Eye care use trends in Ontario's public health care system:a 22-year population-based study.

OBJECTIVE: To investigate patterns of eye care use by Ontarians from 1997 to 2019. DESIGN: Population-based, repeated cross-sectional analyses. PARTICIPANTS: Ontarians insured under the Ontario Health Insurance Plan. METHODS: Ontario Health Insurance Plan claims from 1997 to 2019 were analysed. Eye care use was identified using provider-submitted eye disease diagnoses. Annual eye visits (including revisits) and distinct eye patients (excluding revisits) per 100 population were calculated by age group, urban/rural residence, emergency versus nonemergency visits, and provider type (ophthalmologist, optometrist, primary care providers, and emergency physicians). RESULTS: From 1997 to 2019, per 100 population, nonemergency eye visits increased from 59.4 to 76.9, whereas emergency visits decreased (1.2 to 0.9). Distinct eye patients per 100 population decreased for both nonemergency cases (32.0 to 25.1) and emergency cases (1.0 to 0.8). Average visits per patient increased from 1.9 to 3.1 for non-emergency cases and remained at 1.2 for emergency cases. Among nonemergency cases, visits per patient to ophthalmologists more than doubled (3.5 to 8.7). After 2004, optometrist visits declined among Ontarians aged 20-64 years, whereas ophthalmologist visits increased substantially. For other age groups, visits to both providers were stable or slightly increased. Rural residents had fewer nonemergency visits than urban residents (60.5 vs 64.6 per 100 population) but more than twice the emergency visit rate (2.3 vs 1.0). CONCLUSIONS: From 1997 to 2019, Ontarians' nonemergency eye visits, especially to ophthalmologists, increased, with fewer patients making more visits, whereas emergency visits declined. Rural residents had lower nonemergency but higher emergency visit rates. After 2004, optometrist visits among working-age Ontarians decrease, whereas ophthalmologist visits increased.