Eye care utilisation in Newfoundland and Labrador: access barriers and vision health outcomes

Prevalence of glaucoma in Canada: results from the 2016-2019 Canadian Health Measures Survey

OBJECTIVE

To estimate the prevalence of glaucoma in Canada based on self-reports and test data, including Frequency Doubling Technology Perimetry (FDT), optic nerve vertical cup-to-disc ratio (CDR), intraocular pressure (IOP), and use of glaucoma medications.

DESIGN

Cross-sectional survey.

PARTICIPANTS

2,600-4,100 participants aged 40-79 in the Canadian Health Measures Survey 2016-2019 with available information from self-report, CDR, FDT, and IOP.

METHODS

Glaucoma was defined by self-reports, CDR ≥ 0.7 only, or failed FDT only. Incorporating results of CDR, FDT, IOP, and use of glaucoma medications, participants were further classified as definite glaucoma (failed FDT and CDR ≥ 0.7) or glaucoma suspects (CDR ≥ 0.7 only, failed FDT only, or IOP > 21 mmHg only, or "normal" values of FDT, CDR, and IOP but used glaucoma medications). Survey weights were used in analyses.

RESULTS

The glaucoma prevalence was 2.5% (95% confidence interval [CI] 1.7%-3.3%) utilizing self-reports, 3.0% (95% CI 2.1%-3.9%) by CDR ≥ 0.7 only and 10.3% (7.8%-12.8%) with failed FDT only. Merging test data, the prevalence of definite glaucoma was 0.7% (95% CI 0.3%-1.1%) and the prevalence of suspected glaucoma was 16.3% (95% CI 13.2%-19.4%). Among the patients suspected of having glaucoma, 44.4% had ocular hypertension (OHT, mean IOP 22.8 mmHg) and 6.8% used glaucoma medications. IOP ≥28 mmHg was found in 2.4% of OHT individuals, and none used glaucoma medications.37.5% of Canadians with definite glaucoma were unaware they had glaucoma.

CONCLUSIONS

Glaucoma prevalence in Canadians aged 40-79 varied between 0.7% and 10.3% depending on definition used. 16.3% of Canadians were labeled "glaucoma suspects". Nearly 40% of Canadians with definite glaucoma were unaware of having glaucoma.

Eye care service utilization and associated factors among adults in Debre Berhan Town, North Shewa, Ethiopia, 2023

Introduction

Globally, the utilization of eye care services varies widely, ranging from 18 to 90%. Low utilization of eye care services can lead to delayed detection of vision problems. However, there are limited data on the proportion of eye care service utilization and its associated factors in Ethiopia at the community level.

Objective

The objective of this study was to determine the proportion of eye care service utilization and its associated factors among adults in Debre Birhan town, North Shewa, Ethiopia.

Methods

Using a multistage sampling method, a community-based cross-sectional study was conducted on 960 adults in Debre Birhan town from 8 May to 8 June 2023. Binary logistic regression was performed. Variables with a p-value of less than 0.05 were considered significant.

Results

A total of 940 study participants participated, resulting in a response rate of 97.9%. The mean age of the participants was 54.67 years (SD ± 8.69). The proportion of good-level eye care service utilization was found to be 32.98% [95% confidence interval (CI): 29.97, 35.99]. Factors positively associated with good-level eye care service utilization included older age [adjusted odds ratio (AOR) = 1.58, 95%CI: 1.00, 2.51], higher educational status (AOR = 2.25, 95%CI: 1.25, 4.06), high family monthly income (AOR = 8.70, 95%CI: 4.99,15.18), awareness of regular eye checkups (AOR = 1.77, 95%CI: 1.15, 2.73), a history of eye disease (AOR = 2.57, 95%CI: 1.77,3.74), health insurance (AOR = 1.99, 95% CI: 1.34, 2.95), and history of spectacle use (AOR = 1.94, 95%CI:1.34, 2.80).

Conclusion

The study revealed that the proportion of good-level eye care service utilization was low. Older age, higher educational status, high family monthly income, awareness of regular eye checkups, a history of eye disease, health insurance, and history of spectacle use were significantly associated with a good level of eye care service utilization.

