Optometrists in Quebec treat over 185,000 eye emergencies every year.
For patients without a designated optometry clinic, emergency care is usually quick and relatively inexpensive—but only if you can get through the door.
Imagine this: you suddenly feel pain in your eye, or flashes of light or floaters appear in your vision. Will you be able to get help quickly if you don’t already have an optometrist?
That’s the question Benoît Tousignant, a professor at the Université de Montréal’s School of Optometry and School of Public Health, set out to answer with his students Catherine Binette and Ariane Duchesne. Their study, published in the journal Clinical and Experimental Optometry, paints a surprising picture of access to emergency eye care for patients without a regular optometrist—especially in suburban areas, where the situation appears even more concerning.
Optometrists in Quebec are authorized to prescribe medication and remove foreign objects from the eye. They handle over 185,000 emergencies each year, helping patients avoid unnecessary visits to hospital emergency rooms or walk-in clinics.
Mystery calls to test the system
To realistically measure access to optometry services, the researchers used a method well known in public health: simulated patients. Between May and June 2022, Catherine Binette and Ariane Duchesne—then students at the School of Optometry—called 95 optometry clinics across Quebec from Tuesday to Thursday, posing as new patients with urgent concerns. They used two scenarios: one involving a red eye, possibly conjunctivitis, and another with more alarming symptoms—flashes of light and floaters—suggesting a potential retinal tear.
“These are both common scenarios in clinics. We wanted to cover a range of severity—from mild cases to more serious ones that could have major consequences for vision,” explains Professor Tousignant.
The study could have been conducted differently. “We could have just asked the clinics whether they treat emergencies, but that would likely have led to biased answers,” he adds.
Half of patients don’t get an appointment
The results even surprised the researchers: more than half of the clinics (53.9%) did not offer an appointment. Tousignant called the finding “disappointing,” especially since all optometrists are trained to handle such cases, and ophthalmology clinics and emergency rooms are often overwhelmed.
It’s worth noting that the study only focused on new patients. Those with an existing relationship with a clinic likely have better access to care.
Significant regional differences
Another finding: rural clinics were more likely to offer appointments. This is good news for people living in remote areas where hospital resources are limited or far away. Rural clinics provided appointments in 68.9% of cases, compared to only 40% in urban areas and 30% in suburban ones. This paradox may be due to the lack of specialized hospital services in rural areas, which pushes optometrists to take on more responsibility locally.
Simpler cases more likely to be accepted
In terms of the medical issue presented, clinics were slightly more likely to accept conjunctivitis cases (34.8%) than suspected retinal tears (30.3%). When only one appointment was offered, clinics tended to favour the simpler scenario.
According to Tousignant, this likely comes down to logistics:
“A conjunctivitis is quick to diagnose,” he says. “A few minutes between patients is enough. But cases involving flashes or floaters require pupil dilation, longer testing, and sometimes referral to a specialist. In practice, we know that some aspects of clinic organization can make it easier to handle emergencies.”
When an appointment is granted, it’s quick and affordable
The good news: when clinics did offer appointments, they were prompt. The average wait time was 3.7 hours. More serious cases were seen faster (3 hours) than less urgent ones (4.9 hours).
As for cost, fees paid by patients were moderate and consistent: an average of $55 across the province. “I expected higher fees in rural areas, but they were actually quite uniform,” Tousignant notes.
A matter of distribution, not resources
The study does not question the competence of Quebec optometrists or their important role in emergency care. Rather, it highlights a distribution issue. Some clinics handle a large share of emergencies, while others accept very few—or none at all.
“This isn’t just about training or the number of professionals in a given area, which is the usual argument to improve healthcare access,” Tousignant concludes. “We need to understand why some clinics accept emergencies and others don’t. And before making recommendations, I’d be cautious. We should conduct another study to pinpoint what’s working in the clinics that take a lot of emergency patients, and what’s preventing others from doing so. That way, we can better identify the barriers—and the solutions.