Notes on Aboriginal Vision

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Visual Function Status of a Southern Alberta First Nations Community Elementary Grades Cohort: By the Numbers.

Presentation at the Calgary Vision Event, September 20, 2015. The following notes were provided to the Premier, Rachel Notley, and since I felt the tone and coverage were agreeable to this sort of post, the notes are reproduced below verbatim.

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There are many causes of reading and behaviour problems. If a child has healthy eyes, this is not an indication the he will have adequate visual function to succeed unimpeded in school. Most children with visual impediments to learning and development (VILD) will express these as difficulty with attention, learning, language, emotional lability, coordination problems, and varied medical concerns such as headache. In Alberta, these visual problems

Slides 2 & 3 describes cohort. No names of community or children are given due to privacy concerns, and politics: It is extremely complicated to gather this information formally, nor are there are facilities in place to monitor or track these numbers. The data here is from a retrospective analysis of exam data collected during site-based exams. All research has been done pro-bono. From a doctor’s perspective, managing First Nations vision concerns is so onerous that it is for all intents and purposes impossible to ensure these children get the help they need.

Slides 4-10 describe the distribution of refractive conditions of the population. That is, what eyesight issues are present. We see that while the nearsighted kids are more obvious to spot, the real concern are those with significant farsightedness and astigmatism, both of which are much harder to ascertain by simple observation, and both of which generally go uncorrected.

Notably, significant astigmatism is very high in this population. Of 320 children, 23 had significant enough nearsightedness to interfere with distant vision (so, blur while looking at the front of class, but an overall benefit at near distance). 36 children are sufficiently farsighted to have it interfere with near work/attention/reading. 129 children had sufficient astigmatism as to interfere with near and far vision, rendering reading and near work more difficult than need be. Many of the cases of refractive imbalance are significant enough to prevent full development of eyesight and visual function.

Slide 9: Shows there is a gradual  decrease in incidence of nearsightedness as kids age. This is expected.

Slide 10 shows a baseline of astigmatism that is sufficient enough to interfere with reading and cause eyestrain and headache.

Slides 11-14 demonstrate the frequency/incidence of binocular vision problems such as difficulty tracking a moving target, scanning text, or eye turns. Currently in Alberta there is NO funding to address these concerns, so these children are left to make due through standard medical care – a great cost with little benefit.

Slide 15: Of the entire cohort, a total of 24% had received eye exams of any sort. Of those in K and Grades 1-2, the number hovers near 0%. Frequently, children are referred only when they show severe signs of trouble, or when they are nearsighted. In the former, when children show trouble, it is often too late to assist in a timely fashion. Then, there are many others who struggle needlessly with less obvious visual functional concerns. In the case of the latter, the nearsighted children, while they are noticed, their problems are usually not that significant as they have strong vision at near distances where most learning occurs.

Slide 16: Explores the relative frequency in which children who need help get the help, even help as simple as glasses. We can see that the nearsighted kids (M= myopia) are much more likely to get glasses than those who need them most, the children with astigmatism (A) and those who are farsighted (H = hyperopia). OD = right eye, OS = left eye.

Slide 17: For those where glasses were indicated for reading or full-time therapeutic wear, only 28% of girls and 19% of boys had received an eye exam (near 0% for K and Grade 1). Less than 20% of girls, and about 12% of boys who needed them actually had glasses – this is across the entire cohort. Again we see that for those who need glasses, the number that need them due to astigmatism is disproportionately high. These numbers are reflected in other community assessments as well.

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