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Does OHIP Cover Eye Exams?

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View from behind a patient's head as he sits in a chair and looks at a Snellen chart as directed by the optometrist.

Good eye health is crucial to maintaining an overall healthy lifestyle. And just like any other part of our body, our eyes need regular comprehensive eye exams to check proper functioning. 

However, for many Ontarians, eye exams can be a significant expense. That’s where OHIP comes in. OHIP covers:

  • 1 eye exam once per year for those 19 and younger
  • 1 eye exam every 12 months for those 20 to 64 with potential sight-threatening eye conditions
  • 1 eye exam every 12 months for those 65 and up with potential sight-threatening eye conditions
  • 1 eye exam every 18 months for those 65 and up without a potential sight-threatening eye condition 

The Importance of Eye Exams

Eye exams for adults, seniors, and children go beyond the vision tests. Comprehensive eye exams are assessments conducted by your eye doctor to evaluate the overall health of your eyes.

A standard eye exam may include tests for visual acuity, eye coordination, and a prescription for corrective lenses. Regular eye exams are crucial for maintaining clear vision, but they can also detect the early signs of some vision problems and health conditions.

Conditions such as glaucoma, macular degeneration, and diabetic retinopathy often manifest without noticeable symptoms in their initial phases. An eye exam can catch these issues early and facilitate timely intervention. 

How Often Should You Have an Eye Exam?

The frequency of eye exams depends on various factors, including age, overall health, any pre-existing eye conditions, and your family history of eye disease. The Canadian Association of Optometrists recommends the following frequency for eye exams:

  • Infants: Infants should have their first eye exam between 6 and 9 months. 
  • Preschool children: Between the ages of 2 and 5 years, preschool children should have at least 1 eye exam.
  • School-aged children: Children between ages 6 and 19 should have an annual eye exam. 
  • Adults: Adults aged 20 to 39 should have an eye exam every 2 to 3 years. Adults aged 40 to 64 should have an eye exam every 2 years. Adults 65 or older should have an eye exam annually or as recommended. 

OHIP Coverage for Eye Exams 

OHIP covers eye health services such as eye exams for certain demographics and under specific circumstances. 

Children & Youth 

OHIP covers children and youth 19 years old or younger for the following eye exams:

  • 1 major eye exam every 12 months
  • Any minor assessments needed
  • Partial examinations in between regular check-ups for a specific eye or vision problem 

Adults

OHIP covers adults 20 to 64 years old for the following eye exams with an eligible medical condition affecting their eyes: 

  • 1 major eye exam once every 12 months
  • 2 additional follow-up minor assessments

Eligible medical conditions include:

  • Diabetes mellitus: A confirmed diagnosis of diabetes makes you eligible for an annual OHIP-insured eye exam. 
  • Glaucoma: A confirmed diagnosis of glaucoma is eligible for an OHIP-insured eye exam. A person examined for glaucoma isn’t OHIP-insured for an eye exam.  
  • Cataracts: An eye exam that determines surgery is required is covered by OHIP. 
  • Retinal disease: An acute or progressive retinal disease is eligible for an OHIP-insured eye exam. 
  • Corneal disease: An acute or progressive corneal disease is eligible for an OHIP-insured eye exam. 
  • Uveitis: An active condition at the time of the exam is eligible for OHIP insurance.  
  • Optic pathway disease: An acute or progressive optic pathway disease is eligible for an OHIP-insured eye exam. 
  • Strabismus (crossed eyes): A sudden onset of strabismus from injury or disease is eligible for an OHIP-insured eye exam. 
  • Medication: A person taking Chloroquine, Hydroxychloroquine, Ethambutol, or Tamoxifen is eligible for an OHIP-insured eye exam. 

65 Years & Older

OHIP covers adults 65 and over for the following eye exams with an eligible medical condition affecting their eyes: 

  • 1 major eye exam once every 12 months

OHIP covers adults 65 and over for the following eye exams without an eligible medical condition affecting their eyes: 

  • 1 major eye exam once every 18 months
  • 2 additional follow-up minor assessments

While OHIP covers the above eye exams, it does not cover additional services, such as prescription eyeglasses or contact lenses. If you have an employer or private plan or are on the Ontario Disability Support Program (ODSP) or Ontario Works, you may be eligible for additional eye care coverage. 

An optometrist talking to a female patient in an optical clinic.

Maintain Healthy Eyes & Vision with Eye Exams

Regular eye exams can be essential for the early detection and treatment of eye disease, and can help you maintain your visual acuity and quality of life. At St. Clair Eye Clinic, we provide eye exams for the entire family. Contact us for more information on eye exams and OHIP coverage. 

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Written by Dr. Neel Vyas

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