Diabetes and Aboriginal vision health Le diabète et la santé oculaire des Autochtones
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CJO RCO
CANADIAN JOURNAL OF OPTOMETRY REVUE CANADIENNE D’ OPTOMÉTRIE
VOL 72 NO 4 AUGUST / AOÛT 2010
Diabetes and Aboriginal vision health
Le diabète et la santé oculaire des Autochtones
ABORIGINAL PRESCHOOL VISION SCREENING IN BC – CLOSING THE HEALTH GAP
OUR ABORIGINAL RELATIONS – WHEN FAMILY DOCTORS AND ABORIGINAL PATIENTS MEET
October is Eye Health Month
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CJO RCO
CaNadiaN JourNal of optometry
reVue CaNadieNNe d’optométrie
Vol 72, No 4
august/août 2010
(Date of issue: August 2010)
(Date de parution: août 2010)
ISSN 0045-5075
CANADIAN JOURNAL OF OPTOMETRY REVUE CANADIENNE D’ OPTOMÉTRIE
The Canadian Journal of Optometry is the official publication of the
Canadian Association of Optometrists (CAO) /
La Revue canadienne d’optométrie est la publication officielle de
l’Association canadienne des optométristes (ACO) :
234 Argyle Avenue, Ottawa, ON, K2P 1B9. Phone 613 235-7924 /
888 263-4676, fax 613 235-2025, e-mail info@opto.ca,
website www.opto.ca. Publications Mail Registration No. 558206 / President’s Podium / Mot du président
Envoi de publication – Enregistrement no. 558206.
The Canadian Journal of Optometry / La Revue canadienne d’optométrie Celebrate Eye Health Month / Célébration du mois de la santé de l’œil
(USPS#0009-364) is published six times per year at CDN$55, and CDN$65
for subsriptions outside of Canada. Address changes should be sent to
Dr. Kirsten North . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
CAO, 234 Argyle Avenue, Ottawa, ON K2P 1B9.
•
The CJO*RCO is the official publication of the CAO. However, opinions and Diabetes and Aboriginal vision health / Le diabète et la santé oculaire
commentaries published in the CJO*RCO are not necessarily either the
official opinion or policy of CAO unless specifically identified as such.
des Autochtones
Because legislation varies from province to province, CAO advises
optometrists to consult with their provincial licensing authority before
Dr. Paul Chris. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
following any of the practice management advice offered in CJO*RCO.
The CJO*RCO welcomes new advertisers. In keeping with our goal of
advancing awareness, education and professionalism of members of the
CAO, any and all advertising may be submitted, prior to its publication,
for review by the National Publications Committee of the CAO. Aboriginal preschool vision screening in BC – closing the health gap
CAO reserves the right to accept or reject any advertisement submitted
for placement in the CJO*RCO. Donna Atkinson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
•
La CJO*RCO est la publication officielle de l’ACO. Les avis et les
commentaires publiés dans la CJO*RCO ne répresentent toutefois pas
Our Aboriginal relations – When family doctors and Aboriginal patients meet
nécessairement la position ou la politique officielle de l’ACO, à moins
qu’il en soit précisé ainsi. Étant donné que les lois sont différentes d’une
Catherine T. Elliott MD MHSc CCFP & Sarah N. de Leeuw MA PhD . . . . . . . . . . 26
province à l’autre, l’ACO conseille aux optométristes de vérifier avec
l’organisme provincial compétent qui les habilite avant de se conformer
aux conseils de la CJO*RCO sur la gestion de leurs activités.
La CJO*RCO est prête à accueillir de nouveaux annonceurs. Dans
l’esprit de l’objectif de la CJO*RCO visant à favoriser la sensibilisation,
la formation et le professionnalisme des membres de l’ACO, on pourra
soumettre tout matériel publicitaire avant publication pour examen par
le Comité national des publications de l’ACO. L’ACO se réserve le droit
d’accepter ou de refuser toute publicité dont on a demandé l’insertion Cover & page 9, photographs: Fred Cattroll.
dans la CJO*RCO. Fred, is a nationally recognized photographer, with an extensive list of clients, including the National
• Gallery of Canada, the New York Times, the Washington Post, and the National Arts Centre. His lifetime
work of negatives, slides, prints and digital files, was recently requested by the Canadian Museum of
Chair, National Publications Committee / Président,
Civilization. His work is regarded as a national treasure. A permanent exhibition of his work is in the
Comité national des publications : Dr Paul Geneau
First Peoples Hall at the Museum of Civilization.
Academic Editors / Rédacteurs académiques :
University of Waterloo, Dr B. Ralph Chou
Université de Montréal, Dr Claude Giasson
Advertising Coordinator / Coordonnatrice des publicités ;
Managing Editor / Rédactrice administrative :
Leslie Laskarin
Editorial/Production Assistant / Adjoint de production et réviseur :
Tony Gibbs
Printing Consultant / Impression : Vurtur Communications
Uniform requirements for manuscripts: login to the member site at opto.ca
Translation / Traduction: or contact CAO.
Tessier Translations / Les Traductions Tessier
Exigences uniformes pour les manuscrits: voir sur le site des membres à
Translation Editor / Réviseure des traductions :
Claudette Gagnon
opto.ca ou contacter l’ACO.
CaNadiaN JourNal of optometr y | reVue C a N a d i e N N e d ’o p t o m é t r i e Vol 72 | No 4 August / Août 2010 1
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PRESIDENT'S PODIUM MOT DU PRÉSIDENT
Celebrate Eye Health Month
Célébration du mois de la santé de l’œil
BY / PAR kiRSTEn nORTH, OD, PRESiDEnT CAO
T his issue of CJO includes a member ‘toolkit’
for October’s Eye Health Month and the 2010
theme, Seeing Smart – Make your Child’s First
Exam an Eye Exam. The toolkit provides an overview
membership. By entering the ‘Eye Dare You’ contest,
you also have the opportunity to win a prize.
