After undergoing four eye surgeries this year alone, Lisa Adams is almost completed the painful and arduous process of improving her unusually severe nearsightedness and macular degeneration.
There is one step left: An optometrist must examine her eyes to determine her new prescription for trifocal lenses so that she can see properly.
The problem is, her date was canceled.
As of September 1, 98 percent of optometrists were refusing services to the 2.9 million patients covered for eye care by the Ontario Health Insurance Plan (OHIP), including children under 19, people over 65 and people with certain eye conditions, such as Adams.
The Ontario Association of Optometrists (OAO) has recommended that its members withdraw the service in order to pressure the province to increase the amount it pays per exam. But almost a month later, the two parties remain at a standstill with no end in sight.
Adams, 38, who lives in Durham Region and is a social worker at the school board, now finds herself with throbbing headaches as she struggles to see and work. Before retina and lens replacement surgeries, she said she was considered legally blind and had a prescription for minus 32. Now she needs one for about minus six.
âMy vision has changed a million times in the past five months, with each operation, so my brain is very confused as to how to operate on my eyes,â Adams said.
“Not being able to go there and have a full exam and checkup is really damaging my health and my vision.”
Health Insurance patients stranded without care
She said she went through half a dozen pairs of different strength glasses that she had accumulated between surgeries. She wears different shoes depending on the task at hand, whether it’s working at her computer, writing a note, or driving. Trifocal lenses would combine them all into one so she could see properly all the time, she said.
Even though she has visual coverage through her benefits, she is not allowed to use it or pay out of pocket. In Ontario, medical professionals, including optometrists, are prohibited from billing OHIP patients for provincially-covered services, the health ministry has confirmed.
But Adams said she still supports her optometrist in joining the action and believes the province needs to step up its efforts.
At the center of the dispute is the amount optometrists should be reimbursed by the province for OHIP patient care. Right now, the province pays an average of $ 44.65 per exam, which optometrists say has only increased by $ 5 over the past 30 years and covers about half of the actual cost.
It’s also the lowest rate in the country, said Ritesh Patel, OAO member and Toronto optometrist. The second lowest reimbursement rate is Manitoba at $ 77 and the highest is Alberta at $ 137.
Patel said Ontario must cover at least $ 80 per OHIP exam.
âAnything less than that is frankly unfair and unrealistic in the long run,â Patel said. “What we are looking for is for the government to understand and recognize that we have essentially been funding the system for over 32 years.”
Province offering a single payment
The Ministry of Health will increase OHIP payments by 8% (approximately $ 4 more per exam) retroactive to April and provide a one-time payment of $ 39 million, a “fair and reasonable proposal. “said spokesperson David Jensen. The ministry is now awaiting the return of the OAO to the table.
âOur government has made every effort to lay the groundwork for a long-term relationship with the Ontario Association of Optometrists,â said Jensen.
What the province has offered is simply not enough, Patel said, calling the one-time payment a “bribe” that would amount to just over $ 1 per person for every exam done in the past 10. years and does not solve the problem in the long run. .
Asked how patients are supposed to cope, Patel said this is the real struggle optometrists face, who have to turn away an average of 15,000 people every day across Ontario. But he said it is the province that allows this “collateral damage” to occur.
“They’re going to make it look like they’re greedy optometrists looking for more money,” he said. “But at the same time, everyone can agree that if you haven’t had a raise for 32 years, that’s pretty absurd.”
If optometrists refuse to treat a patient, they are supposed to write referrals for treatment elsewhere, Jensen said. The Ministry of Health wrote to the College of Optometrists of Ontario âto stress the importance of ensuring that in any professional action, its members conduct themselves appropriately in accordance with the policies and guidelines of the Order â.
âThe College assured us that it remained focused on its mandate of protecting the public and that it would be ready to receive and investigate any complaints should a problem arise,â Jensen said.
Mother, son also affected
The action not only affects Adams, but also his 68-year-old mother, Marie Gage, who suffers from glaucoma and myopic degeneration which has caused vision loss in her left eye and is said to be regularly monitored by her optometrist, with her next date later. this autumn.
Gage said she is afraid of experiencing permanent vision loss if her care is delayed. She saw the impact with her own eyes, when her grandfather was diagnosed with glaucoma and without modern treatments, went blind at the age of 50.
“If the vision is disturbed or permanently gone, suddenly you are much more dependent and therefore society bears other costs for that addiction,” Gage said. “So this seems like a proactive need that we have to value.”
Adams’s nine-year-old son is also due for his annual eye exam, which she says has been canceled.
âWith our family history of eye disease, it’s very scary not to see him pass his regular checkups,â Adams said.
“My biggest worry is how long this will last and how many undiagnosed eye diseases will occur. If people don’t get the proper care for their eyes, it can lead to significant vision loss.”