Ontario provides limited funding to cover the costs of PROSE lenses for qualifying patients at the Kensington Eye Institute in Toronto. A patient and their doctor must apply to this program. However, the program almost never accepts dry eye and NCP patients, and it appears to prefer funding patients with visible eye damage or irregularities and sight-impairment.

Eye care providers also face barriers which prevent them from providing essential care to their patients. In a 2018 survey of Canadian ophthalmologists, half of respondents reported that autologous serum tears are inaccessible to their practice due to financial and logistical barriers. Insufficient reimbursement for providing the service was reported as a major detractant. 68% of ophthalmologists stated they would prescribe serum tears to their patients if they were more accessible⁶.

Results from this study reinforce the fact that there are significant disparities in terms of access to essential healthcare for ocular surface disorders. Not only is autologous serum financially inaccessible to many patients, many of their doctors are unable to even offer it to their patients who require it.

Quebec’s healthcare system covers the costs of autologous serum tears and prokera if they are prescribed by ophthalmologists employed with a hospital. However, accessing these treatments is notoriously challenging. Quebecois patients report that doctors are discouraged from prescribing serum tears, and that finding one willing to do so is extremely difficult³.

It is important to distinguish between the essential treatments offered by eye care professionals to treat serious eye diseases, and the elective procedures in the cosmetic industry that have an unfortunate overlap in terminology.

Intense pulsed light (IPL) is used in ophthalmic care to stimulate the meibomian glands to produce more meibum, a vital component of a healthy tear film. Improving the quality of tear film is an essential component of treating most OSDs

Autologous serum tears (AST) and platelet rich plasma (PRP) are eyedrops made from a patient's own blood that assist in healing defects on the ocular surface and corneal nerve abnormalities.

IPL, AST, and PRP are also used for skincare treatments in the cosmetic industry. The overlap in terminology between skin rejuvenation procedures and ophthalmological treatments have further inhibited OSD patients from accessing adequate funding for these essential treatments. Provincial health insurance programs and private health insurance plans may be under the false impression that these treatments offered in an ophthalmological setting are elective and cosmetic.

With the lack of recognition and funding for OSDs, the provinces are currently violating their obligations under the Canada Health Act, which exists “to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers”⁷. To meet their obligations under these acts, the provincial governments must improve the state of medical care for OSD patients.

It is also in the financial interest of the provincial governments to improve the state of healthcare for OSD patients. When not properly treated, OSD renders patients disabled and unable to work. When patients can access treatments, they become more functional and can resume full-time work, thus resuming an active role in society and the workforce. The provinces will directly benefit from supporting the healthcare of OSD patients who often rely on disability programs and social assistance to survive. Providing these patients with adequate access to treatments is more cost effective than having to support them on disability programs.