Eye care utilization in Canada: disparity in the publicly funded health care system.

OBJECTIVES: To examine patterns in, determinants of, and barriers to eye care utilization in Canada.
DESIGN: Cross-sectional survey. PARTICIPANTS: All 132,221 respondents to the Canadian Community Health Survey 2005.
METHODS: Eye care utilization was self-reported and was defined as having seen or talked on the telephone with an eye care provider (ophthalmologist or optometrist) in a 12-month period. Associations of interest were assessed by prevalence ratios (PR).
RESULTS: Forty percent (11 million) of Canadians aged 12 years or older reported utilization of eye care providers. The lowest utilization rates occurred in people aged 30-39 years and the highest in those aged 70 years and older. Utilization was not related to levels of education or household income in people with self-reported glaucoma, cataracts, or diabetes. Among Canadians without these conditions, significantly less utilization occurred in men, in those with less than a postsecondary education, and in those with annual household incomes under $30,000. Canadians residing in Newfoundland and Labrador utilized eye care providers significantly less than those residing in other provinces (adjusted PR 0.80, 95% CI 0.74-0.86). Fourteen percent of glaucoma patients, 37% of diabetic patients, and 41% of people aged 65 years or older did not access eye care providers over a 12-month period.
CONCLUSIONS: Marked disparities occur in eye care utilization among Canadians without known eye diseases. A substantial proportion of people at a high risk of vision loss do not access eye care providers. Attributable factors are likely incomplete government coverage, asymptomatic ocular diseases, and lack of perceived benefits of eye care services.