Tests and Fees

Examination Fees

Consultation/ Follow-up appointments with your ophthalmologist:

with Dr. Kogan, Dr. Rahman or Dr. Zuñiga

Most of the appointment is covered by your provincial health insurance (including consultation visit with the Ophthalmologist and certain tests as specified below). Some of the tests that provide more comprehensive information about your eyes, are not covered (see below). If you do not have health coverage, you will be charged a fee to cover the cost of the appointment and any tests required.

Tests and Fees

Visual field testing - Covered by Manitoba Health

If you are scheduled for a visual field test, you will be called in by one of our technicians at the beginning of your appointment for this test.

Visual field testing is a way of identifying whether your peripheral or "side" vision and central vision have any blind spots or blank areas. Because your eyes work together and one eye's visual field overlaps partially with the other, you may not be aware of defects unless each eye is tested separately.

On return and follow-up visits, visual field testing will be repeated to see if there are any changes. This test is essential in understanding if your glaucoma is stable or getting worse. Over time, these tests are graphed to show the rate of progression or how fast your glaucoma is changing. This gives very important information in planning your customized treatment plan.

Visual Field Testing Methods

Virtual Reality Visual Field Testing

GEM Clinic is using the newest technology for visual field testing with virtual reality. Overall, patients find this method of testing much easier and faster than the traditional method of placing you head in a dome and testing each eye separately (see below). We still use this traditional method in some cases, but we are using the Olleyes VisuALL virtually reality system for most examinations. It features virtual reality goggles that are place over your head and a clicker to hold in hand. It has a very helpful AI assistant named "Annie" who will tell you exactly how to do the test and let you know how you are doing at every step. Annie can speak over 30 languages and can be customized to your preferred language (as available). The test takes about 3-5 minutes for both eyes. This instrument can be easily sanitized and is portable so even wheelchair bound patients and patients with neck issues do not have to worry about positioning into the machine. If you where a turban or large headdress, the goggles may not fit over this and you may need to be testing with the traditional method or adjust your turban size (if possible).

Traditional Visual Field Testing

The traditional visual field testing is performed by testing each eye separately. Generally, the right eye is tested first, and then the left eye. Your non-tested eye will be patched and you will be seated in front of a dome-shaped machine. Your head will be positioned in a chin rest within the dome. You will be asked to stare at a light straight ahead of you, while other lights are flashed at you from all sides of the dome, one at a time. As you notice these other lights using your side vision, you will need to press a clicking device to tell the machine that you have seen the light. It is important to continue to look straight ahead at the target in front of you and resist the urge to look directly at the other lights. You also need to press the clicking device as soon as you see the other lights. The lights will get dimmer as the test tries to figure out how sensitive your eyes are at picking up light. In this way, most of your peripheral or side vision as well as your central vision are tested. Any blank spots in your vision are mapped out.

OCT (Optical Coherence Tomograph) - Fee $120

An OCT machine can produce complex, layered imaging of the front, and back of the eye including imaging of the optic (eye) nerve and macula (central retina). This allows for detailed examination of the various parts of the eye.

OCT can be used to help aid in the early diagnosis and management of glaucoma. It can also be used to assess the retina to help with diagnosis and management of diseases such as diabetic macular edema (swelling), post-cataract cystoid macular edema (swelling), macular degeneration, and macular holes. It is used to assess any changes caused by the potential side effects of Plaquenil (hydroxychloroquine) therapy.

OCT is an important tool to use for planning cataract surgery (especially if a premium intraocular lens is being considered). It is also a powerful teaching tool for patients and their families to be able to actually show you what is going on in your eye (s).

OCT imaging takes 5 - 10 minutes. The technician will position you in the OCT machine to take the images, and guide you through the process. This test usually does not require any dilating drops and will not alter your vision. You will be able to drive after this test (unless there is a rare need to dilate due to poor image quality).

Pachymetry - Fee $40

This test measures your corneal thickness. Freezing or anaesthetic eye drops (lasting 10 minutes) will be applied to your eyes, therefore you will not feel anything. The doctor or technician will use a small hand-held device to gently and briefly press against the cornea making the device beep several times.

Pachymetry is a measurement of the central corneal thickness (CCT). If your cornea is thicker than the average person, your eye pressure measurements may be artificially high. If your corneal thickness is thinner than average, your eye pressures may be artificially low. Some studies suggest that people with thinner than average corneas may have increased risk of developing glaucoma. Average central corneal thickness is around 545 microns (1000 microns = 1mm).

Diurnal Tension Curve (DTC) and Water Drinking Test (WDT) - Covered by Manitoba Health

Eye pressure varies throughout the day. Often, our office pressures don't give us a good idea of what's happening over the course of the day. If a patient is getting worse even though the eye pressures seem to be normal at the time of the visit, there may be other factors affecting the glaucoma (like low blood pressure or sleep apnea), or the eye pressures may be spiking outside office hours when we are unable to measure them.

In order to test for this, we can do either a DTC or a WDT. Both these tests help us determine if there are higher pressures or a tendency for higher pressures throughout the day which we might be missing at the office visit. This will help us make sure you are adequately treated for your glaucoma.

