Poll shows Ontarians back expanded optometrist role in health care

Optometrists urge Ontario to update OHIP’s 35-year-old model, arguing they can safely divert 65% of ER eye cases.

As Ontario’s government seeks solutions to stabilize an overburdened health care system, the province’s optometrists are positioning themselves as a ready and willing, but financially constrained, solution. The Ontario Association of Optometrists (OAO) argues that its members represent an “underutilized pressure release valve” for hospital emergency rooms.

Dr. Shaina Nensi, the association’s president, said that optometrists possess the specific skills and infrastructure to immediately address a significant portion of non-life-threatening cases that currently crowd emergency departments.

“We, as optometrists have the specialized training, equipment and capacity to be able to manage cases that currently clog our hospital waiting rooms,” said Nensi.

She further emphasized the clinical efficacy of community-based eye care, citing research that suggests optometrists can deliver superior outcomes for urgent eye problems compared to general ER staff.

“Research shows that optometrists can actually more accurately diagnose and treat sight threatening issues than general ER staff,” said Nensi.

“So, it really is the right place for Ontarians to go to get this care.”

Broken funding model

The call for change is backed by strong public sentiment. A recent Ipsos poll commissioned by the OAO found overwhelming support for expanding the role of optometrists in the healthcare continuum. Key findings from the survey include:

• Nine in 10 Ontarians would feel comfortable receiving treatment for common eye conditions, such as infections, inflammation, or foreign body removal, from an optometrist.
• Seven in 10 Ontarians support expanding the roles of optometrists as a strategy to reduce wait times for specialists.
• Nine in 10 Ontarians are comfortable with optometrists providing more in-office treatment, citing confidence in their level of training and continuing education.

However, Nensi told CTV News that the profession’s ability to step up is directly hindered by an outdated compensation structure. She stressed that providing emergency care under the current system is financially unsustainable for individual practices.

“The current OHIP model is over 35 years old and it does force optometrists to hold emergency slots at a financial loss to their practices,” Nensi said.

“That does make it unsustainable to operate, to be able to provide the front-line urgent care that the system desperately needs.”

‘Frustrating day’ in northern Ontario

The real-world impact of this funding model was illustrated by Dr. Karine Briand, an optometrist of 15 years based in Timmins. She recounted a recent long weekend where she volunteered to see emergency cases to keep them out of the local hospital, only to find her professional sacrifice came at a personal financial loss.

“There was a day where I said, you know, it’s a long weekend. We don’t have anyone here. If there’s emergencies, let me know. I’ll come in,” Briand recounted.

“I came in for four emergencies and generated $150 and so, I spent my entire day triaging emergencies coming and going from my home for $150.”

Briand described the experience as deeply frustrating, questioning her decision to provide the service. She told CTV News that such financial disincentives could force optometrists to redirect patients back to hospital ERs, which are already struggling.

“That was a really frustrating day in terms of saying like, ‘Why did I do this? I should have just sent this to the emergency room because, you know, I sacrificed my day and I didn’t cover any costs at this point,’” Briand said.

According to the OAO, conditions like eye infections, pink eye and corneal foreign bodies are frequent ER visits. Nensi said that research indicates a large majority of these cases are more appropriately managed in an optometry clinic, potentially freeing up hospital resources for true emergencies.

“The research shows that 65 per cent of those conditions that present to the emergency rooms would actually be better handled in an optometrist office,” she said.

Ministry eyes scope expansion amidst concerns

In response to inquiries from CTV News, the Ministry of Health acknowledged the potential for optometrists to play a larger role. A statement from Press Secretary Ema Popovic outlined the government’s current efforts to expand the scope of practice for the profession.

The ministry highlighted proposed changes that would allow optometrists to perform minor surgical procedures in-office, use laser therapy, order diagnostic tests and independently manage certain conditions like open-angle glaucoma. Officials added that these initiatives build on previous investments, including adding cataract surgeries and connecting people to primary care, to alleviate pressures in emergency departments.

Despite these proposed expansions, Briand pointed to lingering gaps, particularly for patients in the north. She explained that current regulations create a precarious situation for vulnerable patients who cannot access the required specialist care for advanced conditions.

“When I say, you know, working outside of scope is part of our scope expansion would be to allow us to treat any glaucoma patient,” said Briand.

“We don’t have care for advanced glaucoma in northern Ontario and so, if I continue to prescribe those glaucoma drops, then I am working outside of my scope.”

She highlighted the impossible choice this creates for practitioners: deny a patient necessary medication or practice beyond their permitted limits.

“And I, you know, when I got put in a position of like, well, I’m not going to not renew to their glaucoma drops like they need the treatment – but they cannot seek the care elsewhere.”

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