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Eye-Care Cuts "disastrous"

Editor's Note: The following article is taken from the Toronto Star, May 28, 2004. *Image: Dr. Judith Parks, President of the Ontario Association of Optometrists, in an optometrist office

Hundreds of thousands of Ontarians could face vision loss or blindness if the province follows through on a plan to delist routine eye exams for adults, according to vision-care experts.

"The results will be disastrous, the cost will be enormous," says Dr. Judith Parks, President of the Ontario Association of Optometrists. "People will go blind that need not. The health and safety of our patients will suffer. People will experience more preventable eye disease."

Parks says the day the Ontario budget was delivered, her group was told adults with certain medical conditions would continue to have their optometric eye examinations covered, "specifically ? adults with diabetes and glaucoma." However, she says the province now says this is not so.

She says she was "horrified" to learn the province will cover such conditions only if a patient is treated by a medical doctor. Family doctors do not have the time, specialized equipment and expertise to routinely screen for such eye conditions, she says.

And ophthalmologists, who are medical doctors trained as eye disease and surgery specialists, are in short supply and swamped with long waiting lists, she says.

Parks said routine eye exams, now covered every two years for people age 20 to 64, screen for and detect many eye diseases before there is permanent or significant damage to eyesight.

"Many of the most serious diseases do not present with symptoms before damage is done," she says. "You can slow the pace or reduce the damage but not if you don't detect them early."

Cutting off eye exams until a person is 65 is dangerous because many serious eye conditions start during the forties and fifties and that is the time effective treatment can be undertaken, eye experts say. The association, whose members treat 9 million patients in Ontario, is holding a news conference at Queen's Park today to voice its concerns.

Dr. David White, President of the College of Optometrists of Ontario, is also "quite concerned." He says, "Ultimately we save (health care dollars) if we catch these things early."

Diabetic retinopathy, glaucoma, types of macular degeneration and Retinitis Pigmentosa--which can lead to blindness--must be detected before symptoms are significant in order to prevent or minimize permanent damage to eyesight, Parks says. All can affect people between the ages of 20 and 65.

Studies show people who have to pay for eye exams postpone or ignore them until a serious problem presents, when it is often too late, she says.

Jim Sanders, President of CNIB Canada, says it is crucial that adults get eye exams every two years, even if their eyes seem healthy. Too many people ignore them before a serious symptom develops, he says. If the cost of exams further deters people from getting regular eye checkups, he says he would be very concerned.

Toronto optometrist, Dr. Bernard Fresco, says although he is willing to reduce fees for patients in need, many people are too proud to ask. "There is no question about it. There will be very serious consequences."

Dr. Murray Turnour, registrar at the College, says that, besides increasing the chance that eye diseases will go undetected, limiting access to eye examinations is a public safety issue. Optometrists are obligated to report if a person's vision is unsafe for their class of driving licence.

"The optometrist has a mandatory obligation to report this to the Ministry of Transportation for public safety purposes," he says.

Reducing access to eye exams also means more people will go with out-of-date eyeglass prescriptions, eye doctors say. With so many people working on computers, this will reduce job productivity, White says.

It will also cause people to seek medical care for headaches and other conditions related to eye strain, further increasing the burden on the health care budget.

The current fee of $39 now paid for the bi-annual exams has been frozen for 15 years, the association says. This barely covers the true cost of the exams and puts pressure on eye doctors to see too many patients for too little time, Fresco says.

"I guess they (the province) are hoping that the insurance companies will step in, but this is not a solution," he says.

Glaucoma, one of the most common causes of blindness, affects 1 in 100 Canadians over age 40 according to the CNIB, and though it often occurs in older people, it can develop at any age. It occurs "slowly ? painlessly, even unnoticeably," according to the institute's website.

Early symptoms of retinitis pigmentosa can start at any age but usually occur during young adulthood, the group says. Night blindness (when adjusting to the dark happens very slowly) and loss of side vision are the two most common symptoms, notes the CNIB.

Diabetic retinopathy is the leading cause of blindness. According to the CNIB, most people who have had diabetes for more than 20 years have some form of retinopathy.

The CNIB says that although macular degeneration may develop slowly or quickly, it usually occurs gradually over a few years and everyone over 45 should be checked for it.

Reprinted with permission--Torstar Syndication Services.

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