Eye Health Month has been celebrated in Canada
for the past 12 years. Prior to that, CAO celebrated
of the national public relations campaign as well as Save Your Vision week during the same timeframe as
ideas and resources for CAO members. the American Optometric Association campaign. The
CAO members play an important role in mak- decision to adopt a month long program in October
ing Eye Health Month a success. Promotion in your was made to differentiate Canadian Optometry and to
practice and community has a cumulative effect and have our ‘own’ campaign.
complements what is done at a national and provincial Eye Health Month has become firmly established on
level. the health awareness calendar resulting in queries from
Your participation also supports your provincial the media, health units, and government agencies. It
association’s effort to show that it has the most active also has the unintended consequence of others within
SeeingSmart•VoirPrévoir their eyes deserve an optometrist • Leurs yeux méritent un optométriste
Eye Dare You Win an Apple iPad
Je vous mets au défi Gagner un iPad d’Apple
Take the EYE DARE YOU challenge Prenez le DÉFI pour promouvoir la
to promote eye health awareness sensibilisation de la santé de l’œil dans
in your area and you could win an votre communauté et courez la chance
Apple iPad. de gagner un iPad d’Apple.
Send in details of your October Envoyez un bref compte rendu de
Eye Health Month project to votre projet du Mois de la santé de
eyedareyou@opto.ca l’œil en octobre à defi@opto.ca
For more information call Pour plus d’information, contactez-nous
888 263-4676 ext. 213. à 888 263-4676 poste 213.
CaNadiaN JourNal of optometr y | reVue C a N a d i e N N e d ’o p t o m é t r i e Vol 72 | No 4 August / Août 2010 3
the eye care sector celebrating Eye Health Month as Le Mois de la santé de l’œil est célébré au Canada
their own. While some may see this as an infringe- depuis 12 ans. Auparavant, l’ACO célébrait la Se-
ment, most see it as flattery that reflects the legitimacy maine de la vision en même temps que la campagne
of optometry’s annual campaign. de l’American Optometric Association. La décision
This year’s theme of children’s vision is a natural d’adopter en octobre une programmation s’étendant
choice. We can point to the need for comprehensive sur tout le mois est guidée par votre volonté de dif-
eye care for children, gaps in awareness and provin- férencier l’optométrie canadienne et de nous doter de
cial coverage, and the important relationship between notre « propre » campagne.
vision and learning. Provincial programs such as Eye Les requêtes des médias, des unités sanitaires et des
See, Eye Learn can be profiled with pride. organismes gouvernementaux ont contribué à ancrer
To manage the campaign, CAO retained a Toronto solidement le Mois de la santé de l’œil dans le calen-
based public relations firm. The cost of the campaign drier des activités de sensibilisation à la santé oculaire.
is supported by funds from Eye Health of Canada Le Mois de la santé de l’œil est également célebré par
industry partners. In addition, CAO solicited the co- d'autres du secteur de la santé oculaire; une con-
chairs of the National Public Education Committee séquence inattendue de ce succès. Si certains voient
and Children’s Vision Committee to capably assist in en cette appropriation un manque de respect, la plu-
the review of key messages and strategies. We also part s’en estiment flattés et estiment que cela reflète la
have a group of media spokespeople, many of whom légitimité de la campagne annuelle de l’optométrie.
have volunteered for this task each year. Thank you Le thème retenu cette année pour la vision des
to all! enfants s’est imposé de manière naturelle. Il va nous
I encourage each of you to review the Eye Health permettre d’attirer l’attention sur la nécessité de
Month toolkit and to participate in this year’s cam- prodiguer aux enfants des soins oculo-visuels com-
paign. Make us proud! plets, de combler les écarts qui existent en matière de
sensibilisation et de couverture au niveau provincial
et de mettre en avant la relation essentielle entre la
vision et l’apprentissage. Nous pourrons décrire avec
fierté des programmes provinciaux comme Eye See,
L e présent numéro de la RCO comprend une
« trousse » pour les membres pour le Mois
de la santé de l’œil en octobre et le thème
de l’année 2010, Voir Prévoir – Faites vérifier la vue
de votre enfant en bas âge. Cette trousse offre une
Eye Learn.
Pour gérer cette campagne, l’ACO a retenu les
services d’une entreprise de relations publiques de
Toronto. Cette campagne est supportée financière-
ment par des fonds provenant de partenaires de
présentation générale de la campagne nationale de re- l’industrie de la santé oculaire au Canada. Par ailleurs,
lations publiques ainsi que des idées et des ressources l’ACO a brigué les coprésidences du Comité national
pour les membres de l’ACO. d’éducation publique et du Comité de la vision pour
Les membres de l’ACO ont un rôle important à jouer les enfants pour pouvoir contribuer à l’analyse des
pour assurer le succès du Mois de la santé de l’œil. Sa stratégies et des messages clés. Nous disposons égale-
promotion dans votre cabinet et dans communauté a ment d’un groupe de porte-paroles auprès des médias,
un effet conjugué et vient compléter les actions qui sont la plupart desquels se portent chaque année volon-
menées aux niveaux national et provincial. taires pour occuper cette tâche. Qu’ils en soient tous
Votre participation soutient également l’effort con- remerciés!!
senti par votre association provinciale pour afficher le J’invite chacun de vous à passer en revue la trousse
plus grand nombre de membres actifs. En participant du Mois de la santé de l’œil et à participer à la cam-
au concours « Je vous mets au défi », vous avez égale- pagne de cette année. Nous devons en être fiers!
ment la possibilité de gagner un prix.
