Optical Prism November 2013 | Page 30

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. •