Ontario changes eye exam eligibility for seniors, those with cataracts, other conditions

Ontario has reached a funding agreement with optometrists that increases some payments to them and changes eligibility for some assessments, 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 ofOptometrists. 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.

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

Optometristssaid the province had been underfunding the OHIP-covered services, leaving them paying around 45 per cent out of pocket.

Eligibility changes

A statement Friday from Health Minister Sylvia Jones saidoptometristshave 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.

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.