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Ontario Premier Doug Ford’s government is facing increasing pressure to resolve the dispute before it gets worse.JOERG SARBACH/The Associated Press

A funding fight between Ontario optometrists and the province has escalated to the point where around 280,000 eye appointments have already been cancelled, with children and seniors caught in the middle of the dispute.

Now, Premier Doug Ford’s government is facing increasing pressure to resolve the issue before it gets worse.

The disagreement stems from the way the government funds eye care under the Ontario Health Insurance Plan. Currently, OHIP pays for eye exams for people 19 years of age and younger, those 65 and older, and people with special conditions, such as diabetes, glaucoma and macular degeneration. It pays about $45 an exam. But Sheldon Salaba, president of the Ontario Association of Optometrists (OAO), said the true cost is almost double that.

On Sept. 1, about 95 per cent of the province’s 2,500 optometrists withdrew services for these groups, to highlight the lack of funding, Dr. Salaba said.

He said optometrists in Ontario receive the least amount of funding of any province with publicly funded optometry services; in Manitoba, it is $77 and in Alberta, it’s $137, for instance.

“We don’t want to see patients being thrown into the middle of this. But it’s not us. It’s the government that has allowed it to get to this level,” Dr. Salaba said. “They refuse to commit to paying what it costs to deliver the services.”

After two days of mediation in August, talks between the two sides broke down, with the OAO refusing to return to the table until the government commits to increase funding over the long-term.

So far, the province has offered to increase reimbursements by 8.48 per cent and has also offered the association a one-time payment of $39-million retroactive to April 1 to account for the increased cost of services. The money will be paid Oct. 1 regardless of whether there is a deal or not.

But the OAO says that is not nearly enough to make eye care sustainable for optometrists who are covering costs out of their own pockets.

Alex Hilkene, a spokesperson for Health Minister Christine Elliott, said the government takes the concerns of optometrists seriously and has proposed “to immediately set up a joint working group, to dig deeply into these and other issues as quickly as possible.”

“It is not reasonable or responsible for the government to agree to any other increase without first engaging in a process of due diligence to validate the facts,” she said, adding that Ontario offered a “fair and reasonable proposal” as a starting point to negotiations.

Opposition NDP Leader Andrea Horwath said Monday the dispute means children returning to school without updated prescriptions are “unable to see the board,” while seniors without access to eye exams are left unable to renew their driver’s licences. She urged the government to negotiate and to increase funding for the services.

“This is happening because Doug Ford decided to penny-pinch,” Ms. Horwath said, adding that the previous Liberal government also underfunded eye care for years.

Green Party Leader Mike Schreiner also called for the government to immediately commit to funding the operating costs for OHIP services. “Kids and seniors are stuck without care because Ford and Elliott refuse to step up,” he said.

The College of Optometrists of Ontario, which regulates the profession and is not involved in the pay dispute, issued a policy last year that said optometrists “must continue to provide urgent care, or any treatment needed to prevent harm, suffering and/or deterioration during a job action.” They can also refer clients to “alternate care,” such as a family doctor or any eye specialist not participating in the job action. The policy leaves the determination of what is an urgent case to an optometrist’s “clinical judgment” and “professional responsibility.”

Dr. Salaba said anyone booked for “routine care” is experiencing delays, but those with an emergency will be referred to other health care providers on a case-by-case basis.

Joe Jamieson, the college’s chief executive officer and registrar, said patients who think they have been wrongly denied urgent services can complain to the regulator.

Mr. Jamieson said many routine annual eye exams could easily be deferred for a short period of time. Determining what cases are more urgent, he said, is more difficult.

“Optometrists have called us and said, ‘Where exactly is that line,’ ” Mr. Jamieson said.

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