How Often Should I Go for an Eye Exam and is it OHIP Covered?

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Blog by Envision Eye Care

Are you wondering how often you should be going for an eye exam? Great, it’s a sign that you care about your ocular health and are likely proactive about preserving it. Here is what you need to know about how often you should go for an eye exam and what the Ontario Health Insurance Plan (OHIP) does and doesn’t cover.

OHIP Eye Care Coverage

OHIP coverage of eye exams is pretty straightforward in most cases.

If you’re over the age of 65, or under the age of 20, OHIP will pay for you to have an eye exam once a year, including any required follow-up.

If you’re receiving benefits from Ontario Works, Family Benefits or the Ontario Disability Support Programs, you likely qualify to have your regular eye exam paid for by that agency once every two years. Be sure to contact them for full details about how to get the coverage you’re entitled to.

If you’re between the ages of 20 and 64, regular eye exams are not covered; however, there are exceptions. eye exams relating to certain medical conditions are covered, even for those between 20 and 64 years of age. These conditions include the following:

  • diseases of the cornea, retina or optic pathway
  • lazy eye (amblyopia)
  • cataracts
  • diabetes
  • glaucoma
  • recurrent uveitis
  • crossed eyes (strabismus)
  • defects of the visual field
  • recurring uveitis

This list may change at any time, so be sure to double check with your primary health care provider and/or OHIP directly to see whether or not your medical condition qualifies you to have OHIP pay for your eye exam. If it’s determined that you do qualify for this type of OHIP coverage, you can get a requisition for care that’s good for up to five years.

If you’re an otherwise healthy adult without coverage, be sure to look into the available options for private insurance coverage – you may be able to obtain this via your employer, or independently.

How often should adults see their eye doctor

Adults should see their eye care professional once a year, unless directed otherwise. Although your exam may not be covered by OHIP, it’s still of vital importance that you go. Regular ocular exams are a key part of “preventative maintenance” for your eyes – they allow any potential problems to be caught early when the odds are best for successfully treating them. If you’re not covered by OHIP, be sure to look into the availability of alternative insurance coverage. This is most commonly obtained via one’s employer, but even if they don’t provide an option for this or you’re self-employed, there are private insurance companies that may be able to provide what you’re looking for.

Ask your eye doctor about fees if you’re not covered, they may not be as high as you think.

Benefits of regular eye exams

Seeing your eye doctor regularly for exams can help to prevent damage to your eyes from treatable conditions. Glaucoma is a classic example of this. If not caught early, it can lead to blindness – but if treated properly early on, it’s usually very easy to prevent serious problems. Amblyopia is another condition that, if caught and treated early, can lead to the prevention of vision loss. And aside from those examples, there are more benign conditions that are easily helped by regular eye exams. For example, if you’re near- or far-sighted, seeing your eye doctor on a schedule that they recommend can help to ensure that you don’t struggle unnecessarily to see clearly.

Now is the time to make an eye exam appointment

If you haven’t already done so, make your next appointment for a “preventative maintenance” or follow-up eye exam. This can go a long way towards maximizing the health of your eyes and maintaining your best possible vision for a lifetime.

If you’re in Oakville or nearby Burlington or Milton, it’s time to visit Envision Eye Care for your eye exam!