4 Vol 72 | No 4 August / Août 2010 CaNadiaN JourNal of optometr y | reVue C a N a d i e N N e d ’o p t o m é t r i e
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Vision Institute of Canada Annual Fall Conference and Trade Show
October 22 – 24, 2010
The Vision Institute of Canada will be to raise awareness of
holding its Annual Fall Conference and eye health among this
Trade Show on October 22nd, 23rd, population.
and 24th at the Hilton Suites Hotel
in Markham, Ontario. This event will The Vision Institute has
provide 20 hours of excellent continu- an extraordinary line-up
ing education including nine hours of of speakers, including
TPA related lectures from Dr. Lou Dr. Ann Macaulay, CM, MD, FCFP, who
Catania, OD, Dr. Larry Alexander, OD, holds the Order of Canada for her
and Dr. David Chow, MD. work on Aboriginal health, and Dr. Jay
Wortman, MD, a Metis physician from
More importantly, this conference will BC who is featured in the documentary
also include a unique Aboriginal Vision My Big Fat Diet. Mr. Angus Toulouse,
Health Lecture Series on Friday, October Ontario Regional Chief of the Assembly
22nd which you are encouraged you to of First Nations will be one of many
attend. Co-sponsored by the Canadian special guests attending from various
Association of Optometrists, this day aboriginal organizations to meet
of lectures for optometrists and staff members of the optometry profession
is part of a special two day Aboriginal and to learn about eye health and the
Vision Health Conference for Aboriginal vision care services. The Aboriginal
health workers and policy makers to Peoples Television Network will be in
help raise awareness about the soaring attendance to document this confer-
rates of diabetes-related blindness ence and help deliver this eye health
facing Canada's native population. awareness message.
The National Collaborating Centre for
Aboriginal Health has called this a The Vision Institute has an ambitious
conference of "national significance" for plan to make 2011 Aboriginal Vision
the Aboriginal community. It represents Health Awareness Year to help educate
an opportunity for optometry to dem- Aboriginal people with diabetes about
onstrate its concern and readiness to the need for yearly comprehensive
respond to this emerging health crisis eye examinations. The importance of
and, together with the Aboriginal com- comprehensive eye exams for native
munity, develop a communication plan children will also be promoted.
20 Hours of Continuing Education, with a special one day Aboriginal Vision Health Lecture Series
PLUS The Annual Meeting of the College of Optometrists of Ontario,
Please join the Vision Institute, in Or contact:
October, for its most important Vision Institute, 16 York Mills Road,
program in three decades. The Vision Suite 110, Toronto, Ontario M2P 2E5
Institute is a non-profit charitable Tel: 416-224-2273 or 1-800-969-8617
organization. The funds raised from Fax: 416-224-9234 The Vision Institute of Canada is a
their conferences support the Vision Or E-mail us at: non-profit charitable organization
Institute’s educational and charitable visioninstitute@globalserve.net dedicated to eye health education,
clinical work. Your support is vital to
Room reservations may be made at the research, and specialized clinical services.
ensure continued success.
Hilton Suites Hotel, 1-800-668-8800 The funds we raise from our educational
programs support the clinical and
For more information and
charitable work of the Institute.
to register, please visit:
www.visioninstitute.optometry.net
OUR EDUCATIONAL
SPONSORS
Lecture Topics
Ontario Association
Session 1 Session 4 Session 6 of Optometrists
Improving Aboriginal Health: Understanding Diabetic Annual Meeting of the College Canadian Association
How Can Health Care Retinopathy of Optometrists of Ontario of Optometrists
Professionals Contribute? Dr. Chris Hudson, OD, PhD with a special lecture by The National Collaborating
Dr. Marlee Spafford, OD, PhD Centre for Aboriginal Health
Dr. Ann C. Macaulay, MD
Epidemiology of Vision Health Johnson & Johnson
Vision Care
Traditional Aboriginal Diets Disorders in Aboriginal People
“My Big Fat Diet” Dr. Barbara Robinson, OD, MPH, PhD Session 7 Alcon Canada
Dr. Jay Wortman, MD Retinal Disease: Bausch & Lomb Canada
From Nutrition to Genetics Bochner Eye Institute
Session 5 Dr. David Chow, MD Cooper Vision
Session 2 Cultural Relevance in Eye
Essilor Canada
Diabetes: The Low-Carb Diet Examinations
Debate “Good Calories, Dr. Graham Strong, OD, MS Session 8 & 9 Novartis
Bad Calories” Glaucoma Diagnosis
Mr. Gary Taubes Social Determinants in and Treatment
Aboriginal Diabetes Dr. Larry Alexander, OD
Dr. Jeffrey Reading, PhD
Session 3
Diabetic Retinopathy: Session 10 & 11:
Telemedicine and Remote Anterior Segment Disease
Northern Communities and Treatment
Dr. Alan Cruess, MD Dr. Lou Catania, OD
15 Hours of CAO Approved Education for Certified Optometric Assistants, Eye Health Book Store & Silent Auction
ARTICLE INVITÉ GUEST ARTICLE
Diabetes and Aboriginal vision health
Le diabète et la santé oculaire des Autochtones
BY / PAR A. PAUL CHRiS, OD, ViSiOn inSTiTUTE OF CAnADA
C anada is home to an
Aboriginal population of
over 1.2 million people,
of whom 61% are First Nations,
34% are Métis (mixed native-
population (243,000), fol-
lowed by BC (196,000), Alberta
(188,000), Manitoba (175,000),
Saskatchewan (142,000), and
Quebec (108,000). The remain-
One of the most significant
consequences of the “psycho-
social stress” associated with
colonization and the loss of
traditional foods and lifestyles is
European descent), and 5% are ing 25,000 live in the other the epidemic of diabetes that is
Inuit. These three distinct groups provinces and territories.3 eroding the health and lives of
all have unique “local geographic The Aboriginal community is Aboriginal people. The extent
and linguistic heritages, cultural also the largest growing segment to which Aboriginal people have
practices and spiritual beliefs.” of the Canadian population, in- been affected is both complex
Slightly more than half live in creasing at a rate six times faster and astonishing. This is a phe-
urban areas but maintain strong than non-Aboriginal people. nomenon affecting indigenous
connections to their communi- Almost half the native popula- people worldwide. The long-
ties of origin.1 Although there has tion is below 25 years of age, term complications associated
been an increase in the number compared to 40 years for the with diabetes, such as blindness,
of Aboriginal people living in non-native population. heart disease, kidney disease,
urban areas, there has actually Aboriginal history in Canada re- infectious disease and amputa-
