Effect of delisting routine eye exams on optometric glaucoma diagnosis billings in Ontario

Routine eye examinations (REEs) are critical for glaucoma detection. In 2004, Ontario discontinued coverage for REEs for healthy individuals aged 20-64. We assessed whether this "delisting" policy affected the rate of new glaucoma diagnoses identified through REE billings.

A population-level intervention study PARTICIPANTS: Ontarians aged 20+ insured under Ontario's universal health coverage.

Using Ontario health administrative data and segmented regression analysis, we assessed changes in the rate (per 10,000 population) of new glaucoma diagnoses billed by optometrists during REEs before (1998-2004) and after (2005-2019) coverage delisting individuals aged 20-64. A comparison group of seniors unaffected by the policy were also assessed across the same 2 periods.

The rate of new glaucoma diagnosis billings by optometrists per 10,000 people, during REEs significantly decreased postdelisting versus predelisting in affected age groups: -10.4 (95% CI: -10.9 to -9.9; p < .0001) for those aged 20-39 and -38.8 (95% CI: -40.9 to -36.8; p < .0001) for those aged 40-64. In unaffected seniors, the rate remained stable postdelisting versus predelisting (+0.1 per 10,000, 95% CI: -3.0 to 3.2; p > .05).

Discontinuation of public funding for REEs in 2004 was associated with significant declines in new glaucoma diagnosis billings submitted by optometrists during REEs in delisted-affected individuals aged 20-64, but not in unaffected seniors. This suggests that delisting of publicly funded REEs may hinder detection of new glaucoma cases. Further study is warranted to investigate whether this decline in new glaucoma diagnosis billings is associated with more advanced glaucoma at first diagnosis.