Eye exam eligibility changes for Ontario seniors under new funding deal with optometrists

Ontario has reached a funding agreement with optometrists that increases some payments to them, but reduces some coverage for patients, including less frequent general eye exams for seniors.

As of Sept. 1, people aged 65 and older will be covered for one eye exam every 18 months, instead of one a year, unless they have a condition affecting their eyes such as macular degeneration, glaucoma or diabetes.

The province said that decision was made with the Ontario Association of Optometrists. It is based on “the best clinical evidence and prioritizes seniors with the highest needs,” the government said, noting Manitoba and Nova Scotia insure eye exams every two years for healthy seniors.

NDP Leader Marit Stiles said the move will hurt seniors.

“Seniors are having a hard enough time right now without having to go longer between eye exams, which are critical to seniors’ health,” she said in a statement.

“Preventative eye care is important to catching issues early and could impact seniors’ ability to live independently. Only seniors who can afford to pay out-of-pocket will be able to get more frequent eye exams.”

The four-year agreement comes after contentious and lengthy talks. Optometrists withdrew from performing provincially insured eye services from September to November 2021 amid a dispute over the amount they were being reimbursed.

The province’s health plan covers annual eye exams for residents aged 19 and under, 65 and older and people with specific health conditions. Optometrists said the province had been underfunding the OHIP-covered services, leaving them paying around 45 per cent out of pocket.

A statement Friday from Health Minister Sylvia Jones said optometrists have ratified a four-year funding agreement that includes an increase to payments for some OHIP-insured services and eye exams for social assistance recipients, but it didn’t detail amounts.

“The way eye care is delivered has changed over the past decade,” Jones said in the written statement.

“Together, we were able to come to a long-term and sustainable agreement. Through their OHIP card, people of all ages will continue to be connected to high-quality and publicly-funded eye care that better reflects the latest best practices and expert advice.”

The statement also lists a number of other eligibility changes under the agreement.

As well, seniors will no longer be able to receive unlimited minor follow-up assessments after an annual eye exam. Instead, they would be able to get two of those assessments every 18 months, or 12 months for seniors with certain medical conditions affecting their eyes.

Adults between age 20 and 64 with lazy eye will no longer be covered for eye exams. People in that age range with strabismus – who are currently covered for eye exams – will now only be able to receive them through OHIP if the condition has a sudden onset.

People with cataracts are currently covered for eye exams, but starting Sept. 1 they will only be covered if they have “clinically significant decreased vision that impacts their daily life” or if a surgery referral is made.

People with retinal disease, corneal disease and optic pathway disease will only be covered if their cases are active, as opposed to being insured for an eye exam at any time.