Mobile ophthalmology clinic achieves long-term success and expands initiatives

The Eye Van project has aided residents of Northern Ontario, incorporating volunteer medical staff and numerous citizens to facilitate the program.

Steve Arshinoff

Since 1972, a mobile ophthalmology clinic has been providing care to the citizens of remote communities in Northern Ontario, Canada, an area larger than Texas north of lakes Superior and Huron, where access to specialized medicine is generally unavailable.

The Ontario Medical Mobile Eye Care Unit, more commonly referred to as the CNIB (Canadian National Institute for the Blind) Eye Van, is a joint operation of the CNIB and the Ontario Medical Association and part of the Prevention of Blindness program, which seeks to provide early diagnosis of conditions that may lead to vision loss.

The Eye Van team includes approximately 25 ophthalmologists, a manager, an administrative secretary, two ophthalmic assistants and a host of individuals who provide community outreach and miscellaneous aid. Each ophthalmologist normally spends a consecutive week volunteering on the van, which operates between March and November.

“Everyone who participates does so for an altruistic reason. Every person that we meet who is taking part in the program is really behind it, making it a fun thing to do,” Steve Arshinoff, MD, FRCSC, OSN Cataract Surgery Board Member, Eye Van ophthalmologist for the past 33 years and medical director for the project, said in an interview with Ocular Surgery News.

The van travels to roughly 30 communities in the large remote but contiguous region, areas where the population number is so small that operating an eye care clinic is economically unfeasible. According to Dr. Arshinoff, each community typically has four family physicians to serve roughly 5,000 to 6,000 inhabitants within a 60-mile radius of town and refer patients for eye examinations.

In addition to conducting complete medical exams using all the facilities available in the best urban ophthalmology practices, the Eye Van team members also monitor selected patients, particularly those with glaucoma and diabetes, and perform minor surgical as well as YAG, selective laser trabeculoplasty and retinal laser procedures, Dr. Arshinoff said. The ophthalmologists do not perform retinal, cataract or glaucoma surgeries, because these treatments require significant postoperative observation and care. However, the mobile clinic is equipped with a list indicating every ophthalmologist within approximately 400 miles as well as each of those physicians’ specialties and availability. All have signed on to receive urgent referrals, if needed, before the Eye Van departs for its annual tour.

Activities and community ties

William S. Hunter, MD, FRCSC, an accomplished Toronto ophthalmologist and ophthalmic pathologist who spent a few years after his medical training as a family physician in one of the most remote regions of Northern Ontario, founded the Eye Van in conjunction with the CNIB and the Ontario Medical Association Section on Ophthalmology. Initially, the program drew ophthalmologists from its former headquarters in Toronto, but now it recruits from the larger ophthalmologic community across Ontario as well as other provinces in Canada, Dr. Arshinoff said.

“It was easy getting doctors, but it was hard to find anybody who had reach across Ontario or any of the small communities across Canada,” Dr. Arshinoff said. “The CNIB has offices everywhere in Canada … so they came on as the administrative arm of the Eye Van project.”

In addition to providing eye care, the project’s surgeons also lecture to the medical communities they encounter. Jeffrey Sher, MD, FRCSC, a volunteer for the Eye Van for the past 27 years and a member of its medical advisory committee, said that the program has joined forces in the past year with the Northern Ontario School of Medicine to provide CME credit to the local family physicians who receive its educational services.

“It is an enthusiastic, dynamic and energetic audience. … You are providing these people with CME that they might not otherwise have an opportunity to get,” he said.

According to Dr. Arshinoff, it is not uncommon for participating ophthalmologists to spend 15 hours per day seeing patients, lecturing, meeting with local medical and political officials, and/or talking with members of service organizations such as the Lions Club. When the Eye Van is not physically present, these individuals reach out to the community and encourage continued utilization of the program’s services to help local residents.

“These are the people who actually make it work,” Dr. Sher said. “Without the local volunteers, the sort of feet on the ground making it happen, we would be parachuting into a vacuum.”

Overseeing all of these activities is the Eye Van’s medical advisory committee, which incorporates a broad range of input into the program’s management, Dr. Arshinoff said.

“There is a myriad of complex issues that we all handle,” Dr. Sher said, “but I think one of the strengths of the Eye Van program is that you are dealing with a large organization like the CNIB, but you have physician input that is equally valued and important, so you have a tremendous amount of input into the running and all the minutiae of making a project like this work.”

The committee also decides on purchases, and while the program receives significant funding from Canada’s Medicare system and additional government and corporate aid, participating physicians contribute to a fund for new equipment and other expenses. This is an unofficial rule that was generated during the program’s graduation to its current medical advisory committee governance in 1990, Dr. Arshinoff said.

“We wanted to make sure that people who came on the Eye Van lost money, because we did not want people to be going for a profit. … We wanted them to come north for good reason, because they wanted to help these people,” he said.

Expanding initiatives

In addition to the Eye Van’s traditional activities, the program has newly partnered with the Northern Diabetes Health Network to promote diabetes awareness. According to Dr. Arshinoff, the Canadian government periodically implements initiatives that focus on a prominent health issue, and their recent focus has led to a cohort educational program that accompanies the Eye Van on its travels.

For the 2011 tour, representatives from the Northern Diabetes Health Network are teaching patients about appropriate diet and exercise, medication, signs and symptoms of high blood pressure, and how to check blood sugar and blood pressure, he said.

The program is always working to increase access to secluded populations because patients may not be capable of traveling for care, Dr. Sher said. The Eye Van staff is collaborating with the Ontario government to implement teleophthalmology screening for diabetic retinopathy to remotely identify patients who are in need of treatment.

“When I am working in Southern Ontario, a lot of what I do is often taken for granted, but [in Northern Ontario], patients understand how difficult health care is to access, so they are truly appreciative. … It is exciting to know you are providing care that may otherwise be completely missed,” he said.

According to Dr. Arshinoff, patients are so appreciative of the program that additional aid is not uncommon. For instance, a transport company has been providing the van with free services for almost two decades, training the nurses to drive a transport truck and providing immediate emergency trucking assistance to the Eye Van team throughout the region. Individual patients and their relatives also often make donations to help support the program.

“It is amazing and most gratifying, when you have a program like this, how all kinds of people are happy to jump on the bandwagon and help,” Dr. Arshinoff said. “No one has ever refused us assistance.” – by Michelle Pagnani

• Steve Arshinoff, MD, FRCSC, can be reached at 2115 Finch Ave. W, Suite 316, Toronto, Ontario M3N 2V6, Canada; 416-745-6969; email: ifix2is@sympatico.ca.
• Jeffrey Sher, MD, FRCSC, can be reached at 26-1070 Stone Church Road, East Hamilton, Ontario, Canada L8W 3K8; 905-318-5338; fax: 905-318-5313; email: idoc@bellnet.ca.
• Disclosure: No companies or products are mentioned that would require financial disclosure.