Fewer people with diabetes are getting eye exams to prevent complications, which researchers call an unintended consequence of the Ontario government's decision to delist the exams for other adults.
Routine eye exams for healthy adults aged 20 to 64 stopped being covered by Ontario's Health Insurance Plan in 2004, but they continue to be insured for people with diabetes of all ages to screen for diabetic retinopathy — a major cause of blindness in people of working age.
Delisting routine eye examinations for adults had the unintended consequence of reducing publicly funded retinopathy screening for people with diabetes, researchers in Ontario say. (Stephen Lam/Reuters) When researchers examined data on publicly funded eye exams of people age 40 and over with diabetes in the province, they found eye exam rates for diabetics aged 40 to 65 years remained steady at 69 per cent until 2004 but dropped after delisting to 61 per cent in 2006 and 57 per cent in 2010.
"The delisting of routine eye examinations for healthy adults in Ontario had the unintended consequence of reducing publicly funded retinopathy screening for people with diabetes," Dr. Tara Kiran, a family doctor and researcher at St. Michael's Hospital in Toronto and her co-authors concluded in Monday's issue of the Canadian Medical Association Journal.
Eye exams rates did not decrease for those 65 and older, an age group not affected by delisting.
Rates of cholesterol testing and blood glucose testing, which are covered by OHIP, rose between 1998 to 2010.
While the researchers did not look at why the number of eye exams dropped, it was likely related to a misunderstanding by patients and health care providers who may have thought that eye exams done by an optometrists were no longer covered for people with diabetes.
Alberta delisted in 1995
An earlier study found delisting in other provinces reduced the probability of patients visiting an optometrist but those with supplemental insurance were more likely to do so, the researchers said.
Alberta delisted eye exams for middle-aged adults in 1995 and Manitoba followed in 1996.
"More research is needed to understand what proportion of diabetes eye examinations are paid for privately, whether disadvantaged residents of Ontario have decided to forgo these examinations entirely because of cost, and whether the decrease in screening was associated with an increase in retinal complications for people with diabetes," the study's authors said.
They suggested that policy changes include better communication to decrease misunderstanding among patients and health care providers.
The study was supported by the Institute for Clinical Evaluative Sciences, which is funded by the Ontario Ministry of Health and Long-Term Care.
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