vision health and eye care: the canadian perspective - CNIB

VISION HEALTH AND EYE CARE: THE CANADIAN PERSPECTIVE NATIONAL VISION HEALTH REPORT

Commissioned by CNIB (Canadian National Institute for the Blind) May 2015 Charitable Registration #119219459

TABLE OF CONTENTS Introduction

2

Methodology

3

Survey highlights: Canadians’ eye health – values and experiences

4

Vision and overall health

5

Corrective lenses

7

Vision problems

8

Perceived likelihood of eye disease or injury

9

Survey highlights: Risk awareness and reduction

10

Awareness of eye diseases

11

Awareness of family history

12

Awareness of risk reduction behaviours

13

Eye safety and use of protective eyewear

14

Wearing sunglasses

15

Computer use and eye health

16

Survey highlights: Eye health and vision care

17

Most recent eye exam

18

Eye exams and kids

19

Access to eye exams

21

Rehabilitation therapy for people with vision loss

22

Survey highlights: Attitudes towards vision loss

23

Knowing someone who is blind or partially sighted

24

Attitudes towards people who are blind or partially sighted

25

Interacting with someone who is blind or partially sighted

26

Perceived quality of life

27

Concerns about experiencing vision loss

28

1

INTRODUCTION

The knowledge gap

Working to create change

As Canada’s primary source of support for people living with vision loss, we at CNIB have long known that a gap exists in Canadians’ knowledge of their own vision health, and what it means to live with a serious loss of sight.

This report demonstrates that there are gaps in Canadians’ knowledge as it relates to their vision health – but it also presents an unexpected dichotomy between our beliefs and our behaviours.

Every week, hundreds of people walk through our doors who have recently lost their vision, often to a preventable eye disease. Far too often, they didn’t know they were at risk for that eye disease, and they didn’t know they might have been able to prevent it in the first place.

It shows that although Canadians believe their vision health is important, many don’t have basic knowledge about how to prevent vision loss or maintain their vision health.

Our experience is that a similar knowledge gap exists even after sight loss has occurred. Often, people don’t know where to turn for help when they lose their vision. As a result, they can face depression, anxiety or long periods of isolation before they finally receive the rehabilitation therapy and support they need to regain their independence. The anecdotal evidence of this knowledge gap is ubiquitous at CNIB, where we hear stories like this from the people we serve every day. But statistical evidence is what inspires Canadians to think and act; and in time, create fundamental changes in our society. This evidence has never existed on a national scale – until now.

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Our goals are to eliminate preventable vision loss in Canada, and to reduce the impact it has on people’s lives when it cannot be prevented. The key to both of these goals is increasing knowledge and understanding, and it is incumbent on all parties – not only patients, but the entire health care community, including CNIB – to take on that responsibility. Together, we must work to increase patient awareness and improve the behaviours laid out in this report – to ensure patients are informed and transitioned with care through every step of their vision health journey.

METHODOLOGY

This report presents findings from a general population survey commissioned by CNIB and conducted by Ipsos Reid between November 17 and 24, 2014, designed to gauge public opinion, knowledge and behaviours relating to vision health in Canada. Within this one-week period, a sample of 2,764 Canadians aged 18-plus was interviewed online via the Ipsos i-Say online panel. Data were weighted to ensure the sample’s regional and age/sex composition reflects that of the actual population according to census information.

Overall, results of this survey are considered accurate to within plus or minus 2.1 percentage points 19 times out of 20. This credibility interval will be larger within regions and for other sub-groupings of the overall survey population. More information about survey methodology is available by request. CNIB acknowledges with gratitude the support and input of Dr. William Hodge, ophthalmologist, (Ontario) and Dr. Kevin Woodard, optometrist, (Saskatchewan) on the formation of all survey questions.

