The impact of delisting of routine eye examinations on glaucoma detection in Ontario

Abstract

Purpose : In 2004, the Ontario government delisted/de-insured routine eye exams for individuals aged 20-64. We assessed if glaucoma detection rates were reduced post- vs pre-2004 among Ontarians affected by delisting.

Methods : Physician billing data for Ontarians aged 20+ (n is about 8 million) from 2000-2014 were analyzed using segmented regression analysis. Glaucoma detection was defined as the first glaucoma diagnostic code submitted by an ophthalmologist/optometrist among Ontarians who did not visit an ophthalmologist/optometrist in the year prior to the study year. Data from patients with a new glaucoma diagnostic code were computed for the proportion of patients who underwent 2+ visual fields and 2+ tonometry within a year.

Results : Post-delisting, glaucoma detection was reduced in all age groups: -2.7% (p<0.0001) in age group 20-39, -8.2% (p<0.0001) in age group 40-64, and -2.1% (p=0.0003) in age group 65+. This corresponds to a decreased number of glaucoma patients detected in 2005 versus 2004: -8,800 (p<0.001) in the 20-39 group, -32,234 (p<0.0001) in the 40-64 group, and -3,255 (p=0.0012) in the 65+ group.

Significantly reduced glaucoma detection was seen in males, females, rural and urban residents among delisting affected (20-64) and unaffected (65+) age groups. Interestingly, Ontarians living in the most affluent neighborhood areas also had significantly reduced glaucoma detection: -2.7% (p<0.0001) for the 20-39 group, -9.0% (p<0.0001) for the 40-64 group and -2.3% (p<0.001) for the 65+. Among Ontarians residing in the poorest neighborhoods, the reduced glaucoma detection was -2.2% (p<0.0001) for the 20-39 group, -7.2% (p<0.0001) for the 40-64 group and -2.3% (p<0.001) for the 65+ group.

Among patients with newly detected glaucoma, the proportion of patients who had at least two visual fields and two tonometry tests in one year significantly increased in 2005 vs 2004 in the delisting affected age groups (0.8%, p=0.0024 for the 20-39 group and 0.7%, p=0.0017 for the 40-64 group) but remained unchanged among delisting unaffected 65+ group (0.1%, p=0.50).

Conclusions : Delisting of routine eye exams in 2004 seems to be associated with significantly reduced glaucoma detection irrespective of socio-demographics. Further investigation is needed to determine if Ontario’s delisting of eye exams was responsible for increased rate of advanced glaucoma at diagnosis.

This is a 2020 ARVO Annual Meeting abstract.