He says CAO firmly supports optometrists being compensated for the services they provide.
“Every province needs a sustainable eye care system and Ontario residents deserve timely and quality care, and a model that allows the appropriate funding for that system.”