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
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
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
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.
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,”
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:
- 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:
- Disclosure: No companies or products are mentioned that would require