Canadian journal of ophthalmology. Journal canadien d'ophtalmologie · 2026
Vision programs for Canadian communities facing care barriers: a systematic review.
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Kaleem Shayaan, Tuitt-Barnes Dream, Rahman Umar, Kaleem Sameen, Balian Carmen, Chandrakumar Manokaraananthan, Lichter Myrna
Аннотация
OBJECTIVE: To systematically review Canadian programs designed to improve access to eye care for communities facing barriers to care and to summarise access outcomes, clinical yield, and implementation features.
METHODS: MEDLINE, Embase, and the Cumulative Index of Nursing and Allied Health were searched through July 30, 2025. Supplementary French-language searches in the 3 databases, as well as French- and English-language searches in Google Scholar, were conducted through June 14, 2026. Two reviewers independently screened records, extracted data, assessed risk of bias, and evaluated certainty of evidence.
RESULTS: Seventeen studies were included. Seven studies focused on Indigenous or First Nations communities, 5 on people experiencing homelessness or marginal housing, and 5 on low-income, immigrant, refugee, or school-based populations. Teleophthalmology, teleretinal, and mobile diabetes screening models were the most common program type (8/17, 47.1%), followed by shelter-based or outreach eye examination programs (5/17, 29.4%), primary care, newcomer, refugee, or policy-based access models (3/17, 17.6%), and school-based screening (1/17, 5.9%). Programs frequently identified unmet need, including high rates of uncorrected refractive error, vision impairment, diabetic retinopathy, glaucoma or glaucoma-suspect status, and referral need. However, referral completion, repeat screening, treatment receipt, and patient-reported outcomes were inconsistently reported.
CONCLUSIONS: Canadian community-based, shelter-based, school-based, mobile, and teleophthalmology programs can reach populations that experience barriers to eye care. The evidence supports the importance of co-location, culturally safe partnerships, low-barrier referral pathways, and spectacle or treatment navigation, but certainty remains limited by observational designs, heterogeneity, and incomplete downstream outcome reporting.
METHODS: MEDLINE, Embase, and the Cumulative Index of Nursing and Allied Health were searched through July 30, 2025. Supplementary French-language searches in the 3 databases, as well as French- and English-language searches in Google Scholar, were conducted through June 14, 2026. Two reviewers independently screened records, extracted data, assessed risk of bias, and evaluated certainty of evidence.
RESULTS: Seventeen studies were included. Seven studies focused on Indigenous or First Nations communities, 5 on people experiencing homelessness or marginal housing, and 5 on low-income, immigrant, refugee, or school-based populations. Teleophthalmology, teleretinal, and mobile diabetes screening models were the most common program type (8/17, 47.1%), followed by shelter-based or outreach eye examination programs (5/17, 29.4%), primary care, newcomer, refugee, or policy-based access models (3/17, 17.6%), and school-based screening (1/17, 5.9%). Programs frequently identified unmet need, including high rates of uncorrected refractive error, vision impairment, diabetic retinopathy, glaucoma or glaucoma-suspect status, and referral need. However, referral completion, repeat screening, treatment receipt, and patient-reported outcomes were inconsistently reported.
CONCLUSIONS: Canadian community-based, shelter-based, school-based, mobile, and teleophthalmology programs can reach populations that experience barriers to eye care. The evidence supports the importance of co-location, culturally safe partnerships, low-barrier referral pathways, and spectacle or treatment navigation, but certainty remains limited by observational designs, heterogeneity, and incomplete downstream outcome reporting.