Barriers and challenges to accessing and utilizing low vision services among people with visual impairment in Canada:...

Visual impairment affects ∼2.18 million Canadians and is associated with reduced quality of life and substantial economic burden. Although low-vision services (LVS) improve independence and functioning, utilization remains low. This systematic review examines barriers to accessing and utilizing LVS in Canada.

A systematic search of MEDLINE, EMBASE, Cochrane Library, CINAHL, grey literature sources, and Google Scholar was conducted from inception to June 15, 2025, and registered with PROSPERO: (CRD420251082000). English-language studies examining barriers to accessing or utilizing LVS in Canada were included. Screening and data extraction were performed independently by multiple reviewers following PRISMA guidelines. Thematic analysis categorized barriers into systemic/structural, personal, and societal domains. Study quality was assessed using the Mixed-Methods Appraisal Tool (MMAT).

Of 730 records identified, 25 studies met inclusion criteria. Systemic barriers included limited-service availability, inconsistent provincial funding, high out-of-pocket costs, geographic maldistribution, and provider-related gaps in referral knowledge and training. Personal barriers included lack of awareness of LVS, financial insecurity, lower educational attainment, comorbid health conditions, and psychosocial resistance, such as stigma or denial. Societal barriers included negative attitudes toward disability, limited family support, cultural and linguistic challenges, and inaccessible public infrastructure. Study quality was moderate to high, with 60% rated 4 stars or higher on MMAT.

Access to LVS in Canada is limited by intersecting structural, personal, and societal factors. Coordinated reforms in provider education, public awareness, funding policy, and inclusive design are needed to improve equitable access and reduce underutilization of low-vision rehabilitation services.