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Why optometrists in Ontario are basically on strike

A pair of glasses on an eye chart

Since Sept. 1, optometrists across Ontario have been refusing to see children and senior citizens because they say they're not getting enough reimbursements.

Ontario’s optometrists hope the provincial government has the vision to increase their pay for seeing patients covered by the Ontario Health Insurance Plan (OHIP), the public health insurance system for the province. Meanwhile, some patients are seeing red because they cannot make an appointment with their optometrist.

Eyecare in Ontario is insured by OHIP until age 20 and for age 65 and older. Individuals not covered by OHIP must pay for eye care or use private insurance.

An optometrist in Ontario may bill no more than $47 per senior citizen’s eye examination, which is the lowest amount in Canada. Alberta’s amount is the highest in Canada. The government there pays optometrists $137 per senior’s examination.

The amounts Ontario optometrists may bill for children’s eye examinations, or for people receiving eye care through the Ontario Disability Support Program, or welfare varies. According to the Ontario Association of Optometrists, the average amount an optometrist in Ontario receives in return for publicly insured services is $44.65 per eye examination. In 1989, the amount was $39.15. Nearby in Quebec, the provincial government pays optometrists $107 per senior’s eye examination.

“Optometry isn’t the same as 30 years ago,” said Hawkesbury optometrist, Dr. Morris Hazan.

He said technologies and techniques have advanced, which means the cost of providing modern services to patients has also increased. Hazan said he has always had a keen interest in ensuring the elderly receive the best eye care available.

“It comes down to what the government funds for services,” said Dr. Joshua Smith, an optometrist in Alexandria and former president of the provincial association. He said the average cost of an eye examination in Ontario is closer to $80 these days and added optometrists also have expenses from operating their practices and paying employees.

“I want to retain my staff,” said Hazan.

Smith said the average of $80 was found in a study by BDO which confidentially reviewed the financial statements of 75 optometry practices representing 300 optometrists across Ontario.

According to Smith, 80-90% of optometry patients covered by OHIP are in rural areas and small towns.

Smith and Hazan said other provinces allow optometrists to bill variably, depending on the nature of the patient’s situation. Glaucoma patients often require numerous appointments per year, but OHIP does not differentiate the billing between patients with glaucoma and those who require glasses.

Hazan said he does not want to end up restricting the number of senior patients he sees.

“That’s not health care.”

Smith said Ontario’s health budget is approximately $70 billion and eye care is 0.2% of that budget. He said if the government increased funding to cover the $80 average, it would still only be 0.4% of the health budget.

“What we’re asking for is rooted in evidence,” he said.

Patients normally covered by OHIP for optometry services in Ontario are not permitted to go to an optometrist and pay for an appointment that would normally be covered by the provincial insurance system. Most patients are instead being directed to see their regular physician, go to hospital emergency departments, urgent care clinics, or see ophthalmologists who have received referrals from optometrists.

Smith and Hazan believe public support for the situation facing optometrists is strong, but not all patients are pleased they cannot make appointments.

“I have my visits covered by OHIP and during my last visit, my prescription had changed so much I was dangerously close to having my driver's license removed on site. I called back in September for my overdue appointment, and they can't see me until November due to this situation,” said Natalie Amell, a resident of L’Orignal, Ontario.

A woman who did not want to be named shared the experience of her 88-year-old father.

They explained that they couldn't see him because of their protest. He waited seven hours in an emergency room to be told he had a scratched cornea. They prescribed drops to heal it and wanted him to go back the next day for a follow-up. He waited 5 hours the next day.”

Other patients said they are unable to get appointments for their children with special needs or are having vision difficulties which are impairing their ability to do their jobs safely. Three patients said they offered to pay for their appointments but were denied due to OHIP regulations.

Meanwhile, optometrists across Ontario are continuing their job action. The provincial association has launched a large-scale public relations campaign asking citizens to contact MPPs, the Minister of Health, and Premier Doug Ford to ask for increases to OHIP eye care funding.