Dr. Jane Barratt
Secretary General, International Federation on Ageing
Dr. Alan Low
Executive Director, Medicines Access Coalition
The eyes are the windows to our physical well-being — and vision experts report seeing some troubling developments, especially among older Canadians.
According to a recent research study conducted by Deloitte on behalf of the Canadian Council of the Blind, missed and postponed vision health appointments over the course of the pandemic have led to a rise of retinal diseases like age-related macular degeneration and diabetic retinopathy, threatening the vision of older Canadians. Data shows a 47 percent decrease in all surgeries across Canada, including surgeries for cataracts, glaucoma, retinal diseases, and other diseases with the potential to lead to vision loss.1
“There’s this myth that, with increasing age, your vision inevitably gets worse and worse until you can’t see at all,” says Dr. Jane Barratt, Secretary General of the International Federation on Ageing (IFA). “The truth is, many of these conditions are preventable. But, because we’ve been in lockdown and facing such severe restrictions, we hear ophthalmologists saying that they’re now seeing advanced stages of disease that could have been avoided with timely checkups and treatments.”
And behind every story or statistic of vision loss, there’s a life made more precarious. In the aging population especially, vision and independence are inextricably intertwined. “When vision changes or vision fails for someone who has had normal vision, the impact is tremendous and life-altering,” says Dr. Alan Low, Executive Director of Medicines Access Coalition. “People with declining vision describe significant impacts to their life and for some, there’s a complete loss of independence as they’re unable to cope with daily routines and activities.”
There’s this myth that, with increasing age, your vision inevitably gets worse and worse until you can’t see at all.
A choice of innovative treatments is available — if we have the freedom to choose
Among the most powerful tools available to slow, halt, or even reverse the progress of these diseases are a class of innovative, and frequently costly, biologic therapies known as anti-VEGF treatments. As the patents expire on the original cohort of these ophthalmological biologics, a new class of drugs known as biosimilars is being engineered to provide a more cost-effective option. Fundamentally similar, but not molecularly identical, biosimilars provide exciting new options for treatment, but there’s a lack of information on the risks and contraindications of switching for existing patients.
In some fields outside of ophthalmology, mandatory switching to biosimilars is already policy in some parts of Canada. In British Columbia, for instance, thousands of people living with rheumatic conditions are waiting to find out if they’ll be able to get an exemption to stay on the medication that’s been successfully managing their condition.
“Coverage across Canada is not consistent and while some provincial plans cover the treatments, others do not,” says Dr. Low. “It’s important to ensure that biosimilar policies that limit which drugs are accessible through a public plan aren’t restrictive, preventing patients and their prescribers from choosing the best therapy for the individual.”
Switching medications is a big decision with a lot of potential consequences. And it’s critical to remember that the switch from a biologic to a biosimilar is, in fact, a change in treatment, even if the desired outcomes are identical. When a person’s vision is on the line, it’s hard to think of these decisions as being anything other than personal.
“If we want to put quality of life first, decisions around treatment must be based on the tailored assessment and critical examination of a physician talking to the patient about the treatments available,” says Dr. Barratt. “That may lead to using a biosimilar, or it may lead to a biologic.”
Eye See You
The IFA’s Eye See You campaign is a collaborative partnership aiming to clear a path to sensible biosimilar policies across Canada. “The goal of the Eye See You campaign is to improve the vision health of older Canadians,” says Dr. Barratt. “We do that by helping to influence and shape policy across sectors and across disciplines. That includes working with patient organizations, working with government to understand their policy, and working with leading ophthalmologists across Canada.”
The world looks very different than it did two years ago. But if we still want to like what we see, we need to implement policies that protect the freedom of Canadians and our vision health providers to make the choices that will safeguard our vision.
This article was made possible with support from a research-based pharmaceutical company.
References
1Canadian Council of the Blind. “Addendum to the Summary Report on the Cost of Vision Loss and Blindness in Canada.” August 2021. Available at: https://ccbnational.net/shaggy/2021/10/12/the-impact-of-covid-19-an-addendum-to-the-cost-of-vision-loss-in-canada-study. Accessed April 20, 2022.
