Inadequate access to vision rehabilitation in Canada: A cross-sectional mixed-methods study

Author Block: Aidan Pucchio1, Daiana R. Pur2, Amin Hatamnejad3, Arushi Sachdev1, Sarenna Lalani1, Mark Bona4, Mahadeo Sukhai5. 1School of Medicine, Queen’s University, 2Schulich School of Medicine & Dentistry, 3Michael G. DeGroote School of Medicine, 4Department of Ophthalmology, Queen’s University, 5CNIB Foundation.
 

Author Disclosure Block: A. Pucchio: None. D.R. Pur: None. A. Hatamnejad: None. A. Sachdev: None. S. Lalani: None. M. Bona: None. M. Sukhai: None.

Abstract Body: 

Purpose: To determine the breadth of the vision rehabilitation (VR) services accessible in Canada and describe barriers to comprehensive low vision care.

Study Design: Cross-sectional mixed-methods study, with online survey and interview components.

Methods: A 45 question survey was distributed to Canadian ophthalmologists, optometrists, opticians, orthoptists, ophthalmic technicians, occupational therapists, and rehabilitation professionals. The survey explored the VR services that participants refer for or provide, the VR services they felt essential, and the accessibility of low vision care. Following survey closure, a stratified random sample of six of each of ophthalmologists, optometrists, opticians, and all remaining professions were invited to participate in an online interview. Interviews consisted of eight scripted questions in which participants detailed their experiences in VR, and barriers to the provision of low vision care. Interview transcripts were analyzed using emergent thematic analysis.

Results: A total of 189 survey responses (of 325 total) met the inclusion criteria. Optometrists were the most highly represented (64, 33%), followed by opticians (55, 29%) and ophthalmologists (44, 23%). Among respondents, the most commonly provided services were assessment of vision loss (162, 86%), education about vision loss (141, 75%), and referral to specialized VR services (135, 71%), while the least commonly provided was orientation and mobility training (6, 3%). The most commonly initiated referrals were for social services such as the CNIB (101, 53%), training in the use of low vision aids (95, 34%), and specialized VR services (71, 38%). Respondents perceived assessment of vision loss to be the most accessible service (181, 95%) and mental healthcare (114, 60%) to be the least accessible. Four major themes emerged in the qualitative analysis, the first of which was limited and fragmented provision of VR. The second was limited access to low vision care, with the subthemes of financial barriers for patients and providers, a lack of awareness of VR services, and poor access to mental healthcare. The third was limited VR training opportunities, with the subthemes of limited formal education and the need to independently learn about low vision. The final theme was poorly defined roles within VR, with the subtheme of poor interdisciplinary communication and collaboration.

Conclusions: Our results describe a national VR system that is not fully meeting the needs of Canadians with low vision. Improved access to VR education and better financial incentives for eye care providers to participate in VR could support a more robust Canadian VR system