He notes that shifting costs to
out-of-pocket for individuals creates
a barrier for people with tighter
finances to getting access to health
care providers. Indeed, the study
found increasing numbers of people
reported that cost was a reason they
did not seek eye examinations in the
past two years.
Partial and full delisting of eye
care services began in early 1992
when Saskatchewan delisted eye
examinations for middle aged patients.
Since then, several other provinces
followed suit. While delisting services
such as eye exams saves government
expenses in the short-term, some
argue it leads to substantially greater
costs later on. According to Dr. Buys,
from a health economic standpoint,
the cost of treating glaucoma increases
with the severity of the disease, plus
there are quality of life cost factors to
the individual and family.
On the bright side, optometrists
in five provinces can now prescribe
glaucoma medications. Theoretically,
this makes treatment more accessible
to patients in rural and remote
26
OPTICAL PRISM | NOV/DEC 2013
communities, said Dr. Thomas
Freddo, professor of optometry at the
University of Waterloo. But, in many
places patients have to pay out-ofpocket for these services, which
creates a barrier for patients with
fewer financial resources.
Having Ministries of Health
reinstate coverage of both eye exams
and glaucoma care would be a step
forward, Freddo said. But even if
more patients came in for screening,
detecting glaucoma is tricky since it is
now recognized that in many cases,
intra-ocular pressure alone won’t
catch the disease since optic nerve
damage can happen with normalrange pressures.
Participants at the recent World
Glaucoma Congress in Vancouver
now describe glaucoma as a chronic,
multi-factorial neuro-degenerative
disease of the central nervous system.
A study released in 2009 by
the Canadian National Institute
for the Blind (CNIB) placed the
financial cost of vision loss due to
glaucoma at a total of $907-million
per year in Canada. That includes
hospital visits, pharmaceuticals,
vision care, rehabilitation, lost
productivity and more.
According to the 2005 report A
Clear Vision, also from the CNIB,
costs to care for an individual with
moderate stage vision loss (20/80 to
20/16) run about $6,414 per year, and
jump to $22,633 per year in people
with highly impaired vision (20/200
to having light perception only).
The vast majority of referrals to
ophthalmologists for glaucoma come
from optometrists. In fact, of newly
presenting glaucoma cases, 82 per
cent came from optometrists,
compared to only seven per cent from
family physicians and seven per cent
from other ophthalmologists, Dr.
Buys said. This reinforces the
important role optometrists play in
the care of glaucoma patients, plus in
some provinces they can administer
and prescribe glaucoma medication.
“Optometrists play a large role.
Optometrists really are primary eye
care providers and play a vital role in
screening for eye disease,” Dr. Buys
said. •