Diurnal Tension Curve (DTC)

The DTC (Diurnal Tension Curve) is usually performed by the technicians or Dr. Buffie, and requires a quick eye pressure check every hour throughout the day or half-day (mini-DTC). This is a long day or half day, however, we encourage patients who have this test to take the day off and enjoy the amenities of the mall in between pressure checks. The pressure checks will require freezing drops each time (since freezing only lasts for about 10-15 mins) and should not take longer than a few minutes on each hour. A DTC is usually scheduled throughout the day (or half-day) from 8:30 to 4:30.

Water Drinking Test (WDT)

The WDT (Water Drinking Test) is a stress test that is done over an hour or so. We ask that you refrain from drinking any liquids 2 hours prior to the test. At the office, we will give you 800 ml (just under a litre) of bottled water to drink within 5 minutes. We will take the pressure before you drink water and then every 15 minutes up to an hour or until the pressure starts to come down. If the eye pressure increases outside normal range during this test, this indicates that your glaucoma may need more treatment. (If your eye pressures go up with this test, you can still drink water/ liquids as usual; just do not drink large volumes of liquids very fast).

Autorefraction - Covered by Manitoba Health

Your approximate prescription for glasses is measured with this test, which is performed by the technician. The technician will guide you through it, placing your chin in the chin rest of the autorefractor machine, and taking measurements while you are staring at the targets in front of you. It is a very simple and fast test, taking about 5 minutes in total. This measurement may be used as a baseline for testing you for glasses, or as perioperative information for cataract surgery. You do not need any freezing drops for this test and it will not distort your vision.

Disc Photos - Covered by Manitoba Health

Disc is another word for the front end or "head" of the optic (or "eye") nerve. Since glaucoma causes changes in the optic nerve, taking a photo or picture of it will provide something for comparison in the future. The technician will position your head in the machine (we currently use our OCT machine to take disc photos). You do not need any dilating or freezing drops for this test (however, if your pupils are too small for the test, you may have to be dilated with drops - "Dilation of Pupils").

A-Scan Biometry - Covered by Manitoba Health

This is a measurement of your eyes in preparation for cataract surgery. The technician will seat you in front of the machine that takes quick measurements of each eye separately. This will provide your doctor with information about what kind of lens you will need to be implanted inside your eye at the time of cataract surgery. In order to get accurate test results, it is important that your eyes are well lubricated and not dry at the time of the test. It is recommended that you use artificial tears 3 to 4 times per day in each eye for one week before taking this test. Also, if you are a contact lens wearer, you should not wear contacts 2 weeks before taking this test. Otherwise, the results of this test can be very inaccurate and could lead to implanting the wrong strength of lens inside your eye. (This means that the implanted lens may either have to be removed later, or you may have to wear stronger glasses after surgery.)

Dilation of pupils - Covered by Manitoba Health

By dilating or widening your pupils, your doctor will be able to see the whole of the inside of your eyes. Looking through an undilated pupil is like peeking into a keyhole and trying to see the room inside. Looking through a dilated or widened pupil is like opening the door to the room and looking inside. It is much easier to see the whole of the room by opening the door.

Dilation allows a better view of the whole retina, optic nerve and macula (the central retina). This is done routinely, usually on an annual basis, and sometimes if a patient is experiencing symptoms such as decreased vision, flashing lights or floaters. In order to dilate your pupils, medicated eye drops are given - usually 2 drops per eye. These take about 20-30 minutes to cause dilation. Either the technician or the doctor applies these drops. After your pupils are dilated, your doctor will use some lights and lenses to examine your eyes.

We always try to confirm whether you are prepared for this test since the dilation effect causes blurry vision especially for near vision, and glare with bright lights. The dilation effect typically lasts up to 4-6 hours and can last even longer in some people. It is not advisable to drive after being dilated. You should also bring your sunglasses to wear afterwards.

iTrace - Fee $80

This test measures the "Dysfunctional Lens Index" or "DLI" which gives your surgeon an idea of how symptomatic your cataracts are and whether they are ready for removal. It also is used to measure the surface of your corneas to see if you have any unusual corneal thinning. It confirms whether you might be eligible for premium intraocular lenses to fix astigmatism (TORIC lenses) and/or be able to focus at various distances without the need for glasses most of the time (Multifocal lenses).

It is advisable to use lubricating eye drops (artificial tears) 3-4 times per day to each eye for one week prior to this test. If you wear contact lenses, you should not wear them for 2 weeks prior to having this test, otherwise the results may not be accurate. The technician will take these measurements by seating you in front of the machine and positioning your head on the chin rest. The measurements do not take long and there are no anaesthetic drops required.

Other Fees

1. Missed appointments: If you fail to give 2 business days notice that you are unable to attend your appointment (barring emergencies), or if you simply do not show up for a scheduled appointment, you may be billed.
2. Forms: Forms are filled out within 1-2 weeks (barring exceptional circumstances) and are charged at a rate of $50 per form. If a form is required earlier than this, an extra $25 will be charged.
3. Copy/Transfer of chart: $150