been a net migration back to First flects years of government forced tions, are an emerging public
Nations communities in the last assimilation and colonization health crisis.5
40 years.2 There are 615 native efforts with the “appropriation of Before 1950, diabetes was
communities (reserves or bands) land and loss of traditional liveli- rare in native communities.6
in Canada. British Columbia has hoods.” The residential school Diabetes was not detected in
the largest number of reserves at system, established in 1892, 1500 First Nations people who
198 followed by Ontario with 153. resulted in the mandatory removal underwent a tuberculosis survey
Ontario has more remote First of children from their homes in Saskatchewan in 1937.7 Today
Nations communities than any and their placement in boarding twenty percent of the Canadian
other region. schools where they were “for- Aboriginal population lives with
Aboriginal people make up bidden to speak their own lan- diabetes, a number that has
3.8% of the Canadian popula- guages.” Many suffered emotional, doubled in the last two decades,
tion, ranking second in the physical, and sexual abuse, turning most likely due to environmental
world to New Zealand, where to drugs and alcohol in later life to (nutrition and lifestyle) factors.6, 7
the Maori people make up 15% deal with their trauma. The atten- Across Canada, type 2 diabetes
of the population. In the United dant loss of self-esteem and the is three to five times higher in
States and Australia, approxi- destruction of family bonds and Aboriginal people than in the
mately 2% of the general popula- parenting skills have caused a cul- general population. According
tion is Aboriginal.2 According to tural shock resulting in ill health, to a Saskatchewan study
the 2006 Aboriginal Census, poverty and family breakdown.4 published in January 2010,
Ontario has the largest native the rate of diabetes among
8 Vol 72 | No 4 August / Août 2010 CaNadiaN JourNal of optometr y | reVue C a N a d i e N N e d ’o p t o m é t r i ePhoto: Fred Cattroll Aboriginal women of child- diabetic retinopathy in Aboriginal A more recent report from bearing age is four times greater Canadians. A study published 2007, the Southern Alberta Study than women in the general popu- that year involving the Sandy of Diabetic Retinopathy, showed lation. Native women also have Lake First Nations community in that prevalence rates of diabetic much higher rates of gestational Northern Ontario reported the retinopathy in type 2 diabetes in diabetes, which dramatically following prevalence rates: non- native and non-native subjects increases a woman’s risk of proliferative diabetic retinopathy were identical, with a prevalence developing diabetes later in life, 24% (NPDR), macular edema rate of 40%, “far higher” than and also makes her offspring (5%) and proliferative diabetic the Sandy Lake study. Native more prone to the disease.7 retinopathy 2% (PDR).9 subjects also tended to have more Diabetes is the leading cause These findings were consistent advanced retinopathy changes of adult blindness in Canada. with an earlier study in 2002 by indicating that Aboriginal ethnicity According to one report, the Maberley, et al.10 The authors of does play a role in the severity of rate of progression and severity the 2005 study suggested that the retinal complications.11 of diabetic retinopathy, unlike relatively low prevalence rates of Despite conflicting research, kidney disease, is no greater in macular edema and PDR “pos- what is clear is that with the Aboriginal people than that of sibly reflect low median duration disproportionate and increasing the general population.8 As re- of diabetes or the presence of number of native people with cently as 2005, there was limited protective genetic factors.”9 diabetes, and its occurrence at a data on the prevalence of much early age than the general CaNadiaN JourNal of optometr y | reVue C a N a d i e N N e d ’o p t o m é t r i e Vol 72 | No 4 August / Août 2010 9
published data on the relation- Aboriginal vision health.
n 74 percent of people who have ships between diabetic retinopathy, Optometry, its partners and
diabetes for 10 years or more will macular edema severity and visual professional organizations, need
develop some form of diabetic
acuity. 13 to work with Aboriginal people
retinopathy.
In the United States the and their organizations to create
n Approximately 14 percent of
people with diabetes have diabetic National Eye Institute was an effective Canadian communi-
macular edema and prevalence created by Congress in 1968 as cation strategy to help educate
increases to 29 percent for people part of the National Institutes of Aboriginal health care workers
with diabetes who use insulin for
Health. In 1991 it established the and eye care professionals about
more than 20 years.
National Eye Health Education Aboriginal eye health issues and
n Left untreated, 25 percent of
people with diabetic macular Program which released a report the importance of annual dilated
edema will develop moderate in 2004 titled: American Indian and eye exams for native Canadians
vision loss within three years. Alaska Native Diabetic Eye Disease living with diabetes.
n Estimates of the rate of annual Communication Plan. This com-
eye exams vary greatly by country
munication plan was designed 1 Macaulay AC. Improving aboriginal health:
and study, but the rate of screen- How can health care professional contribute?
ing is generally fairly low (from to improve the eye health of
Can Fam Phys. Vol. 55: April 2009
40 to 65 percent). American Indians and Alaska
n Worldwide guidelines (for people Natives with diabetes and to raise 2 Bailey S; Native population growing.
with diabetes) recommend awareness about the importance The Canadian Press; Jan 15, 2008
annual screenings with a dilated
of annual dilated eye exams in 3 Atkinson DL Preschool Vision
eye exam from an eye care
specialist. 12 this population.14 Screening and Aboriginal Eye Health:
An environmental scan pro- An Environmental Scan and Literature
– International Diabetes Federation duced in 2007 by the National Review. BC Initiatives; April 2007
Collaborating Centre on Aboriginal 4 Macaulay AC. Improving aboriginal
Health based at the University health: How can health care professional
population, diabetes will lead of Northern British Columbia, contribute? Can Fam Phys. Vol 55: April
to a more significant burden 2009
states:
of preventable vision loss in “…a review of the international 5 Hanley AJ. Diabetes in Indigenous
Aboriginal communities than in literature suggests that Canada Peoples: Medscape Diabetes and
non-Aboriginal groups. Endocrinology. July 2006; http://cme.
