Coverage today is the same as it was in the 1970s – it's time to discard archaic beliefs
Contrary to the adage, “If it ain't broke, don't fix it,” the problem with most group vision benefits plans isn’t just their age, but their refusal to adapt to modern realities. These plans are akin to outdated vehicles, increasingly draining plan sponsors and members of resources without delivering commensurate value, demanding a swift upgrade.
Most vision benefit plans cling to antiquated notions, equating vision care solely with refraction, spectacles, and lenses. The consequence? Nationwide, we witness vision plans that are grossly insufficient, limiting individuals to a single partial eye examination every 24 months for the working population and once every 12 months for children and seniors.
It’s high time to discard these archaic beliefs. Imagine telling someone they can only visit their family doctor once every two years, with no provision for basic health checks without prior authorization, leaving them to bear the expenses. That’s the reality for those reliant on these outdated vision benefits plans.
Coverage limited for advances in optometry
Despite significant advances in optometry and vision care, public and private coverage of these new advancements remains very limited. Vision care coverage today is the same as it was in the 1970s. This leads to problems such as late diagnosis, vision loss, higher treatment costs, lower employee productivity – and, ultimately, lower return on investment for insurers and sponsors.
It is time for vision benefits plans to catch up with modern medicine and optometry. At the very least, vision benefits plans should allow for full coverage of the modern comprehensive eye examination. This includes diagnostics such as ocular coherence tomography, wide-angle retinal imaging, anterior segment photo documentation, and full-threshold visual field testing when indicated. This allows for early detection and treatment of conditions such as macular degeneration, diabetic and hypertensive retinopathy, glaucoma, cataracts, and other ocular and systemic diseases. There is already evidence that up to 25 percent of diabetes cases can first be detected by optometrists in a comprehensive eye examination. Manifestations of several diseases, including some cancers, are also detected by optometrists during comprehensive eye examinations.
This makes the comprehensive eye examination one of the most effective preventative tools for keeping the workforce healthy.
Eye diseases, including diabetic and hypertensive retinopathy, macular degeneration, and glaucoma, are all leading causes of vision loss that can affect individuals in their working years, particularly as we age. Diabetic retinopathy affects approximately one million Canadians. Unaddressed diabetic retinopathy leads to retinal detachment and blindness. The odds of a person being unable to work because of uncontrolled diabetic retinopathy are roughly twice those of someone whose diabetes and retinopathy are under control. They are also likely to have 40 percent more sick days. Benefit costs can reach almost $20,000 annually, nearly double that of an employee with diabetes whose vision health is preserved.
Successful preventative treatments are available
Macular degeneration affects approximately 2.5 million Canadians. There are age-related macular degeneration (AMD) treatments that are successful in slowing down or stopping the progression of damage to the eye, thus preventing severe vision loss and additional costs to plan sponsors. However, optimal patient outcomes depend on early detection and consequent early treatment.
Glaucoma affects nearly 750,000 Canadians. It is usually too late to prevent permanent vision loss by the time a patient notices glaucoma. Early detection of glaucoma is crucial to its successful management. In addition to the visual manifestations, one in five glaucoma patients suffers from anxiety and depression, and 50 percent suffer from sleep disorders.
The cost of early detection and management through modern diagnostics is not prohibitive. Although fees will vary by province, locality, and provider, the range for modern diagnostics and imaging is usually between $50 and $120. For the average vision care plan, this is equivalent to less than one average-priced prescription drug claim per adult member every two years if every plan member visits their optometrist every 24 months and is identified for diagnostics and imaging.
The Canadian Association of Optometrists calls upon group benefit stakeholders to modernize vision care benefits and fill the gaps in care by including a reasonable allowance for modern diagnostics and imaging procedures to help detect eye disease early and preserve the vision of working Canadians. The rigidity of most current plans, which does not allow optometrists and plan members to use what modern standards of practice have to offer, is doing the opposite. Some Canadian insurance stakeholders are realizing the importance of modernizing vision care benefits. In the coming months, we anticipate that some organizations will begin offering such benefits as modern comprehensive eye examinations to their members. In our view, they will be the ones who will have the competitive edge. We encourage plan sponsors to familiarize themselves with the vision benefits modernization initiative on our dedicated website, Don’t lose sight of vision care benefits (dontlosesight.ca), and to consider offering modern benefits to their members.
Dr. Martin Spiro is president of the Canadian Association of Optometrists (CAO), the national voice of optometry dedicated to providing leadership and support to its 8,300+ members.
