Social Policy in Ontario

What wasn’t discovered until a full grade later, thanks to a kindly Grade 1 teacher who thought I was capable of more than I was doing academically, was that I had serious vision impairment — a myopia of minus-10 dioptres, no less. In layman’s terms, I was severely nearsighted.

Turns out, I wasn’t being difficult when I was passing scissors incorrectly, I couldn’t see them properly. Without glasses, I couldn’t see much at all. No wonder school was a struggle.

Here we are, many decades later, and despite multiple recommendations from professional health organizations including the Canadian Association of Optometrists, the National Coalition for Vision Health and the Canadian Pediatric Society, there remains no standard routine vision testing or eye exam programs for school-age children and youth across the country. Some patchwork programs exist in some provinces, in some cities or for specific income groups in some communities across the country, but many children, older kids and new Canadians are falling through the cracks.

There are kids struggling in school, just as I was, when a pair of glasses might easily solve the problem. There’s only one word for this: unconscionable.

When vision impairment goes unchecked it becomes a kind of invisible disability, affecting literacy, numeracy and skill development. It can also contribute to social exclusion, as a child may hold herself back from play with peers, made difficult because of poor sight. Or, as in my own case, it can even lead to educational exclusion — when academic struggles are wrongly attributed to another cause, such as bad behaviour or cognitive ability.

According to the Canadian Association of Optometrists, one in six children has a vision problem that makes it difficult to learn and read. At present, in many regions across the country, a child’s vision impairment may never be detected or is caught only as a result of attentive educators and caregivers who may suspect a problem. Only 14 per cent of children in Canada under the age of 6 receive professional eye care.

But even when vision impairment is suspected, there remain many barriers to adequate health services, including lack of medical insurance coverage, lack of accessible transportation for appointments, the costs of taking time off work to ferry children to appointments, and the out-of-pocket costs for prescription glasses or other aids. Many new immigrant families may have further struggles navigating the health care system due to linguistic and cultural barriers.

The good news is that there are organizations tackling this issue and making a difference, but they can’t do it on their own — nor should they. For example, the non-profit Toronto Foundation for Student Success(TFSS) launched an initiative in 2007 called the Gift of Sight and Sound, with support from corporate donors and partner non-profit organizations. They screen nearly 10,000 students every year for both vision and hearing problems in the early grades in inner city Toronto.

The screening takes place directly in the school, and if potential problems are detected, children receive full exams by an optometrist. If prescription glasses are required, they are provided free on-site. One in four of the students they have examined so far have had potential vision problems, and four of every five students that attended the subsequent optometry clinic received glasses.

Last year, 2,900 children in the Toronto schools received glasses; if the funding had been available for secondary school programming, the estimated numbers of glasses needed was expected to be similar.

The success of Alberta’s Eye See . . . Eye Learn program, which tests kids before they enter Grade 1, is another excellent model that could be replicated across the country.

The bottom line: thousands of children in Canada are struggling needlessly, as I once did, when something as simple as a routine eye exam and corrective lenses could benefit them enormously.

The Canadian Association of Optometrists has called for a nationalChildren’s Vision Initiative to ensure that all Canadian children have a comprehensive eye exam before they enter the school system. It’s time other health providers echoed this call, and our politicians heed it.

Comprehensive eye health needs to be part of our accessible and affordable health care system. To do otherwise would lack real vision.

Dr. Elizabeth Lee Ford-Jones is an expert adviser with EvidenceNetwork.ca, a pediatrician specializing in social pediatrics and Project Investigator at SickKids and Professor in the Department of Pediatrics at the University of Toronto. The above represent the opinions of Dr. Lee Ford-Jones and not necessarily the official positions of either The Hospital for Sick Children or the University of Toronto.

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