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Access to eye care could be in a crisis in Northern Ontario, says optometrists group

Thirty years of underfunding ran smack-dab into a pandemic and the head of the Ontario Association of Optometrists says there are optometry practices that aren’t going to make it out the other side

There is a chance that some optometrists in Ontario might be forced out of business as they struggle to get back to normal with pandemic restrictions making it a lot harder to do their jobs. That could create a crisis of access to eye care in Northern Ontario and smaller communities across the province. 

Dr. Sheldon Salaba, president of the Ontario Association of Optometrists,  was commenting this week on what he said is the need for the Ontario government to return to the time when it provided full funding to optometrists for annual eye exams. 

 "I have spoken with optometrists in North Bay, Sudbury, rural areas outside of Ottawa and this is definitely an issue for them. We are definitely concerned about the long term viability of a good percentage of our practices," he said.  

"The bills didn't stop when we were shut down for two and a half months. And you know there are substantial numbers. I have two practices in Hamilton and the amount of money that racked up during that time when everything was suspended was in the hundreds of thousands," he revealed.

Practices will fail

"There are going to be practices that most definitely will fail," said Salaba.  "Especially when we went into this scenario where we were subsidizing so many of our (eye) exams so heavily. We used to sort of manage those losses by doing higher volumes in our practices. But now we can't do that," he explained. 

Salaba does not dispute the new regulations for visiting the optometrist, but he said it will require more time. 

"I don't feel the public is overly scared.  When you enter our offices now, everything is being done by appointment. People come to the door and it's locked. We let them in at their appointment time. We take their temperature. We make sure they have a mask they're wearing. We disinfect their hands. They go into a completely different pre-test area, a disinfected room. “Then their examination is provided.”

Salaba said if the patient wants to purchase new glasses, there is no more browsing among the displays. A brief discussion of the types of glasses they might want, several examples are provided on a clean tray so the patients can try on a few pairs. All the frames are then re-cleaned before they're put back on the shelf.

Social distancing is maintained throughout this process, he said.  And it all takes more time he added.

"With the reduction of 40 to 50 per cent of our time slots, we are anticipating that around two million eye exams are going to be eliminated over the next 12 months, due to social distancing requirements and disinfection compared to what we normally see," he said.

Salaba said Ontario optometrists on average provide about five million comprehensive exam services and roughly one million partial exams every year. He said this drop in eye care service is significant. 

"I think this is huge because it means that a lot of people who are used to being able to access routine care aren't going to be able to," said Salaba.

He said the only way to meet the full demand for eye exams would be to extend office hours. Salaba said it would be a complex and expensive solution to go beyond normal hours.

"Optometrists in Ontario are in a unique position because governments have neglected to appropriately fund our services over the last 30 years", he explained.

In that time, everyday costs of supplies, heating, hydro and labour have continued to rise.

"We are now subsidizing more than 50 per cent of the cost to deliver an OHIP insured eye exam", he said.

Salaba said this makes up 50 to 70 per cent of the number of patients they serve. 

To break that down into real spending, Salaba said the Ontario government puts up roughly $150 million a year for eye care while the subsidy provided by the optometrists is roughly $173 million a year.  

"That's just in order to deliver the service," Salaba added. 

Accessibility crisis

He said even if an optometrist schedules a partial exam, at a cost of roughly $25, it will still take half an hour to do the exam properly. Salaba said that is no longer viable. He said that could lead to some optometry offices being shut down, which will create a crisis of accessibility.

"In remote communities in the North, I think the public relies on optometry offices very importantly to deliver those services, because they often don't have access to opthamologists that can also deliver a similar type of medical care," he said.

Salaba said this means optometrists are treating glaucoma cases in these smaller communities; they're helping to manage eye care for diabetics and other medical conditions.

"I think if the government doesn't come to the table to work to find a funding solution, you're going to see permanent reductions in access to care for people."

Salaba said the OAO has been in talks with Queen's Park for more than 10 years trying to get some sort of equitable funding agreement for eye care. 

"I want to be clear this government isn't the government that created the problem. This has been developing over a long period of time, but they are the government that is going to be responsible for needing to fix it due to the situation that we've all found ourselves in.

"We want to work with the government to come to a solution that makes sense, that can fund the cost of delivering the service and ensure that we're able to provide this type of community access across the province," he said.

He is urging Ontario residents to visit the website where residents will be invited to sign up for a call to action, which will send an email to the Premier Doug Ford, and also to the minister of health and to your local member of provincial parliament).


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Len Gillis, local journalism initiative reporter

About the Author: Len Gillis, local journalism initiative reporter

Len Gillis is a Local Journalism Initiative reporter at covering health care in northeastern Ontario and the COVID-19 pandemic.
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