is well behind other countries in
medscape.com/viewarticle/540921
There are few statistics available addressing Aboriginal eye health
to show the rate of annual dilated and vision care services. Both the 6 Young TK, et al. Type 2 diabetes
eye examinations being received mellitus in Canada’s First Nations: status
United States and Australia have
by Aboriginal Canadians. If trends of an epidemic in progress. CMAJ;
developed innovative, Aboriginal
September 5, 2000; 163 (5)
from other services are any indica- specific, community-controlled
tion, access to annual dilated eye programs and promotional 7 Dyck R, et al. Epidemiology of diabetes
exams for many Aboriginal people mellitus among First Nations and non-
material…” 15
First Nations adults. CMAJ February
with diabetes is limited by geog- Canada has a larger native 23, 2010 182(3)
raphy and the availability of an population, by percentage, than
optometrist or ophthalmologist. 8 Harris SB. Diabetes in indigenous
the United States but is indeed well
peoples: Program and abstracts of the
Several telemedicine projects behind in addressing the Aboriginal American Diabetes Association 66th
using digital retinal cameras have vision health issues that are be- Scientific Sessions; June 9-13, 2006;
been established but are not coming an emerging public health Washington, DC.
filling the need for the diagnostic crisis. More Canadian funding and 9 Hanley AJG, et al. Complications of
vision care services that is re- research are required to fill the Type 2 Diabetes among Aboriginal
quired. There is also a lack of gap in scientific knowledge about Canadians Prevalence and associated risk
10 Vol 72 | No 4 August / Août 2010 CaNadiaN JourNal of optometr y | reVue C a N a d i e N N e d ’o p t o m é t r i e“ ... a review of the international literature suggests that Canada is well behind other
countries in addressing Aboriginal eye health and vision care services. Both the United
States and Australia have developed innovative, Aboriginal specific, community-controlled
programs and promotional material.
”
factors. Diabetes Care; August 2005 Vol tous des « héritages linguistiques Manitoba (175 000), la Saskat-
28 no. 8 2054-2057 et géographiques régionaux, des chewan (142 000) et le Québec
10 Maberley D, et al. Digital photographic pratiques culturelles et des croy- (108 000). Le restant de cette
screening for diabetic retinopathy in the ances spirituelles » qui leur sont population (25 000) dans d’autres
James Bay Cree. Ophthalmic Epidemiol propres. Un peu plus de la moitié provinces et territoires.3
9: 169–178, 2002 d’entre eux vivent dans des régions La collectivité autochtone
11 Ross SA, et al. Diabetic Retinopathy in urbaines et entretiennent des liens est également le segment de la
Native and Nonnative Canadians. Exp étroits avec leur communauté population canadienne ayant la
Diab Res. Vol 2007: Article ID 76271 d’origine(1). Bien que le nombre plus forte croissance, avec un
12 International Diabetes Federation. d’Autochtones vivant en région taux six fois plus rapide que celui
http://www.idf.org/international- urbaine s’accroisse, les dernières des personnes non autochtones.
diabetes-federation website accessed 40 années ont été marquées par un Près de la moitié de la population
July 15, 2010.
solde migratoire positif en faveur autochtone a moins de 25 ans, un
13 Tucker D, et al. Investigation the links des communautés des Premières chiffre à confronter aux 40 ans
between diabetic retinopathy, macular nations.2 Le Canada compte de la population non autochtone.
edema severity and visual acuity in
615 communautés autochtones L’histoire des Autochtones
patients with diabetes. Expert Review
of Ophthalmology; Dec 2008 Vol 3 No
(réserves ou bandes). La Colom- au Canada est liée à des années
6 (673-688) bie-Britannique est la province qui d’assimilation forcée et à des
compte le plus grand nombre de entreprises de colonisation
14 National Eye Health Education
réserves (198) devant l’Ontario menées par le gouvernement qui
Program: American Indian and
Alaska Native Diabetic Eye Disease (153). L’Ontario a davantage de ont conduit à « l’appropriation
Communication Plan. US Department communautés de Premières na- de leurs territoires et la perte de
of Health and Human Services: tions isolées que toutes les autres leurs moyens de subsistance ».
National Eye Institute; January 2004 régions. Le système de pensionnat, mis
15 Atkinson DL. Preschool Vision Les Autochtones représen- en place en 1892, s’est traduit
Screening and Aboriginal Eye Health: tent 3,8 % de la population par des mesures contraignantes
An Environmental Scan and Literature canadienne, un chiffre qui les comme l’enlèvement des enfants
Review. BC Initiatives; April 2007 classe au second rang mondial de leur foyer et leur placement
devant la Nouvelle-Zélande où dans des pensionnats où il leur
le peuple Maori représente 15 % était « interdit de parler leur pro-
de la population. Aux États- pre langue ». Nombre d’entre
L e Canada compte une Unis et en Australie, environ eux ont souffert de violences
population autochtone 2 % de la population générale psychologique, physique et
qui dépasse 1,2 million de est autochtone.2 Selon le recen- sexuelle et se sont tournés plus
personnes parmi lesquelles 61 % sement sur les Autochtones de tard dans leur vie vers la consom-
sont des membres des Premières 2006, l’Ontario est la province mation de drogues ou d’alcool
nations, 34 % des Métis (personnes qui abrite la plus grande popula- pour pouvoir surmonter ces
de descendance mixte autochtone- tion autochtone (243 000), suivie traumatismes. Les pertes d’estime
européenne) et 5 % des Inuits. Ces par la Colombie-Britannique de soi, la destruction des liens
trois groupes distincts présentent (196 000), l’Alberta (188 000), le familiaux et la détérioration des
CaNadiaN JourNal of optometr y | reVue C a N a d i e N N e d ’o p t o m é t r i e Vol 72 | No 4 August / Août 2010 11compétences parentales que tout population générale. Selon une RDP « pouvaient refléter de cour-
cela suppose ont provoqué un étude réalisée en Saskatchewan et tes durées moyennes de diabète ou
choc culturel, à l’origine de pro- publiée en janvier 2010, le taux de la présence de facteurs de protec-
blèmes de santé, de la pauvreté diabète chez les femmes autoch- tion génétique ».9
et de l’éclatement familial.4 tones en âge de procréer est quatre Un rapport plus récent datant
