“My doctor doesn’t do eyes, but the Van is coming!” – Patient of the Eye Van, August 2023
As a teenager, I spent a few summers volunteering for the CNIB, canvassing in my Ottawa neighbourhood for donations. I was somewhat shy, and the idea of knocking on someone’s door to ask for money was not an easy activity for me. My idea of visual impairment was my grandma reading her book with a giant magnifying glass. I didn’t know anyone else who suffered from significant vision loss. Yet the idea of losing one’s vision, something so fundamental to quality of life, was something I could appreciate as worthy of getting outside of my comfort zone. Since then, advocacy and even occasional fundraising was a big part of my past personal and professional life. In medical school I have been involved in health equity initiatives, including working on See the Path, a mentorship in medicine program for Indigenous youth and organizations such as Northern Vision that aims to increase understanding of and access to vision care in rural, remote and Indigenous Communities.
When I was offered an opportunity to volunteer with the Vision Loss and Rehabilitation Canada (VLRC) Eye Van, I jumped at the chance. It really felt like the confluence of so many of my past and present interests and I really wanted to see first-hand how care was being delivered in communities without permanent specialists.
The Eye Van travels over 6,000 km annually providing care to approximately 5,000 patients in various remote, underserved communities in Northern Ontario. Ophthalmologists are recruited from a list from across Ontario and beyond; all willing to donate their time on the Eye Van. The Eye Van is staffed with two ophthalmic technicians, an ophthalmologist and an enthusiastic driver who is himself trained in visual field assessment to maximize the efficiency of the operations. Patients are referred from their last visit with an optometrist, family physician, nurse practitioner or are follow-ups from the previous year. Many patients come with chronic presentations such as diabetes, glaucoma, as well as acute vision changes.
Remarkably, the Eye Van is well-equipped with everything from a slit lamp to a laser which performs posterior capsulotomy (YAG) and Selective Laser Trabeculoplasty (SLT) procedures. Small oculoplastic procedures can also be done. If the ophthalmologist notes the need for a YAG or SLT procedure, the patient would be offered to have it done then on the spot, often saving patients from a longer drive to a bigger center such as Winnipeg or Thunder Bay. The downstream benefits of this are tremendous. I heard patients say they were on a waitlist of many months and were extremely grateful that they had just been saved a long drive, time off work and additional travel costs. For many, the Eye Van is a rare encounter with a health care provider and in the past, staff have even caught a life-threatening emergency.
The patient experience:
While I was there, I noted the long days of the hard-working staff. From 8am to often 5 or 6pm, staff were seeing patients, doing thorough visual field and acuity tests one by one. While some patients felt frustrated for having to wait in the small waiting room within the limited space inside the Eye Van, the overwhelming and recurring sentiment was gratitude. They described how their doctor warned them that they’d need more extensive eye care, that she “doesn’t do eyes” but that “the Van is coming!” Many patients thanked us for being there and I would hear statements like “my eyes are my life” and “my vision is everything.”
While I naturally wondered about the continuity of care for these patients for a service that is only available annually, I was pleased to see that the assessments and treatments were communicated with their referring health care provider. Additionally, detailed instructions were given for next steps and future follow-ups. Considerations for accessibility to future care and travel time also informed the care offered on the Eye Van. If a patient couldn’t realistically receive treatment needed in the next couple of months, if indicated, it would be offered there on the Eye Van. While the Eye Van might have only been in a community for a few days, there was significant thought given to what happens after it leaves. I was both impressed with how much can be done in small space and the meaningful impact that a travelling van can have on patient care. The Eye Van was a welcome guest in the community. As one patient noted “we’re all millionaires when we have our vision!” I will forever be grateful to Vision Loss Rehabilitation Canada for having me and for the privilege of being part of this unique patient experience.
Thank you Natalie Mezey for your blog post submission and tellings us about your amazing work this summer with the VLRC Eye Van.
