Artificial eyes and facial prosthetics

Who qualifies

To qualify, you must:

• be an Ontario resident
• have a valid Ontario health card
• have a long-term physical disability requiring an artificial eye(s) or a facial prosthetic(s)

We do not consider your income.

Who does not qualify

You do not qualify, if:

• you already qualify for or are receiving financial support from the Workplace Safety and Insurance Board for the same artificial eye(s) or facial prosthetic(s)
• you are a Group “A” veteran and already qualify for, or are receiving, financial support from Veterans Affairs Canada for the same artificial eye(s) or facial prosthetic(s)

Artificial eyes

You may have lost an eye, or have suffered permanent damage to it, due to disease or non-work-related injury.

Through the Assistive Devices Program, we help cover the cost of artificial eyes (also called ocular prostheses).

This includes:

• customized artificial eye(s)
• customized artificial eye(s) for porous implant
  • an implant with openings throughout to allow fibrous tissue growth
• customized scleral lens
  • the sclera is white outermost layer of the eyeball

Devices covered

We also cover some related devices, including:

• scleral trial shells
• custom conformers used to hold the shape of the eye socket after surgery
• template (such as a duplicate of the conformer in wax)
• titanium peg to secure the artificial eye and aid natural movement

Procedures covered

You can also apply for help covering the costs of the following procedures:

• making artificial eye(s)
• coupling procedure for porous implant
• making of scleral lens
• therapeutic build-up
• reduction
• retouching veins and colour
• impression of orbital cavity taken under anaesthesia
• reglazing

Replacing artificial eyes

You can apply to replace artificial eyes and related devices if:

• the size of your eye-socket has changed due to growth or atrophy
• change in your medical condition
• normal wear to prosthetic(s) no longer under warranty

We do not cover costs to replace a lost artificial eye or repair artificial eyes damaged through misuse.

What is not covered

The ADP does not cover:

• a second artificial eye for the same side if the original one still works
• prosthetic implants using hydroxyapatite and attachment posts
• repairs to artificial eyes, conformers and scleral lens prosthetics
  • damage from misuse is your responsibility

Amount covered for artificial eyes

If you qualify, and your application is approved, we will cover 75% of the cost for an artificial eye or related prosthetics.

You pay 25% of the cost.

Apply for artificial eyes

Follow these three steps to apply:

1. Get examined by your family doctor, or an ophthalmologist or optometrist. The examination will confirm whether you need an artificial eye or not.

   The doctor will fill out their part of the application form and refer you to an ocularist registered with the Assistive Devices Program.

2. Meet with the registered ocularist, who will confirm the type of artificial eye(s) you need and fit you for them. The ocularist is also the one who makes your artificial eye(s).
3. Arrange a date and time to receive the artificial eye(s). The ocularist will complete the application form and submit it to us on your behalf.

Facial prosthetics

You may need facial prosthetics due to a congenital condition, disease or injury (outside of work).

Through the Assistive Devices Program, we help cover the cost of:

• extraoral facial prosthetics (such as artificial noses, ears, eye sockets)
• intraoral facial prosthetics (such as palatal lifts, mandibular, or jawbone, extensions)

Replacing facial prosthetics

You can apply to replace intraoral and extraoral prosthetics originally purchased through the ADP.

You must need a replacement for one of the following reasons:

• change in your physical size/shape due to growth or atrophy
• change in your medical condition
• deterioration of the prosthetic jeopardizes your health

We do not cover costs to replace a lost prosthetic or repair prosthetics damaged through misuse.

Facial prosthetics not covered

The ADP does not cover facial prosthetics, such as:

• a second prosthetic for the same part of the face (extraoral) or for the same site in the mouth (intraoral)
• implants
• prosthetics made by vendors outside Ontario or who are not registered with the ADP

Procedures covered for intraoral prosthetics

You can also apply to get the following procedures covered for intraoral prosthetics:

• relining
• tissue conditioning (re-establishing tone and health to irritated tissue)
• adjustments (reduction or build-up of prosthetic)

Amount covered for facial prosthetics

If you qualify, and your application is approved, we will cover 75% of the cost for both types of facial prosthetics.

You will pay 25% of the cost.

Find a vendor and apply for facial prosthetics

Follow these five steps to apply:

1. Choose the application form you need:
   • extraoral prosthetics
   • intraoral prosthetics
2. Get examined by:
   • a plastic surgeon, ophthalmologist, oncologist or otolaryngologist if you need an extraoral prosthetic (such as artificial nose, ears, eye sockets)
   • a dentist if you need an intraoral prosthetic
3. The doctor, dentist or specialist who examines you will fill out their part of the form and refer you to a:
   • restorative prosthetist for extraoral prosthetics
   • prosthodontist or dentist certified in prosthodontics for intraoral prosthetics
4. Find a business that will make and sell you the prosthetic(s). The business must be registered with the ADP. With the help of the restorative prosthetist or prosthodontist, use the table below to find a registered business.

5. Meet with staff at the business. They will complete the application form and send it to us on your behalf.

What happens next

Whether you’ve applied for an artificial eye(s) or a facial prosthetic, we aim to review your application within 8 weeks of receiving it.

If you order or buy the artificial eye(s) or facial prosthetic(s) before we have completed our review, and your application is denied, you are responsible for the full cost.

If your application is denied, we will send you a letter explaining why and what you can do to follow up, including appealing our decision.

If your application is approved

If your application is approved, we will notify your vendor by mail.

The vendor will contact you to let you know of our decision and to arrange a time for your artificial eye(s) or facial prosthetic(s) to be delivered.

Getting up to 100% coverage

Through the Assistive Devices Program, we cover up to 100% of the cost for artificial eyes and facial prosthetics, if you receive financial support from one of these programs:

• Ontario Works
• Ontario Disability Support Program
• Assistance for Children with Severe Disabilities