The Crisis of Vision in Canada

The title of this piece is deliberately polyvalent – there are many crises of vision in Canada, in the literal and figurative senses. To begin with, while there seems to be an endless thirst for more and more money in increasingly specific ocular health issues, diminishing returns in this area should lead us to question why so much for so little? The answer here is that Medicine has a tremendously powerful lobby in Canada, as elsewhere, and so public policy becomes very strongly focused around medical interests, in spite of the vanishing ROI.

At the same time, there is a relative decrease in resources for the public for access to basic visual functional care, and I suspect this is for the same reasons: Vision function is not viewed as a medical concern, and so for many, it is of no concern at all.

For now, we are speaking of children’s learning and development needs, but the same base arguments apply to varied aspects of medical care for vision-related disorders from strabismus and amblyopia, to vertigo, brain injury, dementia, and anywhere else the visual inputs to behaviour are likely to impact on health and performance.

This very narrow vision of human health and function, however outrageous it might be, means that very large part of the population is left without adequate care for physical disabilities. Why is this view outrageous? This is simple: Human’s are a visual being by design, and when vision is challenged functionally, it impacts us in many significant but often imperceptible ways to the untrained professionals in medicine. It is estimated that as many as 8% of the population suffers under the burden of convergence insufficiency, for example, and combined with other visual functional concerns, we can safely estimate somewhere around 25% of Canadians have some sort of visual impediment to learning and development. I personally have documented rates of basic Visual Impediments to Learning and Development (VILD) in some Aboriginal groups as high as 50%. When these VILD are ignored, or outright discounted, we are left with conclusion that what is wrong must be medical, requiring medical solutions.

Family doctors, for example, have little to no training in visual function, but when parents bring children to medical clinics for help, the family physician will note some trouble and refer to additional medical diagnostics for help. Left with no clear understanding of the problems at hand, parents are most often likely to be referred to medication, psychiatry, psychology, and children are left to languish in treatments and testing that is often stultifying and dehumanizing, leaving children utterly defeated and frustrated. The cost to families is staggering, while the cost to public health, social services, education and even corrections continue to rocket skyward.

We have seen in recent editions of the Canadian Journal of Optometry a heated debate over the value and veracity of ‘VT’, beginning with a somewhat misguided and possibly mean-spirited article by a group of medical practitioners in Montreal (see references). In a somewhat politically predictable but clinically surprising move, the Editor-in-Chief labeled this as a ‘controversial’ topic, which implies there is much doubt around the value of VT in child learning and development: There is no controversy for the thousands of families and clinicians who see the results of their efforts daily.

While we did see a number of strong responses from COVD and a few individual doctors, neither self-appointed ‘national’ organization made any public statement on the matter. This also amounts to a crisis of vision: Until we stand together in science to beat down common misconceptions about vision rehabilitation and work diligently as public advocates, we will remain at the mercy of the behemoth of publicly-funded health policy, even when such policy is grounded in non-sense and written by non-experts.

Alternatively, we can close our own eyes as vision rehabilitation and development optometrists and pretend that visual function amounts to refracting to 20/20, and nothing more. As it stands, with no national voice, we remain mute except for the occasional risk-taker who is willing to speak out about what we know to be true: There is no support for visual function in Canada, and this remains a great tragedy and travesty of public health justice.

Currently, there are relatively few OD’s in Canada who either recognize, engage in, or refer to VT. Sadly, many still feel OD’s are subservient to MD’s, and that we should avoid clinical interests that are not related to basic refraction and ‘pink eye’. For their part, developmental OD’s are relatively reluctant to speak up and out. VTOD’s above all must be prepared with a strong clinical and scientific armamentarium when faced with the ongoing onslaught of attacks from outside. Any national group must address these concerns and show the world we are worthy, educated, and valuable members of a comprehensive health care community. Anything else is just a ‘club’ of people with similar interests.

The two so-called national orgs for vision for their part have been relatively quiet, and have, as a two-headed snake, shown limited mobility with much consumption of resources, and an associated accumulation of waste in the middle. I only hope it does not devour itself and leave us with nothing. Sadly, given relative lack of structure, national representation, or voice, neither org appears to be suited to the arduous task of national representation of VTOD’s in the face of certain push-back.

I would like to thank Dr. Julien Goyard Ruel, who has added his voice to the national discussion with an eloquent and clinically-relevant piece, even though the Quebec Société (College) leadership has proven itself to be not only less than accommodating to even any discussion around vision rehabilitation, but has issued statements that are surprisingly anti-VTOD and anti-fact in this regard. Thanks also to all those who contributed to the COVD official response, and to Dr. Yves Sauvé at the University of Alberta who kindly and generously assisted in translations of the French and English versions of these important documents.

All behavioural/developmental OD’s in Canada are strongly compelled to support a national organization for public education, clinical research, and advocacy. To this end, the Calgary Vision Event 2015 will include discussions around national representation and advocacy, and there might even be a special announcement about a new foundation to make this possible. As it stands, the lack of national vision leaves a blind spot that other groups can, have, and will exploit to ensure vision rehab remains absent from the Canadian healthcare marketplace.

References:

  1. The initial piece in CJO, presented as ‘clinical research’: http://digital.turn-page.com/i/431237-cjo-76-2/2
  2. The replies to the initial ‘research’ piece: https://opto.ca/sites/default/files/resources/documents/cjo_journal_77-2_online_final.pdf

 

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