Getting Eye Care

Ophthalmologists and optometrists work together in the Waterloo Region to manage and treat patients with eye disease.  We communicate our medical findings and care plans with one another on a regular basis and often rely on each other to co-manage certain patients.  Our roles are different but complementary and collaboration allows us to provide excellent care to patients in the Waterloo Region.

Ophthalmologists and optometrists also collaborate with family doctors, emergency room doctors, and specialists and there are several care pathways for patients with eye disease. Below we will outline the different roles of each provider and the common care pathways.

What is an ophthalmologist?

Ophthalmologists, or eye physicians and surgeons, are specialists who manage patients with eye disease. You require a referral from a primary care provider (optometrist, family doctor, nurse practitioner, emergency room physician) to see an ophthalmologist.

Ophthalmologists are trained to diagnose and treat patients with all levels of eye disease.  Patients can be managed medically (drops, medications) or with procedures. Ophthalmologists perform lasers and intraocular (inside the eye) and extraocular (around the eye) surgeries.  Many ophthalmologists will have a subspecialty interest such as retina, glaucoma, cornea, paediatrics, oculoplastics and others.

Ophthalmologists go to medical school for 4 years after completing a 4 year undergraduate degree and sometimes also a postgraduate degree (Masters or PhD).  Once they complete medical school they begin a 5 year postgraduate ophthalmology residency training program in the management of eye diseases and eye surgery. Several ophthalmologists will then pursue fellowship training in subspecialties that require 1 to 2 more years of training.

Ophthalmologists, like other medical doctors and surgeons, are regulated healthcare professionals governed provincially by the College of Physicians and Surgeons of Ontario. OHIP covers all medically necessary visits, tests and procedures (lasers and surgeries) performed by an ophthalmologist.  Ophthalmologists are on staff at local hospitals and provide call coverage 24/7 for patients.

What is an optometrist?

An optometrist is a primary eye care provider and many people in the Waterloo Region will have a “family optometrist” much like they have a family doctor.  You can schedule an appointment with an optometrist without a referral.

Optometrists see healthy patients, prescribe glasses and contact lenses, screen for eye disease in those at risk, diagnose and treat many eye diseases but will refer to an ophthalmologist if more advanced care and surgery is required.

Optometrists complete a 4-year Doctor of Optometry degree that requires 3 years of prior university study.  Many optometrists in the Waterloo Region will have trained locally at the University of Waterloo School of Optometry and Vision Sciences. Qualified optometrists may then do a year of postgraduate training in an area of interest such as vision rehabilitation, cornea and contact lenses, pediatric optometry, ocular diseases and others.

Optometry is a regulated healthcare profession and governed provincially by the College of Optometrists of Ontario. The Ontario health insurance plan (OHIP) covers yearly patient optometry exams for those under 20 or over 65 years of age.  OHIP also covers yearly optometrist exams for patients with certain eye diseases at any age. Patients not covered by OHIP may be covered by their private health insurance plans for optometrist visits.

Care pathways for patients

A care pathway is the usual route that gets a patient the treatment they need. There are a number of different ways that patients end up with a diagnosis of an eye disease that requires management. Below we will outline some of the common care pathways.

Childhood eye diseases

Many children with eye disease will have the disease identified at a comprehensive eye exam with their optometrist. It is important to have eye diseases in babies and children managed as early as possible because the visual system is still developing and early recognition may significantly improve the vision outcome. For this reason babies should have their first comprehensive eye exam with their optometrist between 6 and 12 months of age.

Common childhood eye conditions can often be managed initially by the optometrist with glasses, sometimes patching, and follow-up assessments.  If specialist care is required, the child will be referred directly to an ophthalmologist and the relevant eye health details will help them triage the referral based on urgency.

Sometimes eye problems are identified at the family doctor’s office or by the nurse practitioner, for example if the red reflex in the eye is abnormal, if the child’s visual behaviour isn’t normal, or if the eyes do not look aligned. The best care pathway for this child is to be seen in the weeks ahead by the family optometrist for a comprehensive eye exam. If specialist care is required, the child can be referred to an ophthalmologist with relevant details on eye health provided. Rarely the problem is urgent and an optometrist will be able to identify this on the dilated eye examination.

