Please visit the British Columbia Association of Optometrists website to read a very important posting regarding new regulations set to be implemented in our province that will serve to blind our population by ignorance. The change in the Health Professions Act will permit opticians to dispense glasses or contact lenses without the need for anything more than computerized eyesight testing to estimate the required strength. By no longer requiring a proper examination by an Optometrist or Ophthalmologist, the people of our province will no longer be screened for asymptomatic eye diseases like glaucoma, retinal tears, and other conditions that will lead to permanent visual loss if not found and treated early.
Unfortunately, this is a bigger crime that the government is pushing through our legislature than the much publicized Harmonized Sales Tax (HST.) The cost-benefit analysis of the HST is something the government of BC may indeed be correct about, but the concept that both Health Services Minister Kevin Falcon and the right honourable Premier Gordon Campbell have stated that there is no such thing as an asymptomatic eye condition has no basis on reality and is blatant ignorance of how the eye gets ravaged by diseases that can sneak up on us all.
As a glaucoma sub-specialized Ophthalmologist, I see the devastating loss of vision that can result from inadequate screening eye examinations. Glaucoma is asymptomatic until half the optic nerve is destroyed and the irreversible process is well under way. By no longer requiring an eye exam by an Optometrist or Ophthalmologist for a prescription, there will be more patients not presenting with glaucoma until they become symptomatic - which means not until they are already partially blind. If detected on routine eye examination, this would not happen.
Keith Gordon, the Canadian National Institute for the Blind (CNIB) Vice President Research and Service Quality sent a letter to Minister Kevin Falcon, with a copy to Premier Gordon Campbell on 8Apr2010 that emphasizes the need for routine eye examinations and references the Canadian Ophthalmological Society policy on routine eye examinations.
Thomas Freddo, Professor and Director of the University of Waterloo School of Optometry has also sent a detailed letter, containing other key references, to Mr Falcon and Mr Campbell. He goes into detail to explain that allowing just sight testing and not even requiring proper full refraction means that patients will not even be getting acceptable measurements for glasses prescriptions. As for awaiting the presence of symptoms for conditions that afflict the eye, he states this is "an unacceptable standard for any health care system in any jurisdiction in a developed country. If one only considers glaucoma, the risk should be deemed unacceptable. In its most common forms, symptoms only occur very late in the course of glaucoma, when nothing can be done to regain what has been lost and little can be done to prevent patients from losing their remaining vision."
I really have little more to add to this debate that is not already very well stated by Keith Gordon and Thomas Freddo in their statements. The only point I might add is that Dr Freddo may have offended our colleagues in developing countries, many of which have eye care at least as good as ours. Perhaps Premier Campbell's own words can also help illustrate how he and Minister Falcon show a complete lack of understanding of the evidence of the importance of proper eye examinations. His own words are contained below in an email that he sent to a patient this week in response to her concerns over this change in the regulations that is scheduled to be implemented May 1. To highlight Gordon Campbell's own words from this message, "I can assure you Ministry of Health Services staff have examined the medical evidence and have determined there is no strong evidence to suggest regular eye examinations for asymptomatic individuals aged 19 to 65 improve health outcomes."
As a glaucoma sup-specialized Ophthalmologist, I can assure you that the Ministry of Health Services staff never examined the correct medical evidence and have absolutely no medical evidence to base their decision to impair the health of British Columbians. This is a grave dis-service to the public good that will result in permanent visual loss to our citizens. The extra burden on society in lost productivity and extra health care costs to treat patients not presenting until they have symptomatic eye disease is completely preventible. The government must not be allowed to outlaw routine eye exams for patients who want to buy glasses and contact lenses from on-line companies. There is no cost-saving to British Columbians by government enabled blindness.
Letter to Minister from Keith Gordon, Canadian National Institute for the Blind (Thursday, 8 April 2010 at 12:00 PM) Keith Gordon, VP Research and Service Quality
Letter to Minister from Thomas Freddo, University of Waterloo Optometry (Friday, 16 April 2010 at 12:00 PM) Thomas Freddo, Professor and Director
E-mail exchange between Gordon Campbell and patient (Monday, 26 April 2010 at 12:00 PM) Gordon Campbell, Premier British Columbia
Speak Out For Eye Health, BC Association of Optometrists
Proposed changes to regulations will put eye health and safety of B.C. public at risk (Wednesday, 24 March 2010 at 12:00 PM) BCAO
Battle heats up over new B.C. eye regulations (Thursday, 22 April 2010 at 12:00 PM) JONATHAN FOWLIE, VANCOUVER SUN excerpt below as article no longer available on-line:
"A new government policy that will soon allow people easier and cheaper access to prescription glasses and contact lenses is coming under fire as a reckless move that will compromise eye health throughout the province."
The following comments were copied from original submission dates and posted as a journal follow-up article in preparation for changing to DISQUS for future commenting on my blog.)
On 28Apr2010 a reader wrote:
I think that the checking of the intraocular pressure by an optometrist or an ophthalmologist as part of a screening test to detect eye disease in al patients with eye-related symptoms is very important. 4% of general population are found to be either glaucomatous by this method (7% of those with +ve family history). Inspection of the optic disc for glaucomatous cupping and retinal examination to detect retinal detachment or other diseases (e.g. retinitis pigmentosa) through dilated pupil should also be done at same time.
Everyone knows this. Question is whether individual should pay for this or whether it should be mandated by (and by inference also paid for) by Provincial Government.
As an eyeglass wearer with a high degree of myopia, I know that my eyes should have a thorough examination every time I need new lenses. But what about people replacing accidentally broken glasses or lost eyeglasses who don't need a new eye examination and have lost their prescription also? Eye exams are expensive, it cost me $70 to get one last time (with the HST added I believe). I can see the argument for both. What about people with basically almost perfect vision and only need slight correction? If they are older, then an full examination is necessary (to determine if they need bifocals for example). If you must make full eye examinations mandatory to fill a new prescription, it should be paid for by the government. If I lost my glasses, I'd be just as crippled as anyone who lost a leg or arm. I wouldn't be able to work, I'd probably get hit by a car as I can only see about 10 cm away from me or less. I don't understand why eye health and dental health are not included with our health plans.
To the "high myope" - your prescription is kept on file for the case you describe above. If it was expired, it would warrant a new examination. Having a high degree of myopia, you state that you understand that you need an examination but what you seem to fail to understand is the fact that many individuals with so called "perfect vision" have asymptomatic disease that can only be detected by a thorough examination. Diabetes, glaucoma, hypertension, high cholesterol, and even brain tumors are just a handful of diseases optometrists and ophthalmologists diagnose in patients on a daily basis. When you change laws that make it seem to the public that an eye exam is not necessary, many of these people walk around undiagnosed until it is too late to do anything to correct their vision loss, or in the worse case senario of a brain tumor, until death. The publics perception that an eye exam does nothing more than make sure you can see clearly is false, alarming, and dangerous. And just because it is necessary, does not mean the government should have to pay for it. But the government should recognize the improtance of it. Failure to do so will result in blindness that cannot be corrected with glasses. You make reference to being blind without your glasses; what will be worse will be the thousands of individuals made permanently blind and disabled by not realizing the improtance of regular eye examinations.