Ontario Government and Ontario Association of Optometrists Reach Historic Agreement

“The way eye care is delivered has changed over the past decade,” said Sylvia Jones, Deputy Premier and Minister of Health. “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.”

“I am pleased to announce that we were able to work through a new historic four-year funding agreement,” said Dr. Josephine Pepe, President of the Ontario Association of Optometrists. “We will be working together to ensure optometrists can continue providing the high-quality access to care that Ontarians deserve, both now and for future generations.”

Beginning April 1, 2023, payments to optometrists will increase for some OHIP insured optometry services and for eye exams provided to social assistance recipients.

On September 1, 2023, changes included in the agreement will begin to help increase access to care for people with chronic diseases such as glaucoma and ocular complications due to diabetes. Seniors diagnosed with an eligible medical condition requiring ongoing monitoring will continue to receive an OHIP-insured annual eye exam as well as two follow-up minor assessments. Seniors who do not have an eligible medical condition, such as macular degeneration, glaucoma or diabetes, will continue to receive preventative eye care through an OHIP-insured eye exam every 18 months, as well as two additional follow-up minor assessments.

There are no changes under this agreement to eligibility coverage for children or Ontarians receiving social assistance.

Changes for Seniors (aged 65 years or older) Effective September 1, 2023

Annual Eye Exams

Current: One exam every 12 months for all seniors aged 65 years or older.

Change: Seniors with eligible medical conditions affecting their eyes such as macular degeneration, glaucoma or diabetes will continue to receive one exam every 12 months. Seniors without an eligible medical condition will receive one exam every 18 months.

Rationale: This change reflects consensus reached between the OAO and the Ministry of Health on an appropriate amount of OHIP coverage over this timeframe based on the best clinical evidence and prioritizes seniors with the highest needs. This change also aligns with other provinces, such as Manitoba and Nova Scotia, which insure eye exams every 24 months for healthy seniors.

Minor Follow-Up Assessments

Current: Seniors aged 65 and older are eligible to receive an unlimited number of minor follow-up assessments following the annual eye exam.

Change: Seniors with eligible medical conditions affecting their eyes can receive two minor follow-up assessment exams every 12 months following the annual eye exam. Seniors without an eligible medical condition can receive two minor follow-up assessment exams every 18 months following the annual eye exam.

Rationale: This change reflects consensus reached between the OAO and the Ministry of Health on an appropriate amount of OHIP coverage over this timeframe based on the best clinical evidence and prioritizes seniors with the highest needs. This change also aligns with Alberta, which has a limit of one minor assessment per 12-months unless there are special circumstances.

Changes to Coverage for Eligible Medical Conditions Effective September 1, 2023

Amblyopia and Strabismus

Current: Adults aged 20 to 64 with amblyopia (lazy eye) and strabismus (misaligned eyes) are eligible to receive OHIP insured eye exams.

Change: Adults aged 20 to 64 who have sudden onset of strabismus will continue to be insured. Monitoring children with these conditions will continue to be insured. Adults aged 20 to 64 with either of these conditions will continue to be able to seek medical care from a primary care provider in response to any complications or acute concerns.

Rationale: Clinical evidence demonstrates that monitoring these conditions is most effective in early childhood when the eye has not yet stabilized and when treatment can have an impact. This change also aligns with other provinces, including Manitoba, Quebec, Nova Scotia and Saskatchewan.

Diabetes

Current: Documented history of diabetes is required in order to be eligible to receive an insured eye exam.

Change: Optometrists can clinically assess and verify whether a patient has diabetes in order to receive an insured eye exam.

Rationale: This change empowers optometrists to clinically assess their patients and is informed by expert advice from the OAO to help ensure care is available to those that need it most. This is consistent with all other provinces that cover these services.

Cataracts

Current: Eye exams are insured by OHIP for people with cataracts, even when they do not experience decreased vision that impacts their daily life.

Change: Eye exams will continue to be insured for adults with cataracts that have clinically significant decreased vision that impacts their daily life, or when a surgery referral is made.

Rationale: For many people, cataracts are caused by normal changes in their eyes as they age and go unnoticed. Clinical evidence demonstrates that monitoring patients who do not experience clinically significant decreased visual quality or require surgical treatment does not lead to improved health outcomes.

Uveitis

Current: Only people with uveitis (inflammation inside your eye) that is reoccurring receive an insured eye exam, regardless if it is currently inflamed or not.

Change: OHIP will insure an eye exam for any person if uveitis is currently inflamed (whether it is reoccurring or not).

Rationale: This change is informed by clinical evidence and expert advice from the OAO that identifying and treating uveitis when it is active is the most effective way of treating the condition. Monitoring of this condition does not reduce the risk of reoccurrence.

Retinal Eye Disease, Corneal Disease and Optic Pathway Disease

Current: People with these conditions, regardless of it being active or not, are eligible for an insured eye exam at any time.

Change: People with active cases of these conditions will be insured under OHIP.

Rationale: This change is informed by clinical evidence and expert advice that monitoring conditions does not reduce the risk of reoccurrence once these conditions have stabilized, become inactive or no longer require treatment.

Visual Field Assessments

Current: Visual field assessments, which are tests to measure the extent of what the eye sees in any direction without movement, are available to all OHIP patients even if they don’t have a condition that would benefit from the test.

Change: People who benefit from this assessment, including those who are diagnosed with retinal disease, glaucoma, active optic pathway disease, acquired cranial nerve palsy causing strabismus, and those who require ocular drug toxicity screening, will be eligible for an OHIP-insured visual field assessment.

Rationale: This change is informed by expert advice from the OAO that there is no clinical need for people without these conditions to receive these tests.

Changes to Eye Exam Referral Forms Effective September 1, 2023

Current: People can obtain a referral letter from their primary care provider to receive an OHIP-insured eye exam from an optometrist.

Change: People with an eligible medical condition will be able to receive an insured eye exam from an optometrist without a referral letter.

Rationale: People with eligible medical conditions will continue to receive the appropriate level of OHIP insured care based on clinical evidence.