Question 11: Are amblyopia and strabismus still insured conditions?
Answer 11: OAO has received inquiries from members about the insurance of amblyopia
(diagnostic code 368) and strabismus (diagnostic code 378) under the Major Eye Exam
(MEE – V409) for adults aged 20 to 64.
As part of this agreement, in Year Two (beginning July 1 2008) the Ministry was to seek
cabinet approval to implement an amended list of medical conditions allowing direct
access for the V409 – Major Eye Exam. This amended list replaced ‘visual field defect’
with ‘optic pathway disease’, added ‘recurrent uveitis’, and removed ‘amblyopia’ and
‘strabismus’. It was suggested that ‘acute strabismus’, given its association with systemic
conditions, continue to be insured under the Acute Intermediate Assessment.
Despite the recommendations of the joint OAO/MOHLTC negotiating teams,
cabinet decided that none of the existing qualifying conditions were to be removed
from the V409 (MEE).
Therefore, under the Schedule of Benefits for Optometry Services, as of July 1 2008 adult
patients aged 20 to 64 are insured as follows:
“The patient has one of the following medical conditions: diabetes mellitus,
glaucoma, cataract, retinal disease, amblyopia, visual field defects, corneal
disease, strabismus, recurrent uveitis or optic pathway disease”.
Please note that the Ministry has insisted that both amblyopia and strabismus
(acquired and infantile) remained insured conditions.
Once patients have been diagnosed with one or more of the medical conditions listed
above, they are eligible for OHIP coverage.