3

SURVEY HIGHLIGHTS:

CANADIANS’ EYE HEALTH – VALUES AND EXPERIENCES

On a day-to-day basis, our eyesight is something that can be easy to take for granted. But when asked about their vision and how they value it, Canadians view it strongly as one of their most important health priorities.

4

VISION AND OVERALL HEALTH Survey results show Canadians value their vision and believe maintaining their eye health is important. When asked about the relative importance of different aspects of preventive care in preserving one’s overall health, Canadians rank maintaining

vision health and preventing vision loss third, following heart health and weight management.

Q. Of the following, please select the three most important options in terms of maintaining your overall health from the list below. Heart Health and Maintenance

Weight Management

Maintaining Vision Health/ Preventing Vision Loss

Preventing Mental Health Issues

Preventing Diabetes

Preventing Breast Cancer

Preventing Prostate Cancer

Preventing Lung or Esophageal Cancer

Maintaining Hearing/ Auditory Health

Base: All respondents (2,764)

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The high priority placed on vision health is further emphasized by the fact that Canadians rank eye exams above exams for breast cancer,

prostate cancer and diabetes in terms of their importance to overall health maintenance.

Q. How important do you believe regularly getting the following exams to be in terms of health maintenance? Dental Check Ups

Eye Exams

Physicals

Breast Cancer Examinations

HDL Cholesterol Test

Prostate Cancer Examinations

Diabetes Test

Hearing Test


6

CORRECTIVE LENSES

A strong majority of Canadians across all age groups wear glasses or contact lenses Seven out of 10 Canadians surveyed (71%) report they wear glasses or contact lenses,

with the strongest results among Canadians aged 55 and up (80%).

Q. Do you wear contact lenses or glasses?

Age Breakdown 18-34

60%

35-54

70%

55+

80%

71% YES 29% NO


7

VISION PROBLEMS An estimated nine million Canadians don’t see clearly, even when wearing eyeglasses or contacts. Vision loss is defined as an inability to see clearly, even while wearing corrective lenses and to the point that it impedes the ability to perform everyday tasks.

Twenty-six per cent of Canadians (an estimated nine million people) report experiencing this degree of impairment. Among them, less than half (42%) say they have been recommended to see a specialist to discuss vision loss.

Q. Do you consider yourself to be someone living with vision loss (based on the definition provided)?

Q. Have you ever been recommended to see a specialist to discuss vision loss?

26% YES

74% NO


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58% NO

42% YES

Base: Consider themselves to be living with vision loss (723)

PERCEIVED LIKELIHOOD OF EYE DISEASE OR INJURY Most Canadians believe themselves likely to develop an eye disease and/or sustain an eye injury, suggesting concern about this aspect of their health. Fifty-eight per cent of Canadians believe themselves likely to develop an eye disease, overestimating the average lifetime risk of 14%.

A smaller number, 43%, believe themselves likely to sustain an eye injury.

Q. How likely do you believe it is that you may...

Develop an eye disease in your lifetime

Sustain an eye injury in your lifetime

Very likely

Somewhat likely

Somewhat unlikely

Very unlikely


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SURVEY HIGHLIGHTS:

RISK AWARENESS AND REDUCTION

Despite valuing their vision, many Canadians aren’t as aware of the risk factors for vision loss as they need to be – and sometimes, are missing out on critical opportunities to reduce their risk.

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AWARENESS OF EYE DISEASES

An estimated 5.6 million Canadians are living with a vision-threatening eye disease, including: AMD: 1,437,200; Glaucoma: 271,200; Diabetic Retinopathy: 688,600; Cataracts: 3,198,200

Canadians are aware of some, but not all, common vision-threatening eye diseases. Among the four major vision-threatening eye diseases, the overwhelming majority of Canadians have heard of cataracts (90%) and glaucoma (86%). However, only 60% have heard of age-related macular degeneration

(AMD), the leading cause of vision loss among seniors, and only 32% have heard of diabetic retinopathy, the leading cause of vision loss among Canadians under 50. Five per cent indicated they had not heard of any of the diseases listed.

