Objective: To describe patterns of access to eyeglass insurance by Canadians. Design: A population-based, cross-sectional survey. Participants: A total of 134 072 respondents to the Canadian Community Health Survey 2003 who were aged ≥12 years. Methods: We compared self-reported insurance coverage for eyeglasses or contact lenses provided by private, government, or employer-paid plans. Results: Overall, 55.0% of Canadians aged ≥12 years had insurance that covers all or part of the costs of optical correction. School-age children (63.3%) and individuals aged 20–39 years (55.9%) and 40–64 years (59.5%) had higher coverage rates than seniors (aged ≥65 years) (33.8%, p < 0.05). Canadians residing in the 3 territories had the highest coverage (76.9%), while those in Quebec had the lowest coverage (39.1%, p < 0.05). Lower coverage was reported among immigrants (47.3%) versus nonimmigrants (57.4%, p < 0.05), nonwhites (49.2%) versus whites (56.4%, p < 0.05) and aboriginals (70.7%), and the self-employed (38.5%) versus employees (63.8%). Among Canadians in the 20–64 years age group, individuals in the lower or middle income bracket were 40% (prevalence ratio [PR] 0.60, p < 0.05) less likely to have insurance than those in the upper-middle or higher income bracket after adjusting for ethnicity, immigrant status, and education. Compared to those with university or college education, individuals with less than secondary school education were 13% (adjusted PR 0.87, p < 0.05) less likely to have insurance. Conclusions: Significant disparities exist in eyeglass insurance coverage in Canada. Individuals with low levels of income and education, and the self-employed, seniors, immigrants, nonwhites, and residents of Quebec had less coverage. Studies are needed to understand whether these disparities contribute to the visual impairment burden in Canada. © 2018 The Authors

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