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Impact of discontinuing government-funded routine eye exams on new glaucoma diagnoses in Ontario

      Abstract

      Objective

      In 2004, government-funded routine eye exams were discontinued for individuals aged 20–64 years in Ontario. We assessed whether this policy change reduced the rate of new glaucoma diagnoses.

      Design

      Cohort-based time-series analysis.

      Participants

      Ontarians aged 20+ years in 2000–2014.

      Methods

      Province-wide physician billing data were analyzed using segmented regression analysis. New glaucoma diagnoses were defined as the first glaucoma diagnostic billing code submitted by an ophthalmologist or optometrist among Ontarians who did not visit an ophthalmologist or an optometrist in the year prior to the study year.

      Results

      Post- versus pre-2004, the rate of new glaucoma billings was reduced in all age groups: –2.7‰ (p < 0.0001) in the age group 20–39 years, –8.2‰ (p < 0.0001) in the age group 40–64 years (p < 0.0001), and –2.1‰ (p = 0.0003) in the age group 65+ years. This corresponds to a decreased number of individuals with a new glaucoma billing after 2004 versus before 2004: –8,800 (p < 0.001) in the age group 20–39 years, –32,234 (p < 0.0001) in the age group 40–64 years, and –3,255 (p = 0.0012) in the age group 65+ years. Reduced rates of new glaucoma diagnostic billings were seen in males, females and rural and urban residents among policy-affected and policy-unaffected age groups. Ontarians living in the wealthiest neighbourhood areas also had a significantly reduced rate after versus before 2004: –2.7‰ (p < 0.0001) for the age group 20–39 years, –9.0‰ (p < 0.0001) for the age group 40–64 years, and –2.3‰ (p < 0.001) for the age group 65+ years.

      Conclusions

      Discontinuation of government-funding for routine eye exams was associated with a significantly reduced rate of new glaucoma diagnostic billings irrespective of sociodemographics. More research is needed to understand the reduced glaucoma billings in unaffected seniors and those living in the wealthiest neighbourhood areas.
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