L’une des conséquences fois supérieur à celui des femmes de 2007 (Southern Alberta Study
marquantes de ce « stress de la population générale. Les of Diabetic Retinopathy) a montré
psychosocial », qui s’ajoute aux femmes autochtones présentent que le taux de prévalence de la
effets de la colonisation et à la également des taux de diabète ges- rétinopathie diabétique chez les
perte des nourritures tradition- tationnel bien supérieurs, lesquels sujets autochtones et non au-
nelles et des modes de vie, est augmentent de façon spectaculaire tochtones atteints d’un diabète
l’épidémie de diabète qui mine la le risque pour une femme de voir de type 2 était équivalent dans
santé et la vie des Autochtones. se développer un diabète plus tard ces deux populations, soit 40 %,
Il est stupéfiant de constater à au cours de sa vie, mais aussi de un taux « bien supérieur » à celui
quel point les Autochtones ont rendre sa descendance plus encline révélé par l’étude de la com-
été touchés par cette épidémie à cette maladie.7 munauté Sandy Lake. Les sujets
dont les causes sont complexes. Il Le diabète est la cause princi- autochtones sont également plus
s’agit d’un phénomène qui affecte pale de la cécité chez l’adulte au enclins à présenter des évolutions
tous les peuples autochtones dans Canada. Selon une étude, la vitesse de rétinopathie plus rapides, ce qui
le monde. Les complications à de progression et la sévérité de montrerait que leur origine eth-
long terme associées au diabète, la rétinopathie diabétique, con- nique joue un rôle dans la gravité
comme la cécité, les cardiopathies, trairement aux néphropathies, ne des complications rétiniennes.11
les néphropathies, les maladies serait pas plus grande parmi les En dépit de résultats de recher-
infectieuses et les amputations, Autochtones que dans la popula- che contradictoires, il est désor-
constituent une situation de crise tion générale.8 Pas plus tard qu’en mais clair que l’on fait face à un
naissante en termes de santé 2005, on ne disposait que de peu nombre croissant et dispropor-
publique.5 de données sur la prévalence de tionné de personnes autochtones
Avant 1950, le diabète restait la rétinopathie diabétique chez atteintes du diabète et, d’autre
une affection rare dans les com- les Autochtones du Canada. Une part, que cette maladie survient
munautés autochtones.6 Le diabète étude publiée cette année sur la à un stade bien plus précoce que
n’a d’ailleurs pas été détecté parmi communauté de Premières nations dans la population générale; on
les 1 500 membres des Premières Sandy Lake, située dans le Nord sait en outre que le diabète va
nations qui firent l’objet d’un suivi de l’Ontario, a révélé les taux de entraîner davantage de cas évi-
de la tuberculose en Saskatchewan prévalence suivants : 24 % pour tables de perte de vision, au sein
en 1937.7 Aujourd’hui, c’est 20 % la rétinopathie diabétique non des communautés autochtones que
de la population autochtone proliférante (RDNP), 5 % pour dans les groupes non autochtones.
canadienne qui vit avec le diabète, l’œdème maculaire et 2 % pour la Il existe peu de statistiques qui
un pourcentage qui a doublé au rétinopathie diabétique proliférante rendent compte du taux annuel
cours des deux dernières décen- (RDP).9 d’examen de la vision à pupille di-
nies, vraisemblablement en raison Ces résultats correspondent à latée dont bénéficient les Autoch-
de facteurs environnementaux ceux d’une étude antérieure menée tones canadiens. Si les tendances
(la nutrition et le style de vie).6, 7 en 2002 par Maberley et coll.10 qui émanent d’autres services sont
Partout au Canada, on constate Les auteurs de l’étude de 2005 ont de quelques enseignements, force
que le taux de diabète de type 2 avancé l’hypothèse que les taux est de constater que l’accès de
est de trois à cinq fois plus élevé de prévalence relativement bas en nombreux Autochtones atteints de
chez les Autochtones que dans la matière d’œdème maculaire et de diabète aux examens annuels de la
12 Vol 72 | No 4 August / Août 2010 CaNadiaN JourNal of optometr y | reVue C a N a d i e N N e d ’o p t o m é t r i emaculaires et l’acuité visuelle.13 nir de nouveaux problèmes de
n 74 % des personnes atteintes de Aux États-Unis, le Congrès a santé publique. Le Canada doit
diabète depuis au moins 10 ans créé en 1968 le National Eye In- mobiliser davantage de fonds
vont développer une forme quel-
stitute comme entité du National et consentir plus d’efforts de
conque de rétinopathie diabé-
tique. Institutes of Health. En 1991, recherche pour combler son
n Environ 14 % des personnes cet institut a mis en place le écart en matière de connaissance
atteintes de diabète présentent National Eye Health Education scientifique sur la santé oculaire
des œdèmes maculaires d’origine Program qui a publié en 2004 un des Autochtones. Le secteur de
diabétique; cette prévalence
rapport intitulé : American In- l’optométrie, ses partenaires et
s’accroît à 29 % pour les per-
sonnes atteintes de diabète qui dian and Alaska Native Diabetic les organisations professionnelles
utilisent l’insuline depuis plus de Eye Disease Communication doivent travailler de concert
20 ans. Plan. Ce plan de communica- avec les Autochtones et leurs
n Sans traitement, 25 % des per- tion a été élaboré pour améliorer organisations pour développer
sonnes qui souffrent d’un œdème
la santé oculaire des Indiens une stratégie de communication
maculaire d’origine diabétique
développeront une perte de vi- d’Amérique et des Autochtones canadienne plus efficace. Il s’agit
sion modérée d’ici à trois ans. de l’Alaska atteints par le diabète d’aider à sensibiliser les travail-
n Les estimations qui ont été et pour sensibiliser davantage leurs autochtones en soins de
réalisées sur les taux annuels ces populations à l’importance santé, ainsi que les professionnels
d’examen de la vision varient de
de subir un examen annuel de la des soins oculo-visuels aux pro-
manière importante selon les
pays et les études, mais le taux de vision à pupille dilatée.14 blèmes de santé des Autochtones
dépistage est généralement assez Voilà ce qu’affirme une ana- et à l’importance de faire passer
bas (de 40 à 65 %). lyse de la conjoncture réalisée en un examen annuel de la vision
n Les lignes directrices mondiales 2007 par le Centre de collabora- à pupille dilatée aux Canadiens
en la matière recommandent
tion de la santé autochtone abrité autochtones souffrant du diabète.
