Vision care access programs for communities facing barriers to care in Canada: a systematic review

To systematically review Canadian programs designed to improve access to eye care for communities facing barriers to care and to summarise access outcomes, clinical yield, and implementation features.

MEDLINE, Embase, and the Cumulative Index of Nursing and Allied Health were searched through July 30, 2025. Supplementary French-language searches in the 3 databases, as well as French- and English-language searches in Google Scholar, were conducted through June 14, 2026. Two reviewers independently screened records, extracted data, assessed risk of bias, and evaluated certainty of evidence.

Seventeen studies were included. Seven studies focused on Indigenous or First Nations communities, 5 on people experiencing homelessness or marginal housing, and 5 on low-income, immigrant, refugee, or school-based populations. Teleophthalmology, teleretinal, and mobile diabetes screening models were the most common program type (8/17, 47.1%), followed by shelter-based or outreach eye examination programs (5/17, 29.4%), primary care, newcomer, refugee, or policy-based access models (3/17, 17.6%), and school-based screening (1/17, 5.9%). Programs frequently identified unmet need, including high rates of uncorrected refractive error, vision impairment, diabetic retinopathy, glaucoma or glaucoma-suspect status, and referral need. However, referral completion, repeat screening, treatment receipt, and patient-reported outcomes were inconsistently reported.

Canadian community-based, shelter-based, school-based, mobile, and teleophthalmology programs can reach populations that experience barriers to eye care. The evidence supports the importance of co-location, culturally safe partnerships, low-barrier referral pathways, and spectacle or treatment navigation, but certainty remains limited by observational designs, heterogeneity, and incomplete downstream outcome reporting.