Eye Examinations

OHIP Coverage

Eye Examinations

OHIP Coverage

OHIP covers patients that are 19 years of age and younger as well as 65 years of age and older.

A resident of Ontario must have a health card to show that he or she is entitled to health care services paid for by OHIP. The Ministry of Health and Long-Term Care pays for a wide range of services, however, it does not pay for services that are not medically necessary, such as cosmetic surgery.

People 65 years and older and those younger than 20 are covered by OHIP for a routine eye examination provided by their optometrist once every 12 months plus any follow-up assessments that are deemed necessary by their Optometrist.

If you are between the ages of 20 and 64, you are not covered by OHIP and are therefore required to pay for your eye examination. However, there are some eye conditions that grant OHIP coverage for patients between 20 and 64 (read below).

Unfortunately, eye exams requested by the Ministry of Transportation and other third party entities are NOT covered by OHIP

OHIP-Insured Eye Conditions

Diabetes

Diabetes mellitus (DM), commonly referred to as diabetes, is a group of metabolic diseases in which there are high blood sugar levels over a prolonged period. There are two types of diabetes: Type I (insulin-dependent) and Type II (non-insulin-dependent).
Glaucoma

Glaucoma is a group of eye diseases which result in damage to the optic nerve and vision loss. There are several types of glaucoma, but the two main types are open-angle glaucoma and angle-closure glaucoma.
Cataract

A cataract is a clouding of the lens in the eye which leads to a decrease in vision. There are several types of cataracts which include congenital, nuclear, cortical, posterior subcapsular, anterior subcapsular, and more.
Retinal Disease

The retina is a layer of tissue in the back of your eye that senses light and sends images to your brain. Retinal disease affects this vital tissue, and may include mcular degeneration, retinal detachment, diabetic eye disease, retinoblastoma, macular hole, and more.
Amblyopia ("Lazy Eye")

Amblyopia, also known as lazy eye, is a vision development disorder in which an eye fails to achieve normal visual acuity, even with prescription eyeglasses or contact lenses. The two main types are refractive amblyopia and strabismic amblyopia.
Visual Field Defects

Visual field loss may occur in many forms from nearly complete loss of peripheral vision to small areas of partial loss. Damage along the optic pathway causes a variety of visual field defects. The type of visual field defect can help localize the lesion.
Corneal Disease

The cornea is the eye’s outermost layer. It is the clear, dome­shaped surface that covers the front of the eye. It plays an important role in focusing your vision. Corneal disease includes ocular herpes, corneal dystrophies such as Fuch's and keratoconus, keratitis, and more.
Strabismus ("Eye Turn")

Strabismus, also called crossed eyes, is a condition in which the eyes do not properly align with each other when looking at an object. Strabismus can be caused by problems with the eye muscles, the nerves that transmit information to the muscles, or the control center in the brain that directs eye movements.
Recurrent Uveitis

Uveitis is a general term describing a group of inflammatory diseases that produces swelling and destroys eye tissues and often affects a part of the eye called the uvea. These diseases can slightly reduce vision or lead to severe vision loss.
Optic Pathway Disease

The optic pathway includes the retina, optic nerve, optic chiasm, optic radiations, and occipital cortex. Damage along the optic pathway causes a variety of visual field defects. The type of field defect can help localize the lesion.