Veterans Affairs Committee on Feb. 5th, 2008

[Todd Russell, Liberal, Labrador, NL]

Thank you, Mr. Chair.

Good afternoon to Ms. Moore and Mr. Nunan. It's good to have you here.

I was just reflecting that I believe one of the first organizations I helped raise money for when I went to university—because we didn't have much of it in my little town of 50 people on the coast of Labrador, and some people had never heard of many of these organizations—was the CNIB. It's just one of those nice occasions that I sort of reflect on when I see somebody like you here, and the amount of money that gets raised through direct fundraising.

I just wanted to go back to your statistic again that the CNIB has about 1,800 veteran clients. You said this is somewhat low, or you figure this is a low number.

[Catherine Moore]

Statistically speaking, I would say yes, it is low, but I can't really tell you any more than that. I have the same sense as the other gentleman that, indeed, we're missing a group, but how we get to that group is the question.

[Todd Russell, Liberal, Labrador, NL]

Take the 1,800 compared to the overall figures in terms of veterans and the number of people within Canadian society generally who are accessing services for impairments or blindness. How does that compare? I'm trying to see if there's a gap and how big the gap is, even statistically.

[Catherine Moore]

Statistically, we don't know. I can give you some figures, but I want to caution everyone that we don't know the details of this.

According to Statistics Canada's post-censal data in the participation and activity limitation survey, or PALS, 800,000 people in 2006 identified themselves as having a severe visual impairment. That's 800,000 people over the age of 15.

Now, if we take CNIB's statistics on the number of people we have, 65% of our clients are over the age of 70. Again, this is quick and dirty, but because vision loss, as we know, is age related, maybe 50% of the 800,000 are over 65 or over 75, which means we're talking about 400,000 people. Or we'll say it's that amount just in the interests of discussion.

Right now 108,000 people are registered with CNIB. I don't believe in panicking or just throwing figures around, so we don't know if there are 300,000, or 400,000, or even 700,000 more people out there who need to be getting CNIB services. I suspect that's not the case. But as we all know, as everyone in this room is mentioning, there is a gap between the people who are getting services and the people who could benefit from them but are not getting services.

So is that number big? I don't know--but it could be.

[Todd Russell, Liberal, Labrador, NL]

Yes, I can understand that it's very difficult to get a handle on it.

I want to raise another issue. We had some witnesses appear before us regarding falls and falls prevention amongst the veterans. One of my colleagues talked about hearing impairment or injuries dealing with the balance system, which is affected by the inner ear. Is there any correlation between falls and blindness or seeing impairment? Or has any work been done on that?

[Catherine Moore]

Yes, there has been work done on that in the U.S. We have material that we will leave with you that includes indications from the Framingham study, a longitudinal study on health outcomes for people. I think there were 4,000 or 5,000 people in the study over a long period of time. The shocking figure from the study was that over 2004-05, the cost to the U.S. health system for falls and injuries related to vision loss was $2.2 billion.

Again, we don't have the research to say that if we teach people how to use a white cane, if we teach people how to keep their balance even though they no longer have a horizon as a frame of reference, we can prevent all the injuries and falls of somebody with vision loss, because generally we're also talking about somebody who has such other issues as mobility, arthritis, and that sort of thing. However, we can be pretty certain and confident, I think, that if those people were receiving orientation and mobility training--that is, how to move without sight, how to move with a white cane, how to orientate yourself in space without visual references--we could reduce a fair proportion of those falls that are vision related.

[Todd Russell, Liberal, Labrador, NL]

Thank you very much.

[The Chair, Conservative, Rob Anders]

Now we're back to the Conservative Party of Canada, with Mr. Sweet, for five minutes.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

Before you start my time, Mr. Chairman, I'd like to ask Mr. Nunan if he had something to add on that last question.

[Bernard Nunan]

Yes. Cathy was referring to the Framingham study, and I just wanted to point out that you do have it in your folders.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

Thank you.

