Changes to OHIP Coverage for Eye Exams

As of September 1, 2023, changes to OHIP coverage will take effect as per the announcement by the Ontario Ministry of Health (MOH). These changes are made to ensure that people at risk of or have certain eye conditions continue to receive publicly funded care to prevent vision loss.

Please see a summary of OHIP changes below:

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Children 0-19 years old

No Changes

A 0-19 year old patient continues to be eligible for ONE comprehensive eye examination every 12 months under OHIP.

Additional “partial” visits for specific problems (such as red eye) or a doctor-recommended follow up visit will continue to be covered.

Adults 20-64 years old

In general, a patient aged 20 to 64 is not covered under OHIP except

if the patient has one or more of the following potentially sight-threatening conditions, which is eligible for ONE comprehensive eye examination every 12 months under OHIP.

    • Diabetes (confirmed by a physician or medication list)
    • Glaucoma (confirmed diagnosis only, patients “at-risk” for glaucoma are not covered)
    • Retinal Disease
    • Corneal Disease
    • Optic Nerve Disease
    • Cataracts (visual acuity worse than 20/40 or requiring surgery)
    • Uveitis
    • Sudden-onset strabismus (such as related to a tumour or nerve palsy)
    • Patients taking certain medications: Chloroquine, Hydroxychloroquine, Ethambutol, Tamoxifen
  • Patients with Amblyopia or Strabismus (longstanding) will no longer be OHIP-insured.
  • TWO “partial” visits related to the eye condition will be covered. Fees will apply to additional visits or partial visits unrelated to the specific eye condition.

Seniors 65+ years old

A patient aged 65+ must have one or more of the following potentially sight-threatening conditions to be eligible for ONE comprehensive eye examination every 12 months under OHIP.

    • Diabetes (confirmed by a physician or medication list)
    • Glaucoma (confirmed diagnosis only, patients “at-risk” for glaucoma are not covered)
    • Retinal Disease
    • Corneal Disease
    • Optic Nerve Disease
    • Cataracts (visual acuity worse than 20/40 or requiring surgery)
    • Uveitis
    • Sudden-onset strabismus (such as related to a tumour or nerve palsy)
    • Patients taking certain medications: Chloroquine, Hydroxychloroquine, Ethambutol, Tamoxifen

A patient aged 65+ WITHOUT one or more of the potentially sight-threatening conditions will no longer be eligible every 12 months as before.

  • A comprehensive eye exam every 12 months for seniors is still highly recommended for early detection of eye diseases, and patients choosing to do so may be required to pay out of pocket every other year.
  • Alternatively, patients may choose to wait until 18 months to access an OHIP-insured exam.

TWO “partial” visits (ie. red eye or pressure check) will be covered between each comprehensive exam.

Additional Services

The following services are not covered by OHIP and have not been impacted by recent changes. Additional fees apply and may be covered by your health benefits or private insurance plan.

  • Any additional visits or second opinion visits
  • Contact lens assessments
  • Diagnostic testing (ie. Optomap, OCT, dry eye testing)
  • Treatments (ie. epilation of lashes, bandaid contact lenses, dry eye treatment)
  • Spectacle or Contact Lenses

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