national report on state of vision care in canada raises alarm

a report showing that 1,437 canadians lost their eyesight in 2020 during covid-19 disruptions has experts concerned about the continued lag in eye care services.

by emma jones

published oct 13, 2022

last updated may 03, 2023

5 minute read

join the conversation

5 minute read

join the conversation

why did the national report on vision care in canada raise alarm?

while eye-care services did increase in 2021 versus 2020, they did not go back to pre-pandemic levels. getty

a report card released today on vision health care in canada warns that services are still not back to pre-pandemic levels, a result which could have devastating implications for patients. the report, a joint study commissioned by the canadian council of the blind and fighting blindness canada, is an update on a study released last year, which looked at the state of vision health in canada after the covid-19 pandemic. while eye-care services did increase in 2021 versus 2020, they did not get back to pre-pandemic levels, raising concerns about clearing the backlog of patients and addressing current vision needs.

“we had been hearing a lot from the doctors, from the people living with vision loss that were trying to access care, that they were experiencing challenges,” says doug earle, ceo of fighting blindness canada. “but i was not expecting the degree that the backlogs that we faced in 2020 have been exacerbated because the system didn’t bounce back.”

the effects of falling behind on treatments may not be reversible

a total of 1,437 canadians experienced vision loss in 2020 as a direct result of treatment disruptions, according to last year’s report card. many eye-care specialists are deeply concerned this trend will continue because so many patients have missed eye appointments or have fallen behind on treatment plans. (the numbers for vision loss in 2021 have not yet been released.)

“i heard doctors telling us that they were frustrated because people would come into the offices … and they’d unnecessarily lost vision,” says keith gordon, phd, senior research officer for the canadian council of the blind and the report’s author. “patients with glaucoma, for example, who weren’t taking their drops, had lost control of their glaucoma and therefore had lost vision unnecessarily. people who needed specific eye injections were not getting them because they stayed away during covid.”

prescriptions for glaucoma medications in 2021 were also below 2019 levels, the report shows, and anti-vegf injections — used to help prevent abnormal blood vessel growth in the eye — were lower than projected. both of these treatments are critical to prevent vision loss and preserve eye health. the effects of falling behind on treatment plans may not be reversible.

despite substantial financial commitments from governments across canada, surgical volumes have also not returned to pre-pandemic levels, raising concerns about clearing the backlog of patients. many clinics have extended their working hours in an attempt to increase surgical volume, but have to contend with health-care workers’ high burnout levels, explains earle. supply chain issues have also resulted in shortages for certain eye drops and other medications, requiring extra time on behalf of health-care providers to find suitable alternatives.

health canada did not respond to an interview request before publication time.

canadians not going back to the optometrist

outside of surgery backlogs and medication shortages, experts are also concerned about the fall in regular eye check-ups for patients. in 2019, 68 per cent of survey respondents reported they had an eye exam within the last two years; in 2021 that percentage fell by eight points.

“patient engagement, in terms of getting their eyes checked on an annual basis, has definitely changed,” says stephanie kwan, practicing optometrist at specsavers in hamilton, ontario. “i personally found that people were afraid to get their eyes checked and some even waited till they noticed a change or a decline in vision until they came in to see an optometrist.”

conditions like glaucoma rarely have symptoms in early stages, which is why routine check-ups are important — sometimes, the damage can’t be treated.

“getting your eyes checked is so important because some diseases can go undetected for years. bleeding in the back of the eye, glaucoma, macular degeneration are all preventable, when it comes to saving your eyes and keeping your sight,” says kwan. “the thing is, when it comes to the eyes… when it comes to some vision loss, it could be irreversible.”

the reasons people put off eye exams makes sense, of course — but the consequences can be severe.

“if you don’t have anything obviously wrong with your eyes, if you don’t have pain in your eyes, or you can see fairly well you’re going to say, ‘well, geez, i’m not gonna go to see an eye doctor. covid [is] more dangerous to me,’” gordon says. “but by doing that you’re missing important diagnosis of diseases that are asymptomatic, and you may be losing vision as a result.”

kwan stresses that optometry offices are clean and have covid protocols in place to make at-risk patients comfortable returning to regular visits. anyone who is concerned can also call their eye-care provider to book a less busy appointment time and confirm covid protocols.

fighting for a national eye care strategy

earle explains that while the financial commitment by the federal and provincial governments helps, it is only part of the solution to solving critical gaps in vision care, which will only become more severe as canada’s population continues to age.

bill c-284, an act to establish a national strategy for eye care, was introduced in june. if passed, this bill would require parliament to enact a national eye-care strategy within one year, and evaluate the effectiveness of the program in regards to eye disease prevention and treatment within five years.

“what we’re advocating for is that the government put together a national eye health strategy. and look at all aspects of this,” says gordon. “there are now issues related to a shortage of healthcare workers — we have to increase training associated with that — issues related to supply of pharmaceuticals, the supply chain has been disrupted.

there are dozens of issues that need to be looked at and they need to be looked at as a whole.”

more ophthalmologists and optometrists need to be trained and deployed to at-risk locations, which will time and planning, says earle. eye care also needs to be integrated with overall health, so patients at risk of losing their eyesight (for example, patients with diabetes) are aware of funded eye-care services available to them.

more research is also needed to address the growing number of adults in canada who will need vision care in the future.

“we need to get the system integrated, working together, to deliver care in every community so people do not go blind. they don’t have to [go blind],” says earle. “research has delivered treatments that enable people if they’re diagnosed early and have access to those treatments, we can stop preventable blindness.”