OBJECTIVES: Visual loss is significantly associated with increased risk of mortality and decreased quality of life. In Prince Edward Island (PEI), Canada, eye examination and cost of eyeglasses are not covered by provincial health insurance. This study aimed to assess the cost-effectiveness of insured eye examination compared to non-insured eye examination for PEI residents. METHODS: A cost-effectiveness analysis was conducted from a perspective of Canada’s health care system. A target population was a PEI resident aged 42 years or older. Risk of vision loss and utility data were obtained from published literature. Resource utilization and costs associated with managing vision loss and eye examination were obtained from Health PEI, Ontario Ministry of Health and Long-term Care, and published literature. A decision analytic model was used to estimate an incremental cost-effectiveness ratio (ICER). Costs were expressed in 2012 Canadian dollars.  A series of sensitivity analyses, including one-way and two-way sensitivity analyses, was performed to assess the possible uncertainty and robustness of our findings.  RESULTS: Compared with non-insured eye examination, insured eye examination for PEI residents led to an annual gain of 0.01 quality adjusted life year (QALY) and an incremental cost of $5.52 per person, yielding an ICER of $2,785 per QALY. Sensitivity analyses showed that cost-effective estimates were highly sensitive to the incidence of vision loss, rate of eye examination by optometrists, and utility of vision loss. Specifically, higher incidence of vision loss and greater rate of eye examination by optometrists offered lower cost-effectiveness ratios.   CONCLUSIONS: Insured eye examination for PEI residents was a highly cost-effective option compared to non-insured eye examination. This intervention was even more cost-effective if greater proportion of PEI residents received the eye examination by optometrists and if the incidence of vision loss in PEI increased.