Ontario’s inner city children’s vision being left behind

Children from low-income families are less likely to have ever had their vision checked than children from high-income families

By Anand Bery
and Wynn Peterson

TORONTO, Ont. June 13, 2016/ Troy Media/ – Many of them lean forward, almost off their tiny chairs, squinting with one eye to make out a rather large H or O on a chart across the room. Some try to cheat by uncovering their other eye or slyly turning their head to one side.

They are frustrated that this letter game is so difficult – and so are we. How could it be that we, volunteers at an outreach vision screening program in Toronto, are the first to pick up potentially significant vision problems in these children?

The program we run, [popup url=”http://kids2see.org/” height=”1000″ width=”1000″ scrollbars=”1″]Kids2See[/popup], is one of the few community vision screening programs for kindergarten-aged children in Ontario. Kids2See is a volunteer-based program run through the University of Toronto’s Faculty of Medicine. It aims to screen kindergarten children primarily for amblyopia.

Anand Bery

Amblyopia, sometimes called lazy eye, is a relatively common condition present in up to five per cent of children. It develops when the eyes are misaligned or one eye needs glasses much more than the other. It can lead to permanent vision loss if not treated early. With early treatment, children can easily regain much of their vision.

This is where our screenings come in. They are run entirely by volunteer medical students, under the supervision of a licensed optometrist. We are concerned with the lack of accessible vision care in our city and we donate time to try to fill this gap. Our annual budget is just $350, which the medical student society provides to all outreach groups.

While we are screening principally for amblyopia, we also pick up on children’s general vision difficulties, which can markedly impair their social and cognitive development. Up to [popup url=”http://novascotia.ca/dhw/healthy-development/children-evsp.asp” height=”1000″ width=”1000″ scrollbars=”1″]80 per cent[/popup] of learning at the preschool age is visually driven and children are highly unlikely to realize their vision is poor.

Wynn Peterson

At the small number of inner city schools we target, all of which are deemed high needs by the Toronto District School Board, a staggering 41 per cent of the children we screen have never had any type of eye examination.

We are also conducting a research study to better understand barriers to vision care in early childhood. We have noticed a disturbing – and statistically significant – trend. Children from low-income families are less likely to have ever had their vision checked than children from high-income families.

The Canadian Paediatric Society recommends a sequence of eye examinations throughout childhood to age 18. Children with regular access to family doctors, paediatricians or optometrists may receive this kind of care but the results of our survey suggest this is far from universal.

Why doesn’t Ontario’s supposedly universal health-care system include vision screening for amblyopia?

Ontario lags behind other provinces, such as British Columbia and Nova Scotia, which have universal screening programs to detect amblyopia in young children. Ontario could also follow the example of Sweden, which has a nationwide screening [popup url=”http://www.ncbi.nlm.nih.gov/pubmed/9846920″ height=”1000″ width=”1000″ scrollbars=”1″]program[/popup] for amblyopia in preschoolers and has an uptake of more than 99 per cent.

The many resources in Ontario’s publicly-funded system to address vision health are a disorganized, unco-ordinated patchwork. For example, the Toronto District School Board has programs for screening children in Grades 4 to 6 but by that age, while it may be helpful for simple near-sightedness or far-sightedness, it is too late to effectively treat amblyopia.

Ontario Health Insurance (OHIP) covers eye exams for all children under 19 years of age. But parents need the time, resources and awareness to know that these examinations are an important part of promoting their child’s health. Most parents we encounter at the Kids2See visits are not making use of these resources – with potentially serious consequences for their children.

In decades past, nurses from Toronto Public Health visited schools to check every child’s vision. But now, like the school nurse and cafeteria milk programs, that initiative is a relic of a bygone era. Blame provincial budgets that are not focused on preventive care.

Ontario needs a universal vision screening program for preschool children. Maybe then so many children in Toronto wouldn’t have to rely on volunteers to check their vision.

Anand Bery and Wynn Peterson are contributors to EvidenceNetwork.ca and second-year medical students at the University of Toronto. They are co-directors of Kids2See, along with Omri Arbiv and Heather Dunlap.

Anand and Wynn are Troy Media [popup url=”http://marketplace.troymedia.com/our-contributors/” height=”1000″ width=”1000″ scrollbars=”1″]contributors[/popup]. [popup url=”https://www.troymedia.com/become-a-troy-media-contributor/” height=”600″ width=”600″ scrollbars=”1″] Why aren’t you?[/popup]

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