Quebec optometrists question feasibility of performing vision tests in schools

The Quebec government's announcement this week that eye tests will be offered in Quebec elementary schools is being met with caution by optometrists in the province.

In Quebec, only about 20% of children have had their eyes checked before starting school

Quebec Premier Philippe Couillard, centre, reads a book to young children as Quebec Education and Family Minister Sebastien Proulx, right, and Cassandra Gignac, left, at the Quebec Museum of Arts in Quebec City Tuesday. Couillard released the government's strategy on educational services for children up to the age of eight. (Jacques Boissinot/Canadian Press)

The Quebec government's announcement this week that eye tests will be offered in elementary schools is being met with caution by optometrists in the province. 

The tests are part of a $1.4 billion investment in education in the province between now and 2022, announced by Premier Philippe Couillard, Education Minister Sebastien Proulx and Family Minister Luc Fortin Tuesday.

The government says it wants to prevent poor eyesight from hindering learning difficulties. 

While optometrists say they don't know enough about the program yet to celebrate — and are in the midst of tense compensation negotiations with the health ministry — they say they welcome the program's goal of increasing awareness about healthy vision.

Only 20 per cent of children have had their eyes checked by an optometrist before starting school. 

Partial screenings or full exams?

It's unclear if the eye tests will be full exams that can provide prescriptions or if they will be screenings that simply identify issues and lead to a recommendation for a full examination.

Simple screenings can provide a false sense of safety if they are incomplete, says Dr. Danielle de Guise, the director of Université de Montréal's optometry school.

"We don't know yet who will be doing the screenings and how," Deguise said.

She said if the tests provided in schools as part of the program are only partial screenings, it's still good news but "a lot of children can fall through the cracks" because there are issues those tests don't detect.

Dr. Langis Michaud, president of the College of Optometrists of Quebec, whose role is to ensure the doctors follow protocol, says the college will be meeting with the government "to make sure children get the right care…at the right time."

Michaud said the first he heard of the program was at the announcement, which he attended in Quebec City. 

At the bargaining table

Quebec's optometrist association, which represents optometrists' professional interests, is leading negotiations with the health ministry. 

Dr. Steven Carrier, the association's president, says optometrists are paid $42 for eye exams on patients under the age of 18 and over 65.

Only 20 per cent of children in Quebec see an eye doctor before starting school.

Carrier said that doesn't cover operations costs and optometrists end up shelling out $1 for each of those exams.

"They should begin to pay us enough before investing in screenings in schools," Carrier told CBC News. "It's paradoxical."

He said optometrists typically charge about $80 for exams on patients between the ages of 18 and 65, who aren't covered for them under Quebec healthcare.

But Michaud says he's confident the two parties will reach an agreement. 

"I would find illogical that the government say that vision is very important and want to have optometrists as partner to raise success in the educational programs, and on the second day to not recognize our contribution within the RAMQ system," he said.

Up to 1 in 4 kids have vision problem

Michaud says the years prior the age of eight are crucial because of smoother neuroplasticity that allows for some vision problems to be corrected or improved before they get worse.

Between 20 and 25 per cent of school age children have a vision problem, according to Michaud.

Michaud says he didn't expect the government would offer screenings or exams.

"The government of Quebec is recognizing the importance of vision as a key player in the education of our children and as an essential learning tool," he said.