A simple and overdue solution to preventing vision loss

Vision care has changed but group benefits haven’t. Did you know that 90% of vision loss can be prevented but that most group plans don’t provide sufficient coverage for modern diagnostic tools and imaging services that virtually all optometrists can deliver? Fixing the coverage gap and allowing for recall exams for those few patients who may need monitoring or additional diagnostics, is a simple solution. It lowers the risk of vision loss without breaking benefits budgets.

The ability of optometrists to diagnose or detect serious diseases early makes vision care one of the most cost-effective early detection tools available in the healthcare system. When caught early, these issues, along with other eye diseases, can be managed proactively, improving health outcomes and reducing long-term costs associated with delayed treatment and complications, including vision loss.

The Role of Optometrists

Measuring refractive error is always a key component of optometrists’ comprehensive eye examinations and sometimes result in prescriptions for corrective lenses. The comprehensive eye examination, however, also enables optometrists to evaluate and diagnose much more than how well their patients can see. Comprehensive eye examinations that incorporate modern diagnostic tools and imaging are frontline tools for detecting and treating serious eye disease as well as serious systemic health conditions early. Unfortunately, today optometrists are limited in their ability to deliver this critical care because group vision plans either have low maximums for examinations or the list of covered services in an examination is missing coverage for modern diagnostic tests and imaging. These restrictions limit optometrists’ ability to diagnose and detect diseases within their scope of practice, a skill that is a critical tool in early detection and preventative health.

Eye diseases can lead to vision loss if not detected or managed early. Diseases such as glaucoma, diabetic retinopathy, and macular degeneration often progress silently and cause irreversible damage before symptoms are noticeable to the patient. Once vision is lost, it cannot be restored—only regular eye examinations with the appropriate tools can diagnose these diseases early to slow down or stop their progression. Systemic conditions such as diabetes and hypertension, tumours, multiple sclerosis and even Chron’s disease and other health issues can also be detected during an eye exam—often before symptoms present elsewhere.

Challenge and Opportunity

For insurers, advisors, and plan sponsors, vision care presents both a challenge and an opportunity. Often vision care benefits aren’t perceived as a good investment, or a high return benefit, but this is a mistake. Vision is not a cosmetic benefit just because some frames can be costly when driven by personal style preferences. Vision care, which entails the detection of refractive errors, the diagnosis of eye disease, and the detection of other serious health issues is one of the best investments in early detection a plan sponsor can make, and plan members appreciate it. Vision care is a vital part of overall health, and it’s time it was treated as such.

Bill C-284

The recent passage of Bill C-284, an Act to establish a national strategy for eye care, marks a pivotal moment for vision health in Canada. After years of inaction and underinvestment, this legislation signals a long-overdue shift toward prioritizing eye care on the national health agenda. As MP Judy Sgro, who introduced the Bill, aptly stated: “We really have done very little except do a lot of talking.” Bill C-284 is a meaningful step forward—and a timely reminder that the conversation around vision care must now turn into action.

The Act outlines the development of a national strategy that addresses four key areas:

• Identify the needs of healthcare professionals and other experts regarding training and guidance on preventing and treating eye diseases, as well as vision rehabilitation.
• Promote research and improve data collection on the prevention and treatment of eye diseases and vision rehabilitation.
• Encourage information and knowledge sharing between federal and provincial governments about eye disease prevention, treatment, and vision rehabilitation.
• Ensure that the Health Minister can quickly review applications and submissions related to devices and drugs intended for eye diseases, such as macular degeneration, cataracts, glaucoma, and diabetic retinopathy, in accordance with the Food and Drugs Act.

The Act also designates February as Age-Related Macular Degeneration (AMD) Awareness Month.

While the Act focuses on public health policy, it also provides insights into a unique opportunity for insurers, advisors, and plan sponsors to do better. The national momentum the Act will create will raise public awareness of the importance of vision health. The private sector should respond by updating vision care benefits. A strong, forward-looking private benefits sector can—and should—complement public health policy.

Demand Already Exists

Demand for better coverage already exists. According to the Canadian Association of Optometrists national vision care survey in 2024, plan sponsors and advisors want more comprehensive, meaningful coverage. While insurers are generally supportive there has been very little change in the options that are available to plan sponsors. This results in a disconnect between the coverage offered, what is in the best interests of plan members, what plan sponsors are open to, and what advisors want to offer their clients.  

CAO’s survey results should be a wake-up call:

• Over 60% of insurers believe further changes in vision care benefits are needed.
• Roughly 90% of advisors support either the addition of new vision care benefits, like diagnostic tools and imaging or recall examinations, or an increase in existing coverage limits.
• Roughly 65% of plan sponsors agree that improvements are needed in how vision benefits are structured and delivered.

What Should Be Changed?

To meet the evolving needs of plan members and reflect the realities of modern eye care, three critical changes are needed immediately:

1. Increase the comprehensive exam allowance to reflect the true cost of exams that include necessary diagnostic testing and imaging
2. Ensure coverage for modern diagnostic testing and imaging is incorporated into contract language, whether within the comprehensive exam or as a standalone allowance
3. Allow recall exams for individuals at risk of eye disease, ensuring access to timely follow-up care.

These changes are not about adding unnecessary extras— these changes are the basics that should be included in every private plan – both group and individual – to support the health and long-term well-being of plan members. Payers have an opportunity—and a responsibility— to deliver benefits that reflect the eye health needs of Canadians.

The case for modernizing vision care benefits has never been stronger and as our population continues to age, and risks of vision loss increase, the need has never been greater. Now is the time to align vision care benefits with clinical practices and evolving public policy. Insurers should and must work with advisors and plan sponsors to do better to support the health of working Canadians and their families.

Denise Balch has been a benefits professional in sales and consulting roles since the early 1980s and is the President of her own firm, Connex Health, and a consultant to the Canadian Association of Optometrists.

Radiyyah Karodia has a masters in global health, currently working in health policy and healthcare consulting with a focus on vision care and prior authorization through work with Connex Health as a Researcher and as a Policy Analyst for the Canadian Association of Optometrists.