Prevalence of self-reported visual impairment among people in Canada with and without diabetes: findings from population-based surveys from 1994 to 2014

BACKGROUND

Diabetes, a leading cause of visual impairment, is on the rise in Canada. We assessed trends in the prevalence of visual impairment among people in Canada with and without diabetes to inform the development of strategies and policies for the management of visual impairment.

METHODS

We analyzed self-reported data from respondents aged 45 years and older in 7 cycles of nationwide surveys (National Population Health Survey and Canadian Community Health Survey) from 1994/95 to 2013/14. The age- and sex-standardized prevalence of visual impairment was calculated. We assessed comparisons by levels of education and income, using sex-standardized prevalence owing to sparse data.

RESULTS

Among people in Canada with diabetes, the age- and sex-standardized prevalence of visual impairment was 7.37% (95% confidence interval [CI] 5.31%-9.43%) in 1994/95 and 1996/97 combined, decreasing to 3.03% (95% CI 2.48%-3.57%) in 2013/14, giving a standardized prevalence ratio of 0.41 (95% CI 0.30-0.56) comparing 2013/14 with 1994/95 and 1996/97 combined. Among people in Canada without diabetes, visual impairment prevalence decreased from 3.72% (95% CI 3.31%-4.14%) in 1994/95 and 1996/97 combined to 1.69% (95% CI 1.52%-1.87%) in 2013/14, with a standardized prevalence ratio of 0.45 (95% CI 0.40-0.52). Decreased sex-standardized prevalence of visual impairment was observed among people with high and low education levels and incomes among those with and without diabetes.

INTERPRETATION

Visual impairment prevalence was roughly 2 times higher among those with versus without diabetes in all survey years; from 1994 to 2014, visual impairment prevalence decreased among those with and without diabetes irrespective of education and income levels. These results suggest effective collective efforts by clinicians, researchers, the public and government.

Socioeconomic Status and Vision Care Services in Ontario, Canada: A Population-Based Cohort Study

OBJECTIVE

To test the association of material deprivation and the utilization of vision care services for young children.

STUDY DESIGN

We conducted a population-based, repeated measures cohort study using linked health and administrative datasets. All children born in Ontario in 2010 eligible for provincial health insurance were followed from birth until their seventh birthday. The main exposure was neighborhood-level material deprivation quintile, a proxy for socioeconomic status. The primary outcome was receipt of a comprehensive eye examination (not to include a vision screening) by age 7 years from an eye care professional, or family physician.

RESULTS

Of 128 091 children included, female children represented 48.7% of the cohort, 74.4% lived in major urban areas, and 16.2% lived in families receiving income assistance. Only 65% (n = 82 833) had at least 1 comprehensive eye examination, with the lowest uptake (56.9%; n = 31 911) in the most deprived and the highest uptake (70.5%; n =19 860) in the least deprived quintiles. After adjusting for clinical and demographic variables, children living in the least materially deprived quintile had a higher odds of receiving a comprehensive eye examination (aOR 1.43; 95% CI 1.36, 1.51) compared with children in the most materially deprived areas.

CONCLUSIONS

Uptake of comprehensive eye examinations is poor, especially for children living in the most materially deprived neighborhoods. Strategies to improve uptake and reduce inequities are warranted.

Eye-care utilization among a Canadian diabetic refugee population: retrospective cohort study of an interdisciplinary care model

Introduction

Vision health is an important and underutilized health service among newly arrived refugees in Canada, yet the body of literature on eye-care delivery in this population is limited. The study objective was to identify patterns of eye-care utilization among refugee patients with type 2 diabetes mellitus (T2DM) in Newfoundland and Labrador (NL) under an interdisciplinary clinic model comprised of family physicians, eye-care providers, and settlement services.

Methods

This was a retrospective cohort study at the Memorial University Family Medicine clinic. All patients with a new T2DM diagnosis between 2015–2020 were included. Data were described using basic statistics and unpaired t-tests. This study received full ethics approval.

Results

Seventy-three (18 refugee, 55 non-refugee) patients were included. Refugees had a higher rate of referral to an eye-care provider ( p = 0.0475) and were more likely to attend their eye-care provider appointment than non-refugees ( p = 0.016). The time from diagnosis to referral was longer for refugees than non-refugees ( p = 0.0498). A trend towards longer time from referral to appointment attendance for refugees than non-refugees was noted ( p = 0.9069).