Q. Have you heard of any of the following eye diseases? Cataracts

Glaucoma

Age-Related Macular Degeneration (AMD)

Diabetic Retinopathy

Retinitis Pigmentosa

Stargardt’s Disease (STGD)

I have not heard of any of these eye diseases

Most likely to have not heard of any eye diseases Young Adults

10%

Not Born in Canada

10%

First Nations

12%


11

AWARENESS OF FAMILY HISTORY Heredity is a risk factor for most eye diseases, like glaucoma, but half of Canadians don’t know their family eye health history. When asked about whether or not there is a history of eye disease in their family, only 47% reported knowing if this was the case –

meaning more than half are in the dark about potential hereditary risks.

Q. Are you aware of whether or not your family has a history of eye diseases?

47% YES

53% NO


12

AWARENESS OF RISK REDUCTION BEHAVIOURS Canadians understand the importance of key eye-healthy behaviours, but a surprising number miss the connection between smoking and vision health. When asked how important different types of actions and behaviours are to one’s vision health, Canadians strongly endorsed the importance of UV protection, eye safety and regular eye examinations (96% each).

However, a quarter (25%) shockingly do not believe smoking is an important factor in relation to vision health – despite the fact that it significantly increases the risk of several serious eye diseases, including age-related macular degeneration (AMD).

Q. In your opinion, how important do you believe the following are in relation to eye health?


13

EYE SAFETY AND USE OF PROTECTIVE EYEWEAR Protective glasses can prevent eye injuries from all types of activities – but many Canadians don’t wear them when they should. Many eye injuries occur as a result of high-risk activities around the home and in recreational settings. However, only 31% of Canadians report wearing proper eye protection always or often in

their workshop, only 23% while doing yardwork, and only 20% while playing sports - increasing the risk of injuries causing vision loss.

Q. How often do you wear appropriate/required eye protection (not including sunglasses) when participating in the following activities?

Total - Always/often wear eye protection

31%

29%

23%

20%

In my workshop/ when involved In any hobbies

At work

Yardwork/ gardening

Playing sports


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WEARING SUNGLASSES

CNIB recommends Canadians wear sunglasses that have: • Minimum 99% UVA/UVB protection (look for a UV400 sticker) • Dark lenses to reduce glare • Large lenses and wrap-around frames to prevent light coming in from the sides • Mirror coating to reduce the amount of light entering the eye

Most Canadians own sunglasses – but only half wear them year-round as recommended. Four out of five Canadians (83%) own sunglasses, which are important to prevent common eye diseases caused by ultraviolet (UV) rays. However, only 48% report wearing them year-round in

accordance with recommendations; 23% wear them only when they remember; and 11% wear them rarely, increasing the risk of UV-related eye damage.

Q. Do you own sunglasses?

Q. You’ve indicated that you currently own sunglasses. How often do you wear them?

11%

Rarely

17% NO

83% YES

23%

Only when I remember

48%

Daily all year

18%

Daily but only in summer


Base: Owns sunglasses (2,302)

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COMPUTER USE AND EYE HEALTH

To reduce eye strain, follow the 20/20/20 rule when you’re using a computer: • Every 20 minutes • Look at something 20 feet away • For at least 20 seconds

Only half of Canadians who use computers in their jobs are aware of key recommendations for reducing eye strain. Seventy per cent of working Canadians indicate that they use a computer for a significant portion of their workday. Among them, half (51%) are aware it is recommended to take a break every 20 minutes or more frequently in

order to reduce eye strain. Thirty per cent believe the recommendation is to take a break every hour, while one in five (19%) don’t know how often one should take a break.

Q. Does your current occupation require any of the following: Using a computer for a significant portion of your work day?

