Disparities in Access to Pediatric Ophthalmologists Increased Over Past 15 Years

Kara M. Cavuoto, MD

New data from a cross-sectional study report disparities in access to pediatric ophthalmological care have not only remained persistent, but significantly increased over the past 15 years in the United States.¹

Key demographic and socioeconomic differences were observed between populations in areas with or without access to pediatric ophthalmological care, with disparities associated with lower socioeconomic status and the rural-urban gap. Only 10.0% of countries in the country had access to a pediatric ophthalmologist, per the data.

“Considering the metropolitan location preference of practicing pediatric ophthalmologists in conjunction with shortages of pediatric ophthalmologists overall, we can conclude that rural populations disproportionately lack access to such care, which can impact the time to diagnosis, treatment, and management of complications of serious ophthalmological diagnoses in children,” wrote corresponding author Kara M. Cavuoto, MD, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine.

National shortages of pediatric ophthalmologists in relation to the expanding population of the US is apparent in recent years, wherein the shortage is compounded by an overall lack of trainee interest in pediatric ophthalmology and a lack of geographic distribution among the existing practitioners.

An analysis last reported on nationwide pediatric ophthalmologist service coverage in 2007, and the considerable changes in the US demographic landscape requires evaluation to properly understand how the needs of important services have changed. Cavuoto and colleagues aimed to assess the number and location of pediatric ophthalmologists in the US in relation to US population demographic characteristics.

Pediatric ophthalmologists were identified using 2 online public databases in March 2022: the “Find an Ophthalmologist” tool on the American Academy of Ophthalmology (AAO) website and the “Find a Doctor” tool on the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) website.

A total of 1056 pediatric ophthalmologists (611 men [57.9%] and 445 [42.1%] women) in the US were identified. Results show the states with the most pediatric ophthalmologists were California (n = 116 [11.0%]), New York (n = 97 [9.2%]), Florida (n = 69 [6.5%]), and Texas (n = 62 [5.9%]), the four most populous states in the country.

A total of 2828 of 3142 counties (90.0%) and 4 of 50 states (8.0%) had 0 pediatric ophthalmologists. Of the 30 most populous US counties, 19 (63.3%) with the greatest number of pediatric ophthalmologists are also among the 30 most populated counties.

Based on US Census data, there were 3.2 pediatric ophthalmologists per million persons in the US. For the younger US population, there were 12.7 pediatric ophthalmologists per million persons younger than 19 years. In counties with 1 or more pediatric ophthalmologists, there was a mean of 7.7 pediatric ophthalmologists per million persons and a mean of 32.3 pediatric ophthalmologists per million persons younger than 19 years.

Further data suggest counties with 1 or more pediatric ophthalmologists had a greater median household income in 2021 compared with counties with 0 pediatric ophthalmologists. There were higher densities of pediatric ophthalmologists in coastal metropolitan areas such as Los Angeles, California and New York, New York, and lower densities of pediatric ophthalmologists in central northern states, such as Montana and Nebraska.

The study found the proportion of families in each county without internet service, the proportion of persons younger than 19 years without health insurance, and the proportion of households without vehicle access were greater in counties with 0 compared with counties with 1 or more pediatric ophthalmologists.

In a linked editorial², Alejandra G. de Alba Campomanes, MD, MPH, Department of Ophthalmology, University of California, San Francisco, cited major factors related to inequity in the study results, showing median income, internet access, and vehicle access were substantially lower in counties with no pediatric ophthalmologist.

“The paradox of this observation is that populations with more barriers to traveling distances for in-person care and to accessing virtual care (transportation, internet, health insurance) have the least geographic access to eye care professionals,” Campomanes wrote. “This compounds the inequity of access to pediatric ophthalmology care.”

References

1. Walsh HL, Parrish A, Hucko L, Sridhar J, Cavuoto KM. Access to pediatric ophthalmological care by geographic distribution and US population demographic characteristics in 2022. JAMA Ophthalmology. 2023. doi:10.1001/jamaophthalmol.2022.6010

2. Oatts JT, Indaram M, de Alba Campomanes AG. Where have all the pediatric ophthalmologists gone?—pediatric eye care scarcity and the challenge of creating Equitable Health Care Access. JAMA Ophthalmology. 2023. doi:10.1001/jamaophthalmol.2022.6011