Eye Conditions and Emergencies
Patients
Albertans of all ages can benefit from optometric services.
Avoiding long waits in an emergency room is just one of the many reasons
to visit your optometrist for eye emergencies and other conditions
considered medically necessary exams and procedures.
Alberta Health Coverage varies for different age groups, so
for more information on what's covered for you, click here.
For Patients
Eye Conditions and Emergencies / Medically Necessary
Children (0-18) and Seniors (65+)
Albertans in these age groups are automatically covered for one comprehensive eye exam, including an updated prescription, every benefit year (July 1 - June 30). Additional exams and procedures are possible based on clinical need.
Medically Necessary Program for Adults (19-64)
What is considered medically necessary?
A medically necessary visit to an optometrist includes:
• Monitoring for diabetes and glaucoma issues
• Retinal detachment, defects and diseases
• Eye infections or injuries
• Inflammation of the eyelid
• Foreign objects in your eye
• Sudden changes in vision
• Pre and Post-operative care for cataract patients
For more information, check out our FAQ.
Click Here to Find an Optometrist.
While the majority of services are insured by the Alberta Government, there are some uninsured services such as retinal photography and other supplementary tests. Also, regular annual eye examinations (ex: to check or update a glasses/contacts prescription) are not considered to be Medically Necessary, and as such are not covered by Alberta Health.
We always recommend that patients discuss all services and treatments with their optometrist prior to the exam to ensure there are no unforseen costs afterwards.
Optometrists provide quick access for Albertans experiencing eye health problems, whether of an emergent nature or otherwise.
What do I do if I have an eyecare emergency video from AB Docs Site here.
Diabetic Eye Health Exam
Medically Necessary Diabetic Eye Health Exam
What is a diabetic eye health exam, and how does it differ from a routine eye exam?
The first difference is that Alberta Health does NOT cover routine eye exams. Routine eye exams generally include services and tests that may not be necessary in a diabetic eye health exam, such as a refraction. A refraction is the test that determines what strength of a prescription you need, and is necessary for acquiring new glasses or contact lenses.
It is very important to note that unless your vision is fluctuating as a result of your diabetes, a refraction will NOT be included in the diabetic eye health exam. Alberta Health does not cover refractions for the purpose of obtaining a prescription. This cost remains the responsibility of you, the patient.What this means in a practical sense is that you will need to have your diabetic eye health exam and your routine exam on different days. Otherwise, you are responsible for the cost of the entire examination.
So what is a diabetic eye health exam?
This exam will test all areas of vision that may be affected by your diabetes and may include:
• acuity measurement,
• eye pressure measurement,
• dilated fundus exam, and
• slit lamp exam.
If there are other diabetic complications occurring, then additional testing may be done. If you're vision is fluctuating, then a refraction might be covered. Depending on when your last exam was, whether or not it is your first time visiting this particular optometrist, etc., the types of procedures done may vary, so be sure to talk with your doctor before the exam.
How do I get a diabetic eye health exam?
Just call your usual optometrist! All optometrists in Alberta are qualified and able to perform a medically necessary diabetic eye health exam. When you make your appointment, inform your doctor that you are a diabetic and would like to have a diabetic eye health exam.
Communication is vital in any relationship. Always confirm what procedures will be performed, and whether or not they are covered by Alberta Health, BEFORE entering the exam room.
Please note that if this is your first visit to a particular optometrist, or if it has been several years since your last routine eye exam, your optometrist may suggest that you have a full routine eye exam before the diabetic exam. This ensures that the optometrist has knowledge of your complete eye health situation.
If you don't currently have an optometrist,
click here to find one near you.
Why should I get an eye exam?
Diabetics are at high risk for eye health complications such as diabetic retinopathy. A diabetic eye health exam once a year, and a complete routine eye exam every two years, is the recommended minimum standard of care. For more information on how diabetes effects the eyes and the importance of regular eye exams, click here.
For Practitioners
Health Care Practitioners
Make optometrists part of your health team! Optometrists speacialize in the examination, diagnosis, treatment, management and prevention of diseases and disorders of the visual system, the eye and associated structures.
"Coverage for medically necessary visits to optometrists
helps improve patient care by increasing accessibility
and allowing for better patient co-management with ophthalmology."
- Dr. M. Dorey, Ophthalmologist
"I suggest to clients that one of the professionals they can choose
to see with any eye problems is an optometrist, knowing that they
will be seen promptly; receive excellent care; be referred to an
ophthalmologist if necessary and know that Alberta Health now
covers medically necessary optoemtrists visits for all Albertans."
- Betty-Lou Kindleman, R.N.
If you provide patient care in any capacity, click here to read more about the benefits of adding optometrists to your health care team, and the resources available to you.
Health Care Practitioners
What is considered medically necessary?
A medically necessary visit to an optometrist includes:
• Monitoring for diabetes and glaucoma issues
• Retinal detachment, defects and diseases
• Pre and Post-operative care for cataract patients
• Eye infections or injuries
• Inflammation of the eyelid
• Foreign objects in your eye
• Sudden changes in vision
Alberta Health and Wellness’ expansion of the coverage for medically necessary optometry services to include all Albertans creates more options for both the patients and health care providers.
Health care providers can now advise patients to see an optometrist without worrying about the out-of-pocket costs to the patient. This allows the patients to take more control of their eye health, address eye injuries, illnesses and diseases quickly.
It will also make it easier for health care providers to maximize their time and resources, alleviating emergency room stress and waiting time for specialists. Optometrists can play an important role in the ongoing care of these chronic conditions, allowing for increased collaboration between health care providers.
Physicians and other health care providers can refer patients to an Optometrist if they feel their condition is warranted. A list of examples of conditions and services that fall under the Medically Necessary category (with ICD-9 codes in brackets) is available in the resources below.
This team approach benefits everyone – enhancing prevention, supporting early detection and providing effective treatment for eye health conditions.
Resources for Health Care Practitioners
Brochures, Post Cards and Posters
Eye Health Referral Forms
Medically Necessary Conditions (With ICD-9 Codes)
More Resources Available on the
Resources and Materials page.