Q. How often is it recommended for you to take a break from your computer and focus your eyes on something else?

2%

Every 4 hours

19%

Don’t know

30% NO

Base: Employed respondents (1,545)

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70% YES 30%

11%

Every 10 minutes

38%

Every 20 minutes

Every hour

Base: Work with computer (1,088)

SURVEY HIGHLIGHTS: EYE HEALTH AND VISION CARE

Canadians understand the importance of eye exams to monitor the health of their eyes, but access, frequency and insurance coverage are concerns for some groups.

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HOW OFTEN SHOULD YOU GET AN EYE EXAM? The Canadian Association of Optometrists recommends the following schedule for eye examinations:

MOST RECENT EYE EXAM

• Infants and toddlers: Once between 6 and 9 months • Preschool: Once between 2 and 5 years • School-aged children: Annual from age 6 to 19 • Adults 20-39: Once every 2 to 3 years • Adults 40-64: Once every 2 years • Seniors 65+: Once every year

The majority of Canadian adults comply with frequency guidelines for eye examinations, but compliance is low among some high-risk groups. Current guidelines indicate healthy Canadian adults should undergo an examination to check the health of their eyes at least every two years. Seventy-six per cent of Canadians in general indicate they have met this guideline. Interestingly, the lowest compliance (54%) is among Canadians who do not wear glasses or prescription lenses, indicating that Canadians may not be recognizing the link between eye exams and eye health as much as they need to.

Among Canadians with diabetes, who are recommended to have annual exams to monitor for eye disease directly related to diabetes, 88% report having an exam in the last two years. Compliance is lower among Canadians aged 18-34 (64%), as well as First Nations people (68%) and smokers (69%), despite the fact both these groups have an increased risk of eye disease.

Q. Have you had an eye exam to check your general eye health within the last two years?

YES

All Respondents

76%

Not Born in Canada

69%

Smoker

69%

Member of First Nations

68%


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EYE EXAMS AND KIDS Canadian parents value their children’s eye health, but some are not as vigilant as they could be about getting their kids’ eyes examined regularly. Regular eye examinations during the childhood years are vital to diagnose and correct vision problems, and support success in school. The majority of parents surveyed indicate they take their children for regular eye exams (84%) and educate them about the importance of caring

for their eyes (82%). In terms of frequency, 53% indicate their child’s last eye examination was less than a year ago, but one in seven (15%) do not know or cannot remember when their child’s eyes were last examined.

Q. Please state how much you agree or disagree with the following statements: AGREE

I encourage my children to wear appropriate eye protection when playing sports or activities that could pose a danger to eye safety

I take my children for regular eye exams

I teach my children about the importance of maintaining vision health

If my child was experiencing vision loss, they would tell me

My child is aware that living with reduced vision or vision issues isn’t necessary

43%

43%

54%

30%

39%

43%

43%

38%

27%

Strongly agree

43%

Somewhat agree

Somewhat disagree

12% 3% 85%

84%

15%

15% 3% 82%

17%

23%

81%

8% 70%

Strongly disagree


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Vision problems can seriously affect a child’s ability to learn. In fact, National Vision Health Coalition research suggests approximately 60% of kids with literacy issues have an undiagnosed vision problem.

Q. When was your child(ren)’s last eye exam?

57% 55% 53% 49% 38%

29% 24% 22% 17% 15% 9% 6%

5%

5%

5%

4%

5%

2%

Less than one year ago

Total

Base: Parents (719)

20

Less than two years ago

Less than three years ago

Under 1 year old

Three or more years ago

1-4 years old

Don’t know/ can’t remember

5+ years

ACCESS TO EYE EXAMS Canadians generally find it easy to schedule an eye examination in comparison to other health-related appointments. Eighty-seven per cent of Canadians indicate it is somewhat or very easy to schedule an eye exam at a date and time convenient to their schedules.

However, this is less true among foreign-born (82%) and First Nations (78%) people.