Discussion

Refugee patients had higher rates of referral to eye-care providers and utilization of eye-care services. However, refugees also experienced a longer time to access vision screening services suggesting possible gaps in accessible care delivery. This suggests that the interdisciplinary model of care may be effective in referring refugee patients for vision screening and there may be a role for increased collaboration across family physicians, eye-care providers, and settlement services to improve accessibility of vision screening services.

Geographic availability to optometry services across Canada: mapping distribution, need and self-reported use

BACKGROUND

This research investigates the distribution of optometrists in Canada relative to population health needs and self-reported use of vision services.

METHODS

Optometrist locations were gathered from provincial regulatory bodies. Optometrist-to-population ratios (i.e. the number of providers per 10,000 people at the health region level) were then calculated. Utilization of vision care services was extracted from the Canadian Community Health Survey (CCHS) 2013-2014 question regarding self-reported contacts with optometrists or ophthalmologists. Data from the 2016 Statistics Canada census were used to create three population 'need' subgroups (65 years and over; low-income; and people aged 15 and over with less than a high school diploma). Cross-classification mapping compared optometrist distribution to self-reported use of vision care services in relation to need. Each variable was converted into three classes (i.e., low, moderate, and high) using a standard deviation (SD) classification scheme where ±0.5SD from the mean was considered as a cut-off. Three classes: low (< - 0.5SD), moderate (- 0.5 to 0.5SD), and high (> 0.5SD) were used for demonstrating distribution of each variable across health regions.

RESULTS

A total of 5959 optometrists across ten Canadian provinces were included in this analysis. The nationwide distribution of optometrists is variable across Canada; they are predominantly concentrated in urban areas. The national mean ratio of optometrists was 1.70 optometrists per 10,000 people (range = 0.13 to 2.92). Out of 109 health regions (HRs), 26 were classified as low ratios, 51 HRs were classified as moderate ratios, and 32 HRs were high ratios. Thirty-five HRs were classified as low utilization, 39 HRs were classified as moderate, and 32 HRs as high utilization. HRs with a low optometrist ratio relative to eye care utilization and a high proportion of key sociodemographic characteristics (e.g. older age, low income) are located throughout Canada and identified with maps indicating areas of likely greater need for optometry services.

CONCLUSION

This research provides a nationwide overview of vision care provided by optometrists identifying gaps in geographic availability relative to "supply" and "need" factors. This examination of variation in accessibility to optometric services will be useful to inform workforce planning and policies.

Motivators and deterrents for seeking eye care in a Canadian region

BACKGROUND

Motivators and deterrents for seeking eye care in a Canadian setting were sought using a qualitative study. Provincial deregulation of eyewear dispensing in 2010 allows consumers to order eyewear without an optical prescription, thus eliminating a potential motivator for obtaining an eye examination.

METHODS

Convenience sampling was used to obtain 25 members of the public who contributed to one of seven focus groups that were facilitated, audiotaped, anonymised and transcribed. Participants completed a demographic questionnaire. Focus group data analysis employed grounded theory and theme saturation determined the number of focus groups.

RESULTS

Nine men and 16 women participated, ranging in age from 18 to 71 years (mean 41.5; median 40.0). Three main themes were identified as influencers for seeking eye care: priority; advice; and capacity. Priority served as a motivator ('lived experience', 'symptoms', and 'habit') and deterrent ('test distress', 'asymptomatic', 'don't know' and 'other priorities'). Advice was a motivator ('professional' and 'family/friends'), while capacity was a motivator ('insurance') and deterrent ('cost').

CONCLUSION

The motivators and deterrents of seeking eye care in these focus groups were framed by three themes. Key findings not reported previously included the motivators of 'habit', 'advice' and 'insurance' and the potential deterrent of 'test distress'. These factors should be added to other previously reported motivators and deterrents in further exploration of Canadian eye-care seeking behaviours. Such knowledge is needed to develop strategies for improving eye-care literacy in Canada. This is particularly important because eyewear deregulation and/or online eye examinations may encourage members of the public to bypass comprehensive eye care without fully understanding the implications of this decision for their health and wellness.