de procéder à des dépistages
annuels en faisant passer aux par l’University of Northern
personnes atteintes de diabète British Columbia : 1 Macaulay AC. Améliorer la santé des
un examen de la vision à pupille « …une analyse de la littérature Autochtones : Quelle contribution les
dilatée, conduit par un spécialiste professionnels de la santé peuvent-ils
internationale conduit à penser
des soins oculovisuels.12 apporter? Le médecin de famille
que le Canada se situe loin der-
canadien. Vol. 55 : avril 2009
rière d’autres pays en ce qui con-
– Fédération internationale du diabète 2 Bailey S; Native population growing. La
cerne la prestation de services de
Presse Canadienne; Jan 15, 2008
santé oculaire et de soins de la
vue aux Autochtones. Les États- 3 Atkinson DL Preschool Vision
vision à pupille dilatée est limité Screening and Aboriginal Eye
par la situation géographique et Unis et l’Australie ont tous deux
Health : An Aboriginal Eye Health
la disponibilité d’un optométriste élaborés des programmes nova- and Literature Review. BC Initiatives;
ou d’un ophtalmologiste. Plu- teurs, dédiés aux Autochtones et avril 2007
sieurs projets de télémédecine gérés par les communautés; ils 4 Macaulay AC. Améliorer la santé des
s’appuyant sur l’utilisation de ont également conçus des docu- Autochtones : Quelle contribution les
caméras rétiniennes numériques ments de promotion… »15 professionnels de la santé peuvent-ils
ont été mis en place, mais ils ne Bien que le Canada compte apporter? Le médecin de famille
suffisent pas encore à combler le une population autochtone plus canadien. Vol. 55 : avril 2009
besoin en services de diagnostic grande qu’aux États-Unis, il se 5 Hanley AJ. Diabetes in Indigenous
et de soins de la vue. Peu de don- situe bien derrière son voisin Peoples : Medscape Diabetes and
nées ont en outre été publiées dans le règlement des problèmes Endocrinology. Juillet 2006; http://
de santé oculaire des Autoch- cme.medscape.com/viewarticle/540921
sur les liens entre la rétinopathie
diabétique, la gravité des œdèmes tones qui sont en voie de deve-
CaNadiaN JourNal of optometr y | reVue C a N a d i e N N e d ’o p t o m é t r i e Vol 72 | No 4 August / Août 2010 13TargeT
SeaSonal allergic
conjuncTiviTiS
with
alrex
®
Treat the Signs and Symptoms
• ALREX® treats the signs and symptoms of seasonal allergic conjunctivitis1
• Proven efficacy with an excellent safety profile1
• Available in 5 mL bottles
ALREX® (loteprednol etabonate) Ophthalmic Solution 0.2% is indicated for temporary short-term relief of the signs and symptoms of seasonal
allergic conjunctivitis.
Alrex® is for ophthalmic, short-term use only (up to 14 days). If Alrex® is used for 10 days or longer, intraocular pressure should be monitored.
Alrex® is contraindicated in suspected or confirmed infections of the eye: viral diseases of the cornea and conjunctiva including epithelial herpes
simplex keratitis (dendritic keratitis), vaccinia, and varicella; untreated ocular infection of the eye; mycobacterial infection of the eye and fungal
diseases of ocular structures; hypersensitivity to this drug or any ingredient in the formulation or container, or to other corticosteroids.
Reactions associated with ophthalmic steroids include elevated intraocular pressure, which may be associated with optic nerve damage, visual
acuity and field defects, posterior subcapsular cataract formation, secondary ocular infection from pathogens including herpes simplex, and
perforation of the globe where there is thinning of the cornea or sclera.
In clinical studies, adverse events related to loteprednol etabonate were generally mild to moderate, non-serious and did not interrupt continuation
in the studies. The most frequent ocular event reported as related to therapy was increased IOP: 6% (77/1209) in patients receiving loteprednol
etabonate, as compared to 3% (25/806) in the placebo treated patients.
Bausch & Lomb Canada Inc., Vaughan, ON L4K 4B4
©2010 Bausch & Lomb Incorporated ®Denotes trademark of Bausch & Lomb Incorporated or its affiliates
References: 1. ALREX Product Monograph, December 22, 2008patient should be re-evaluated.
Prolonged use of corticosteroids may result in glaucoma with damage to the optic
nerve, defects in visual acuity and fields of vision, and in posterior subcapsular
(loteprednol etabonate ophthalmic suspension 0.2% w/v) cataract formation. Alrex® should not be used in the presence of glaucoma or
elevated intraocular pressure, unless absolutely necessary and careful and close
appropriate ophthalmologic monitoring (including intraocular pressure and lens
Prescribing Summary clarity) is undertaken.
Corneal fungal infections are particularly prone to develop coincidentally with
Patient Selection Criteria long-term local steroid application. Fungus invasion must be considered in any
persistent corneal ulceration involving steroid use. Fungal cultures should be taken
THERAPEUTIC CLASSIFICATION when appropriate.