Q. How easy do you find it is to get an appointment to have the following exams, at a time and date that suits your schedule? Dental Check Ups

Eye Exams

Physicals

HDL Cholesterol Test

Diabetes Test

Hearing Test

Breast Cancer Examinations

Prostate Cancer Examinations


Very easy

Somewhat easy

Not very easy

Not at all easy

I’ve never had one

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REHABILITATION THERAPY FOR PEOPLE WITH VISION LOSS Canadians understand the wide range of rehabilitation therapy required by people who are blind or partially sighted to live safely and independently. Post-vision loss rehabilitation therapy, such as that which is provided by CNIB, enables people who are blind or partially sighted to develop the adaptive skills needed for an active and independent life.

When asked about aspects of that rehabilitation therapy, a strong majority of Canadians (82%) correctly identify the full range.

Q. Should someone lose their sight, which of the following do you consider to be aspects of their rehabilitation?

Learning to travel safely with a white cane

7%

Learning to travel safely with a guide dog

6%

Learning how to maximize use of one’s remaining vision

10%

Learning skills to cook safely and independently in one’s home

8%

Learning how to organize one’s home so that basic self-care skills (dressing one’s self, personal hygiene, etc) can be maintained independently Learning how to use assistive technological devices (eg. Screen readers for a computer)

All of the above

None of the above Base: All respondents (2,764)

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10% 8% 82% 1%

SURVEY HIGHLIGHTS:

ATTITUDES TOWARDS VISION LOSS

Nearly 500,000 Canadians have vision loss severe enough to be considered blind or partially sighted. General public attitudes reflect support and acceptance of this group, tempered with fears and stigmas about vision loss and how it can affect one’s ability to participate in society.

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KNOWING SOMEONE WHO IS BLIND OR PARTIALLY SIGHTED

Only a third of Canadians report knowing someone who is living with vision loss. Yet only one in three (33%) Canadians indicate that they know someone living with vision loss, usually a family member (16%) or friend (10%). Two-thirds (67%) do not know anyone who is blind or partially sighted.

Personally knowing someone who is blind or partially sighted can help dismantle stigmas and create understanding about the experiences and abilities of this group.

Q. Are you close with or do you know anyone living with vision loss?

No connection to anyone with vision loss

67%

Yes, family member

16%

Yes, friend

33% YES

10%

Yes, someone else in my life

9%

Yes, colleague/ co-worker

2%

67% NO

Top groups connected to vision loss Seniors


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39%

First Nations

49%

Diabetic

45%

ATTITUDES TOWARDS PEOPLE WHO ARE BLIND OR PARTIALLY SIGHTED Canadians acknowledge a social stigma towards people who are blind or partially sighted – and many doubt they can live full and independent lives. it is for their sighted counterparts. Furthermore, many believe that people with vision loss cannot blend in and succeed in society (49%), thrive in school (39%), lead healthy social lives (35%) or live and care for themselves independently (33%).

When asked whether there is a general stigma towards people who appear to be blind or partially sighted, seven in 10 (69%) agreed. This stigma is also reflected in the majority opinion (77%) that it is more difficult for people who are blind or partially sighted to find a job than

Q. Please state how much you agree or disagree with the following statements: There is a general public stigma towards individuals exhibiting obvious signs of blindness/partial sight such as an individual using a white cane or a guide dog Most of those with vision loss can live and take care of themselves independently without care

Canadian seniors with vision loss can still maintain their independence

Most Canadians with vision loss lead a healthy social life

AGREE

15%

Those with vision loss are easily able to blend in and succeed in society

Adults with vision loss can find a job as easily as those without vision loss


26%

5%

69%

12%

54%

28%

5%

67%

14%

53%

28%

6%

66%

12%

Children with vision loss can thrive in school as well as those without vision loss

Immigrants with vision loss can successfully manage cultural integration

54%

53%

17% 11%

44%

34%

41%

18%

Strongly agree

3%

31%

46%

9%

5%

32%

42%

52%

Somewhat agree

25%

Somewhat disagree

65%

8%

61%

9%

57%

7%

51% 23%

Strongly disagree

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INTERACTING WITH SOMEONE WHO IS BLIND OR PARTIALLY SIGHTED Most Canadians say they feel comfortable approaching and interacting with someone who is blind or partially sighted – but many aren’t sure how. When asked about their comfort level approaching someone with vision loss on a busy street, a majority (58%) say they would feel comfortable offering and/or providing assistance.

