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Does OHIP Cover Eye Exams for Diabetes? in

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Diabetes can have profound impacts on vision. Diabetes Canada reports that those diagnosed with diabetes are 25 times more likely to suffer blindness than those without diabetes. 

“People don’t realize how closely eye health and diabetes are linked,” says Parm Dhillon, Founder of Image Optical. “Diabetes affects the optic nerve, retina, and speeds up cataract.”

Given around 1 in 10 Canadians lives with diabetes, OHIP’s inclusion of eye exams for people with diabetes is such a vital change. In this guide, we’ll tell you everything about OHIP’s eye exam coverage for people with diabetes and associated conditions.

Eligibility Requirements for OHIP Eye Exam Coverage for People With Diabetes

People Up to 19 Years Old

Anyone in Ontario aged 19 or younger is entitled to one fully-covered eye exam every year through OHIP. The eye exam must be conducted by a licensed optometrist.

Patients in this age group are also eligible to receive interim “minor examinations”. These are visits focused on addressing specific eye or vision issues that arise between annual check-ups. For instance, if your child is experiencing blurred vision and has been diagnosed with diabetes, the visit would be covered by OHIP.

However, OHIP does not extend coverage to consultations for second opinions. If you seek a verification of a diagnosis from another optometrist, it will not be covered by OHIP.

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People Aged 20 to 64

Starting September 1, 2023, people aged 20 to 64 with diabetes (and certain other conditions) can receive an OHIP-insured major eye examination from an optometrist once every 12 months.

You must have been diagnosed with diabetes in order to qualify for an annual OHIP-insured eye exam. You may be required to provide a letter confirming your diabetes diagnosis from your physician. An optometrist may also ask to see the list of medications prescribed for your diabetes.

Diabetes can cause complications; fortunately, OHIP also provides eye exams for those who have been diagnosed with:

Glaucoma: Diabetes doubles the risk of developing glaucoma, which can lead to increased eye pressure and optic nerve damage.

Cataracts: Diabetes can cause cataracts, which can cloud vision and make the lens opaque.

Retinal disease: Diabetic retinopathy is a common retinal disease caused by diabetes, and people can experience leakage, swelling, and vision loss.

Corneal disease: Diabetes can affect the cornea by reducing corneal sensitivity. 47% to 64% of those diagnosed with diabetes will develop corneal disease.

Optic nerve pathway disease: Diabetes can lead to diabetic optic neuropathy.

Uveitis: Diabetes can contribute to uveitis, causing pain, redness, and vision problems. People with pre-existing diabetes are twice as likely to develop uveitis.

Patients taking medications such as Chloroquine, Hydroxychloroquine, Ethambutol, and Tamoxifen are also eligible for an annual OHIP-insured major eye exam. 

Also, anyone experiencing a sudden onset of strabismus due to injury or disease, is eligible to receive an OHIP eye exam.

Patients with diabetes, experiencing any of the conditions above, or taking any of the prescribed medications can also get up to two “minor” eye exams under OHIP every year.

People 65 and Older

As of September 1, 2023, people aged 65 and over with diabetes can receive an OHIP-insured major eye examination from an optometrist once every 12 months.

You can also receive an OHIP eye exam if you have any of the other conditions:

  • Glaucoma
  • Cataracts
  • Retinal disease
  • Corneal disease
  • Optic nerve pathway disease
  • Uveitis

And, as above, anyone taking Chloroquine, Hydroxychloroquine, Ethambutol, or Tamoxifen is also covered. Finally, if you experience a sudden onset of strabismus due to injury or disease, you are eligible to receive an OHIP eye exam.

Plus, you can get up to two “minor” eye exams under OHIP every year, if you have any of the conditions or are taking any of the listed medications.

What Do “Major” and “Minor” OHIP Eye Exams Mean?

OHIP makes a distinction between major (also called comprehensive) eye exams and minor (or ‘partial’) eye exams. However, it doesn’t clearly outline what these differences are. 

What Are Major Eye Exams Under OHIP?

The Canadian Association of Optometrists says a major (or comprehensive) eye exam should involve a detailed assessment of your vision and eye health. 

It typically includes the evaluation of visual acuity, refraction tests to determine the need for corrective lenses, an examination of eye coordination, and muscle function.

Additionally, the exam includes a thorough check of the eye’s internal and external structures using advanced diagnostic tools, which can detect conditions like glaucoma, cataracts, and macular degeneration.

Lastly, the optometrist assesses overall eye health and screens for systemic diseases such as diabetes and high blood pressure that can affect the eyes. 

Major eye exams tend to last anywhere from 20 to 60 minutes.

What Are Minor Eye Exams Under OHIP?

There are no clearly defined guidelines for what a minor (or ‘partial’) eye exam should cover. 

The minor eye exam is intended as a follow-up to the annual major exam. It typically lasts from 10-20 minutes.

The optometrist will ask you about your eye health, assess any prevailing conditions, and address any new symptoms you may be feeling.

Minor exams are useful for detecting if your diabetes (or other eligible condition) is causing further damage to your eye, cornea, or retina. 

person holding eyeglasses

Source: Unsplash

How Often Can You Get an Eye Exam Under OHIP if You Have Diabetes?

If you have diabetes, you can get a major eye exam once every 12 months. If you have any of the other qualifying conditions, or are taking a covered medication, you can receive up to two interim minor eye exams every year.

OHIP Will Not Pay for This Even if You Have Diabetes

While OHIP will cover major eye exams if you have diabetes, it only provides one visit to the optometrist every year. For people whose eyesight is declining, or those who are worried about their eyesight declining, that’s not frequent enough.

In that case, you can pay to visit an optometrist yourself. You may also leverage any vision benefits provided by your workplace or private insurance.

OHIP also does not cover eye care services and products, even for those with diabetes. Prescription glasses or contact lenses, laser eye surgery for vision correction, and cosmetic procedures such as eyelid lifts, are not covered by OHIP.

Again, you may pay for these services yourself. Alternatively, you can avail your employment or private health benefits to cover them.

Getting Eye Exams Regularly Is Essential if You Have Diabetes

OHIP’s inclusion of people with diabetes in its eye exam coverage is a vital and necessary change. The incidence of diabetes is rising rapidly in Ontario, with over 4.4 million people living with diabetes.

It leaves people vulnerable to sight-related issues, making routine eye check-ups essential. Book your free consultation with an optometrist today and learn more about OHIP-covered eye exams.

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