Corticosteroid Prolonged use of corticosteroids may suppress the host response and thus increase
INDICATIONS AND CLINICAL USE the hazard of secondary ocular infections. In those diseases causing thinning of the
Alrex® (loteprednol etabonate) Ophthalmic Suspension is indicated for temporary cornea or sclera, perforations have been known to occur with the use of topical
short-term relief of the signs and symptoms of seasonal allergic conjunctivitis steroids. In acute purulent conditions of the eye, steroids may mask infection or
CONTRAINDICATIONS enhance existing infection.
Suspected or confirmed infection of the eye: viral diseases of the cornea and Use of ocular steroids may prolong the course and may exacerbate the severity of
conjunctiva including epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, many viral infections of the eye (including herpes simplex). Employment of a
and varicella; untreated ocular infection of the eye; mycobacterial infection of the corticosteroid medication in the treatment of patients with a history of herpes
eye and fungal diseases of ocular structures; hypersensitivity to this drug or any simplex requires great caution.
ingredient in the formulation or container, or to other corticosteroids. Formulations with benzalkonium chloride should be used with caution in soft
SPECIAL POPULATIONS contact lens wearers.
Use in Pediatrics (< 18 years of age): ADVERSE REACTIONS
Alrex® should not be used in pediatric patients. Overview
Use in Geriatrics: Reactions associated with ophthalmic steroids include elevated intraocular pressure,
Alrex® should not be used in geriatric patients. The safety and efficacy of Alrex® which may be associated with optic nerve damage, visual acuity and field defects,
have not been established in patients > 65 years of age. posterior subcapsular cataract formation, secondary ocular infection from pathogens
Pregnant Women: including herpes simplex, and perforation of the globe where there is thinning of
Alrex® should not be used in pregnant women, unless the benefit clearly outweighs the cornea or sclera.
the risks. Studies in pregnant women have not been conducted. In nineteen clinical trials ranging from 1 to 42 days in length, 1,209 patients
Nursing Women: received various concentrations of loteprednol etabonate in topical ocular drops
Alrex® should not be used in lactating women, unless the benefit clearly outweighs (0.005%, 0.05%, 0.1%, 0.2%, 0.5%). Adverse events related to loteprednol
the risks. etabonate were generally mild to moderate, non-serious and did not interrupt
continuation in the studies. The most frequent ocular event reported as related to
Safety Information therapy was increased IOP: 6% (77/1209) in patients receiving loteprednol
etabonate, as compared to 3% (25/806) in the placebo treated patients.
WARNINGS AND PRECAUTIONS With the exception of elevations in IOP, the incidence of events in the LE group was
General similar to, or less than that of the placebo control groups. Itching was reported as
For ophthalmic, short-term use only (up to 14 days). related to therapy in 3% of the loteprednol treated eyes, injection, epiphora,
The initial prescription and renewal of Alrex® should be made by a physician only burning/stinging other than at instillation, foreign body sensation, and
after appropriate ophthalmologic examination is performed. If signs and symptoms burning/stinging at instillation were each reported for 2% of eyes. The most
fail to improve after two days, the patient should be re-evaluated. If Alrex® is used frequent non-ocular event reported as related to therapy was headache, reported
for 10 days or longer, intraocular pressure should be closely monitored. for 1.2% of the loteprednol treated subjects and 0.6% of the placebo treated
Prolonged use of corticosteroids may result in cataract and/or glaucoma formation. subjects.
Alrex® should not be used in the presence of glaucoma or elevated intraocular To report an adverse event, contact your Regional Adverse Reaction Monitoring
pressure, unless absolutely necessary and close ophthalmologic monitoring is Office at 1-866-234-2345 or Bausch & Lomb at 1-888-459-5000
undertaken. Extreme caution should be exercised, and duration of treatment should
be kept as short as possible. Administration
Alrex® should not be used in cases of existing (suspected or confirmed) ocular viral,
fungal, or mycobacterial infections. Alrex® may suppress the host response and thus One drop instilled into the affected eye(s) four times daily for up to 14 days. If
increase the hazard of secondary ocular infections. The use of Alrex® in patients scheduled dose is missed, patient should be advised to wait until the next dose and
with a history of herpes simplex requires great caution and close monitoring. then continue as before.
Alrex® contains benzalkonium chloride. SHAKE VIGOROUSLY BEFORE USING. Alrex® should be stored upright between
Alrex® has not been studied in pregnant or nursing women, but has been found to 15°–25°C for up to 28 days after first opening.
be teratogenic in animals. Alrex® should not be used in pregnant or nursing women The preservative in Alrex®, benzalkonium chloride, may be absorbed by soft contact
unless the benefits clearly outweigh the risks. lenses, and can discolour soft contact lenses. Therefore, Alrex® should not be used
Carcinogenesis and Mutagenesis while the patient is wearing soft contact lenses. Patients who wear soft contact
Long-term animal studies have not been conducted to evaluate the carcinogenic lenses and whose eyes are not red should wait ten to fifteen minutes after instilling
potential of loteprednol etabonate. Loteprednol etabonate was not genotoxic in vitro Alrex® before they insert their contact lenses.
in the Ames test, the mouse lymphoma tk assay, or in a chromosome aberration Patients should be advised not to wear a contact lens if their eye is red. Alrex®
test in human lymphocytes, or in vivo in the single dose mouse micronucleus assay. should not be used to treat contact lens related irritation.
Ophthalmologic
Alrex® should be used as a brief temporary treatment. If Alrex® is used for 10 days SUPPLEMENTAL PRODUCT INFORMATION
or longer, intraocular pressure should be closely monitored. The initial prescription WARNINGS AND PRECAUTIONS
and renewal of Alrex® should be made by a physician only after appropriate Sexual Function/Reproduction
The effects of Alrex® on sexual function and reproduction have not been studied in humans. Treatment of male and
ophthalmologic examination is performed, ie. slit lamp biomicroscopy or fluorescein female rats with up to 50 mg/kg/day and 25 mg/kg/day of loteprednol etabonate, respectively, (1000 and 500 times
staining if appropriate. If signs and symptoms fail to improve after two days, the the Alrex® clinical dose) prior to and during mating, was clearly harmful to the rats, but did not impair their copulationYou can also read