However, many express a concern about offending (29%) or embarrassing (21%) the person with an offer of assistance – suggesting greater public education on how to interact with people who are blind or partially sighted may be needed.

Q. When I see an individual living with blindness struggling to navigate a busy street I am…

Comfortable offering and providing assistance, if they would like it

58%

Not sure of their capabilities and am not sure how to offer assistance without offending them

29%

Uncertain how to approach them without embarrassing them or myself

21%

Determined to offer assistance and get them across the street

14%

Afraid to speak to them and/or offer assistance


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5%

PERCEIVED QUALITY OF LIFE Most Canadians do not perceive that people who are blind or partially sighted enjoy a positive quality of life today. Two thirds of Canadians (65%) perceive that people who are blind or partially sighted are barely getting by in society. When asked about reasons, the majority cite inequity in

opportunities (58%), inadequate employment accommodations (50%) or a lack of access to social assistance and resources (49%).

Q. How would you describe the quality of life of the average Canadian living with vision loss?

Q. Why do you believe that Canadians with vision loss are getting by but not comfortably or just merely getting by?

35%

Canadians with vision loss are thriving or getting by


65%

Canadians with vision loss are getting by but not comfortably or merely getting by

They have not had the same opportunities as Canadians without vision loss

58%

They have not been provided the necessary accommodations and allowances from employers and the general public required to succeed

50%

They have not been provided the necessary social assistance resources required to succeed

49%

There is a stigma around Canadians living with vision loss

39%

They have not worked with organizations that would teach them essential skills needed to live with vision loss

37%

Other

5%

Base: Canadians with vision loss are getting by but not comfortably or just merely getting by (1,808)

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CONCERNS ABOUT EXPERIENCING VISION LOSS

VISION LOSS DOESN’T HAVE TO MEAN THE END OF A RICH, FULFILLING AND INDEPENDENT LIFE. With specialized rehabilitation therapy and support from organizations like CNIB, people who are blind or partially sighted can fully participate in every aspect of life.

Canadians believe that if they were to experience a loss of sight, their own lives would be very negatively affected. When asked what would happen if they were to lose their eyesight, most Canadians say they would lose independence (87%) and self-confidence (83%), and feel excluded from the lives of family and friends (58%).

Approximately two-thirds doubt they would be able to maintain employment (67%) or continue to be financial providers (62%).

Q. If you lost your vision as a result of an accident or an eye disease, please indicate whether you would agree or disagree with the following.

I would feel as though I had lost my independence My self-confidence would be negatively affected I would no longer be able to pursue the hobbies and interests I have today I would feel left out or excluded from the lives of my family and friends I would be able to provide for myself and/or my family financially I would be able to maintain my job, with the appropriate assistive technology devices and training I would be confident leaving my house unaccompanied

Agree


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Disagree

This report presents findings from CNIB’s national vision health survey, a first-of-its-kind analysis of Canadians’ true knowledge and understanding of vision health issues, as well as their behaviours in relation to proactive eye care. Put simply, we wanted to find what people know about their eyes, and what they’re doing to keep them healthy.

What we discovered was an unexpected dichotomy between Canadians’ values and behaviours when it comes to their vision health, as well as a definitive gap in our basic vision health knowledge as a nation. For more information, please visit cnib.ca/visionhealthmonth

cnib.ca [email protected] 1-800-563-2642 #visionhealthmonth