Patients with systemic diseases: diabetic retinopathy

Patients with certain diseases, like diabetes, known to be at risk of developing eye disease are covered by OHIP at any age for yearly visits with their optometrist. Diabetic eye disease, like many other chronic conditions, only causes visual problems at the most severe stage of disease and yearly comprehensive eye examinations are required to pick up the diagnosis early.

Patients who get regular optometrist eye examinations will have their diabetic eye disease diagnosed early and often at this stage it can be managed with improved blood sugar control by the family doctor or internist. If the eye disease progresses to more advanced stages, then the patient will be referred to an ophthalmologist for monitoring and treatment that can involve lasers, eye injections, and sometimes surgeries.

In the more severe stages of eye disease, diabetic patients can develop symptoms of blurry vision and/or floaters. If the blurry vision is sudden or severe, patients often present to the hospital emergency room where an ophthalmologist is on call 24/7.  The patient will be directly referred to the ophthalmologist for urgent assessment.

Age-related eye diseases: glaucoma

Comprehensive eye examinations are essential in the diagnosis and management of certain eye diseases, like glaucoma, as often patients do not develop symptoms until the most severe stage of disease. The public relies on the optometrist to pick up early glaucoma disease through routine comprehensive eye examinations with dilation. Patients over the age of 65 are covered by OHIP for yearly optometrist exams because of the increased risk of age-related eye diseases. 

Patients at risk of glaucoma require eye examinations with specialized testing.   Glaucoma is a condition that can be diagnosed on testing long before a patient notices the changes in vision.  Mild forms of glaucoma can be treated by an optometrist independently. Should the glaucoma progress to more advanced disease, or should the optometrist request assistance in management then a referral to an ophthalmologist is made.  The relevant details on eye health will help the ophthalmologist triage the referral based on urgency.

Glaucoma patients who don’t get regular screening eye exams sometimes present to their optometrist for a regular eye exam and are found to have severe disease at diagnosis and are referred urgently to the ophthalmologist.

When should I see an eye doctor?

Children

Babies get a rudimentary eye assessment by their family doctor/nurse practitioner as part of the well-baby visit. The Ontario Association of Optometrists recommends that all babies have their first optometrist exam at 6 months, then if all is normal again at 3 years of age and then yearly. A pediatric eye exam involves taking vision, measuring the alignment and binocularity, measuring for glasses, and doing a thorough assessment of eye health with dilating eye drops. Children should get comprehensive eye examinations to look for common childhood conditions such as strabismus (eye crossing), amblyopia (lazy eye), and refractive error (need for glasses). Link: Pediatric Optometrist Exam

Adults under 65

Healthy adults should get comprehensive eye exams every couple of years with their family optometrist. OHIP does not cover eye examinations in healthy patients between the ages of 20 and 64 but private insurance plans often do. Glaucoma-related visits to the optometrist are always covered by OHIP, at any age, as often as needed to manage the disease throughout life.

Patients with medical diseases or patients taking medications should ask their family doctor, nurse practitioner, specialist, or optometrist if they require more frequent eye examinations.  Patients with diabetes require yearly screening eye examinations with their optometrist and this is covered by OHIP.

Patients who develop visual symptoms should get an eye examination with their optometrist.  Your family doctor can request a medical eye exam for you and OHIP will cover the cost of the optometrist assessment. Link: Major Eye Exam OHIP Request Form.

Adults over 65

OHIP covers yearly comprehensive eye examinations with an optometrist in all adults over 65.  This is because the risk of age-related eye diseases —cataract, glaucoma, macular degeneration—increases over time.  Identifying eye disease early will often reduce disease progression and preserve vision.

Collaborations in Eye Care

Ophthalmologists and optometrists work together in the Waterloo Region to manage and treat patients with eye disease.  We communicate our medical findings and care plans with one another on a regular basis and often rely on each other to co-manage certain patients.  Our roles are different but complementary and collaboration allows us to provide excellent care to patients in the Waterloo Region. Ophthalmologists and optometrists also collaborate with family doctors, emergency room doctors, and specialists and there are several care pathways for patients with eye disease. This team-based approach allows us to use funding resources more responsibly and preserve specialists' advanced expertise for surgical and complex eye care needs.

Cataract surgery wait times

Wait times for cataract surgery are updated quarterly, with wait 1 representing how long it takes to get in to see the surgeon in the office, and wait 2, how long it takes after that to get in for surgery.

How do I find an eye doctor?

You can ask your family doctor about optometrists working in the region or you can use this map to find an optometrist practicing close to your home.

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