Closing Canada’s Diabetic Retinopathy Screening Gap

Did you know diabetic retinopathy (DR) is the leading cause of blindness among working-age Canadians? It doesn’t have to be this way. With routine screening, DR can usually be caught early and treated before vision is lost. The trouble is that Canada is not screening effectively.

Recent studies have shown that 53% of people with diabetes in Alberta do not receive a yearly eye examination, and 34% of those with diabetes in Ontario went unscreened between 2017 and 2019. There is very little data available for the other provinces — a concerning gap that makes it harder to identify areas where more focus is needed.

As with many health issues, those who face the most barriers are most likely to struggle with access to care. That means Indigenous Peoples, those with lower incomes, newcomers to Canada, rural residents and people experiencing homelessness are all falling through the cracks when it comes to needed screening.

One of the main reasons people miss screening is that Canada lacks a process to identify or follow up with those who require it. A family doctor or other health care provider may suggest a patient receive a yearly screening, but it’s up to that person to find an eye health professional, make an appointment and attend. No one follows up if yearly screening doesn’t occur, and there are no systematic screening programs in Canadian provinces. A systematic screening program would identify every eligible patient, invite them for screening on a recurring schedule, contact anyone who misses out, and be accountable for population coverage. This type of program could make a tremendous difference for Canadians.

Another way to improve access is point-of-care screening — doing the screening where the patient already is, whether at their family doctor’s office, a diabetes clinic, a community health centre or another appropriate location. This removes a major barrier, as people can be screened while already attending an appointment, rather than scheduling a second visit. For a parent who needs to arrange childcare to visit the doctor, or a person with limited access to time off work, being screened while attending to another issue is a real incentive.

Point-of-care screening programs are already working successfully in several parts of Canada. Models include mobile screening teams, where trained technicians travel with portable equipment and an off-site ophthalmologist reviews the images, as well as pharmacy-based screening, nurse-led programs, tele-ophthalmology and AI-assisted screening. Expanding these programs and embedding them more systematically across the country could make a significant impact on access.

These models also allow for more culturally tailored options. Screening can be done in ways that respect the unique needs of Indigenous Peoples, newcomers to Canada and rural populations. Providing care in places where people share language, culture and community can help ensure greater program uptake.

For communities without adequate eye health professionals, this access can be an enormous relief. Recent studies show Canada has only 3.35 ophthalmologists per 100,000 people, and many of these specialists are based in major cities far from rural communities. Point-of-care screening reduces the need for patients to travel to see a specialist, since only those with a concerning result need to attend an in-person appointment. For those in fly-in communities, or who live many hours’ drive from a specialist, this makes care substantially more manageable — and saves considerable costs.

And financial burden must be a consideration. With direct treatment costs for DR estimated at $250 million in 2020, there is a strong economic case for action. That figure — which excludes productivity loss, caregiver costs and well-being losses — likely far underestimates the true total.

Together, all of this points to a meaningful opportunity to improve outcomes and reduce vision loss for Canadians. Health care delivery in this country is a provincial and territorial responsibility, but the federal government holds the tools to transform a patchwork of regional DR-screening programs into a coherent, systematic framework. It’s hard not to see the value in that kind of investment.

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References

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