Ms. Moore, thanks for coming.

Since you mentioned the folder, Mr. Shipley mentioned communications, and Mr. Russell mentioned fundraising, I'll mention that I remember standing on Princess Street, back when I was 10 or 11 years old, helping out a Lions Club member with White Cane Week. It was quite big in those days.

Is getting the message out becoming more challenging for CNIB in terms of awareness? I don't see anywhere near the heightened public awareness--what the white cane means, how people can, with dignity, help people who are using the white cane, etc.

[Catherine Moore]

I think CNIB, like all organizations, is struggling a bit in a very loud, competitive world to get its message out. The cold hard fact is that nobody really wants to hear about going blind. Having said that, CNIB has taken a different approach to its communications and public education. We have gone through a rebranding process, which I think sounds funny, because your brand is not what you're about; what you do is what you're about.

We are trying a couple of things, and mitigating the stigma of vision loss is one of them. We say to people, you can still come to CNIB if you have some vision—most people with whom we work do have some—and there is no shame involved.

We are also trying to move into the research around things like whether our training reduces falls and the prevention of blindness. We are also partnering with other groups--ophthalmology, optometry, other research councils, the Foundation Fighting Blindness--because there are ways to avoid blindness. And there are medications coming on the market and that sort of thing. There's retinal research that is leading toward, if not a cure, at least ways to reduce the effects of vision loss.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

You led right into my next question, which is on age-related macular degeneration. I understand that in the United States there are shots that not only arrest it but actually regenerate the retina. Is that correct? Do you know where we are as far as approving that drug is concerned?

[Catherine Moore]

There is a medication available now, which has been approved by Health Canada--it's called Lucentis--but it has not yet passed through the common drug review. This is a particular medication that arrests a very particular type of AMD--wet AMD. A much smaller number of people actually have wet AMD. I can tell you that Veterans Affairs has Lucentis on its formulary, and it will pay for it.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

Lucentis is in a pill form, but there are shots available now in the U.S. Are you familiar with those?

[Catherine Moore]

I'm not as familiar with the shots, but the shots are a variation on Lucentis. It's a complicated thing. There is another medication. Those shots involve that type of medication that has not been clinically tested to be used with eyes. That's the difference.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

In your package you mentioned that it's a cruel irony that cataracts are looked after in this country but not AMD--that if, on the other hand, the same person develops chronic vision loss as a result of a common eye disease, they have to go to CNIB for services. Is this the case across Canada, in every province? Health care is delivered by the province. Are there any exceptions?

[Catherine Moore]

Yes, Quebec is a great exception. Quebec provides a different model of service delivery in which the provincial government takes a much greater fiscal responsibility in providing vision loss services and vision care. C'est bon, Québec.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

When it comes to Veterans Affairs Canada, do they get the same level of treatment, whether it's cataracts or AMD?

[Catherine Moore]

Yes. You can be proud that Veterans Affairs does provide reimbursement to CNIB, fee for services for CNIB, and for other areas in terms of vision loss services. Quebec and Veterans Affairs are the two models that we hope will eventually be adopted by provincial government health systems.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

Thank you very much.

I have one last quick question on the White Cane Week and the promotion, etc. Do the public schools still have awareness for young people on White Cane Week in their curriculum?

[Catherine Moore]

CNIB is no longer involved in White Cane Week. It's another organization called the Canadian Council of the Blind. I believe they are still doing some information provision to the grade schools.

I know what you're talking about. Years ago I worked in Halifax, and we used to have the kids come in every year during White Cane Week. We took them on a tour, to show them how to use a white cane and that sort of thing. One time we had emergency vehicles arrive twice because one of the little persons discovered that 9-1-1 worked on the pay phone during the tour. That's a little aside.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

I still remember how big it was.

[Catherine Moore]

Exactly.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

When they're young it gets imprinted--that behaviour toward people who have sight impairment. They treat them with dignity as well. It lasts a lifetime.