Author’s Name(s): Mostafa Bondok, Mostafa Bondok, Brendan Tao, Christopher Hanson, Gurkaran
Sarohia, Edsel Ing

Author’s Disclosure Block: Mostafa Bondok, none; Mostafa Bondok, none; Brendan Tao, none;
Christopher Hanson, none; Gurkaran Sarohia, none; Edsel Ing, none

Abstract Body
Purpose: Indigenous Canadians experience inequities in eye care. A review of ophthalmic health 
inequities may identify disparities and inform the development of culturally appropriate health 
interventions.
Study Design: Comprehensive literature review.
Methods: We conducted a literature search of Ovid Medline, Ovid Embase, CINAHL – EBSCO and Scopus 
from inception to January 24, 2024. The search strategy was developed with an academic librarian 
and employed both controlled vocabulary and free-text terms. Articles were screened in duplicate by 
two independent reviewers.
Results: The initial search identified 654 articles, supplemented by 57 from reference lists and 6 
from grey literature. After excluding 275 duplicates and 156 irrelevant articles, 223 full-text 
studies were considered. Indigenous Canadians have a greater burden and lesser likelihood to be 
screened for diabetic retinopathy (DR). Barriers to care include poor access, racism, longer wait 
times, mistrust, and avoidance of healthcare systems, while enablers include supportive 
interactions, culturally sensitive programming, and involving Indigenous staff. Indigenous people 
experience less access to cataract surgery and post-operative follow-up due geographical, 
economical, and cultural factors. Inuit people have the highest global rates of angle-closure 
glaucoma (ACG). Tele-glaucoma may reduce time to treatment for open-angle glaucoma. Uveitis occurs 
at a younger age, is more often bilateral and granulomatous with pan-uveal involvement, in part 
because Vogt Koyanagi Harada is more common in Indigenous Canadians. Conjunctival papilloma, 
epiblepharon, trauma-related vision loss, spheroidal degeneration, pterygium, and uncorrected 
refractive errors disproportionally affect Indigenous people. 

Conclusions: Barriers to eye care for Indigenous Canadians are present in rural and urban settings.
Strategies to improve eye care include tele-ophthalmology, mobile screening, better monitoring of 
surgical outcomes/complications, screening for ACG, and more consistent uveitis follow-up.
Ophthalmic care for Indigenous Canadians should be culturally appropriate, integrated with primary 
care, and a holistic approach through Indigenous-led centres is ideal. Ophthalmologists should be 
aware of eye care governmental resources available to Indigenous Canadians. Further research on 
macular degeneration, and ocular infections is needed, and should be conducted following guidance
on research involving Indigenous people.