Ophthalmologic care for Indigenous Canadians

Introduction

Indigenous Canadians (IC) experience inequities in eye care. Identification of these inequities may inform the development of culturally appropriate interventions.

Methods

For this review, a literature search of Ovid Medline, Ovid Embase, CINAHL – EBSCO and Scopus from inception to January 24, 2024 was conducted. Studies were screened by two independent reviewers, and conflicts were resolved through discussion with a third reviewer.

Results

IC have a greater burden but lower likelihood of being screened for diabetic retinopathy (DR). Barriers to DR care include poor access and racism; enablers include supportive interactions, culturally sensitive programming, and the inclusion of Indigenous staff. IC have less access to cataract surgery and post-operative follow-up due to geographic, economic, and cultural factors. Inuit people have the highest global rates of angle-closure glaucoma. Tele-glaucoma may reduce the time to treatment for open-angle glaucoma. Compared to non-IC, uveitis in IC 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 IC. Uncorrected refractive errors, conjunctival papilloma, epiblepharon, and spheroidal keratopathy may disproportionally affect IC.

Conclusions

Barriers to ophthalmic care for IC persist in both rural and urban settings. Health care should be culturally appropriate, integrated with primary care and incorporate tele-ophthalmology if needed. Holistic care at Indigenous-led centres is ideal.