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Are Diabetic Eye Exams Covered by OHIP?

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Woman with dilated pupils.

If you haven’t had a comprehensive eye exam in the last year, then you might only now be learning that the Ontario Health Insurance Plan (OHIP)  changed their coverage for eye exams as of September 1, 2023. These changes were based on clinical evidence and expert opinions, and include increased access to eye care for individuals with ocular complications from diabetes.

Regardless of age, if you have diabetes, you are eligible for 1 annual OHIP-insured comprehensive eye exam and up to 2 follow-up minor assessments every 12 months. These follow-up appointments must focus on issues related to your annual check-up (relating to diabetes) in order to qualify for OHIP coverage.

Why Increase Coverage for Diabetic Eye Exams?

Most people know that having diabetes means your body can’t produce insulin (or deal with the insulin it produces), which requires that you keep an eye on your blood sugar levels in order to stay healthy. However, fewer people are aware that diabetes can affect your eyes. In fact, diabetes is a leading cause of blindness in adults.

Since 1 in 3 Canadians are living with diabetes or pre-diabetes, regular comprehensive eye exams are considered an essential preventative measure that can detect diabetes early, help reduce the risk of vision loss, and minimize the risk of other life threatening complications of diabetes. Since eye exams allow your eyecare provider a clear view of the back of the eye, changes in your vision can be detected before you even notice a difference yourself.

Why You Should Take Advantage of OHIP Coverage

Diabetes can sometimes damage your eyes even before you’ve received an official diagnosis. While, generally, it’s recommended that most adults get an eye exam every 2-3 years, more regular comprehensive eye exams can help detect early warning signs and are an important part of complete diabetes management.

Unfortunately, because diabetes can cause many complications, people with diabetes are at an increased risk of developing vision problems, such as:

  • Cataracts, which causes cloudy vision & makes the lens opaque
  • Corneal Disease, which reduces corneal sensitivity
  • Glaucoma, which increases eye pressure & optic nerve damage
  • Optic Neuropathy, under which inflammation causes nerve dysfunction
  • Uveitis, which causes pain, redness, and other vision problems

The most common of these complications is Diabetic Retinopathy (DR). DR involves damage to the blood vessels in the retina as a consequence of having too much sugar in the blood. This condition affects 500,000 Canadians, and can manifest as blurry vision, black spots or holes in your field of vision, flashes of light, floaters, and general loss of vision.

Since the retina of your eye works like film in a camera to help you see, damage to its blood vessels can have a serious impact on your sight. 

How Can I Reduce My Risk of DR?

Everyone with diabetes can help reduce their risk of DR through regular comprehensive eye exams and by following the ABCDEs:

  1. A1C – blood sugar control should be 7% or less
  2. Blood Pressure – optimal regular blood pressure should be 130/80 mmHg or lower
  3. Cholesterol – LDL-C should be 2.0 mmol/L or less
  4. Drugs for CVD Risk Reduction – various drugs that can be taken (depending on your specific needs) to protect the heart
  5. Exercise/Eating – regular physical activity & healthy eating
  6. Self-Management – including setting personalized goals, ceasing smoking, & regular screening for complications

If you do develop DR, there are very effective treatments available that your eye care team can explain to you.

Woman testing with glucose monitor.

What If I Don’t Know If I Have Diabetes?

You’re not alone. It’s estimated that one million Canadians are living with undiagnosed diabetes

Fortunately, since diabetes can impact your eyes before you are diagnosed, eye exams are an incredibly useful preventative measure for assessing any changes in your eyesight. While each type of diabetes has different symptoms to look out for, visual issues caused by diabetes can include:

  • Blurry vision, caused by a buildup of fluid in the eyes from elevated blood sugar (blurry vision is also one of the most common symptoms of early DR)
  • Diabetic Macular Edema, which can impact your ability to read, write, drive, or recognize faces

A healthcare provider can give you a blood test to measure your blood sugar, which can help confirm a diabetes diagnosis.

Qualifying for a Diabetic Eye Exam

The easiest way to get a diabetic eye exam is to have a documented history of diabetes or a new diabetes diagnosis. However, with the changes in OHIP coverage, “optometrists can clinically assess and verify whether a patient has diabetes in order to receive an insured eye exam.” This change is informed by expert research and advice and provides you the benefit of receiving care when you most need it. 

Those without diabetes can continue receiving their regular eye check-ups and know that OHIP will have them covered if warning signs of diabetes are found in their eyes, while those with diabetes are now more empowered than ever to stay on top of their eyecare without needing to pay extra out-of-pocket for regular exams.

Managing diabetes can be a very involved process with many doctors, which is why it’s important to have people on your team who see you and not just another patient number. Dr. Chris Schell is invested in addressing your unique vision needs to help you enjoy healthy vision and understand your eyes. Contact us today to see how we can help you manage diabetes.

Written by Dr. Chris Schell

Dr. Chris Schell attended the University of Waterloo, earning a Bachelor of Science degree with honours. Dr. Schell then pursued his Doctor of Optometry from Waterloo and graduated on the Dean’s honour list. In 2003, Dr. Schell began practicing optometry in Barrie and in March 2010, he opened his own vision care clinic. In April 2017, Dr. Schell received his Fellowship from the College of Optometrists in Vision Development, an achievement less than 1% of Canadian Optometrists have obtained. Dr. Schell is passionate about teaching his patients about their vision and eye health.

Dr. Schell is passionate about vision therapy, and its power and possibilities are endless! Dr. Schell is a proud member of the College of Optometrists in Vision Development and Optometric Extension Program Foundation. These two groups focus on educating practitioners and providing the resources to implement vision therapy in their clinics.

Dr. Schell is happily married and has 3 amazing young boys and a wonderful daughter. They love being active, and spending time with family and friends keeps them busy. Dr. Schell loves curling during the winter and golfing in the summer.

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