Geographic Disparities Persist in Access to Pediatric Eye Care in US

Kara M. Cavuoto, MD

Credit: University of Miami

A cross-sectional investigation into geographic disparities in pediatric eye care access revealed significant overlap between the distribution of pediatric optometrists and pediatric ophthalmologists across the United States.¹

Despite the percentage of counties without pediatric ophthalmologists (90.2%) remaining unchanged since a 2022 report, the investigation found that 93.5% lacked pediatric optometrists in 2023. Geographic distribution revealed nearly twice the number of pediatric ophthalmologists than pediatric optometrists in the US—this distribution was influenced by demographic factors at the county level, including socioeconomic status.

“Similar issues in access to care have been reported in other pediatric subspecialties outside of ophthalmology, such as neurology and rheumatology, which may provide valuable insight into shortages in pediatric eye specialists,” wrote Kara M. Cavuoto, MD, and colleagues at the Bascom Palmer Eye Institute, University of Miami Miller School of Medicine.

Despite the importance of eye care in the developmental stage, access can be limited by insufficient pediatric ophthalmologists at the national level.² Eye care practices tend to be mainly located in urban areas, reducing access to care in rural areas. Ophthalmologists and optometrists each play critical roles in treating children with ocular diseases, particularly as these diseases both present and are managed differently in children than adults.³

As a result, investigating the disparities in the distribution of pediatric eye care specialists related to population demographics could identify gaps in access to care and benefit future intervention. In this study, Cavuoto and colleagues identified the addresses of practicing pediatric optometrists and pediatric ophthalmologists using 4 online public databases in April 2023.¹

Each address was geocoded and population-level demographics were collected for analysis. Population-level data were collected from the US Census Bureau. Overall county population, diversity index, education level, and median family income were sourced from the US Bureau of Labor Statistics.

Investigators split US counties into 4 groups for analysis: counties with ≥1 pediatric optometrist, counties without pediatric optometrists, counties with ≥1 pediatric ophthalmologist, and counties without pediatric ophthalmologists. Across the 4 databases, the analysis identified 586 pediatric optometrists (51.5% female) and 1060 pediatric ophthalmologists (55.7% male).

Across all US counties, 203 (6.5%) had ≥1 pediatric optometrist and 308 (9.7%) had ≥1 pediatric ophthalmologist, demonstrating notable geographic overlap (odds ratio [OR], 12.7; 95% CI, 9.4 - 17.4; P <.001). Among the 2834 counties lacking pediatric ophthalmologists, 2731 (96.4%) also lacked pediatric optometrists.

Cavuoto and colleagues noted there were more pediatric optometrists in counties with ≥1 pediatric ophthalmologist, compared with counties without pediatric ophthalmologists (32.5% vs. 3.6%; 95% CI, 23.9–34.4; P <.001), but still more than two-thirds of these counties did not have an optometrist.

Meanwhile, a summary of the number of practitioners per million revealed more pediatric ophthalmologists per million people (3.3) than pediatric optometrists (2.5) across all states (P = .047). Across counties with practitioners, the median number of pediatric ophthalmologists per million people of all ages was 5.5, compared with 7.8 pediatric optometrists per million.

Counties with ≥1 pediatric optometrist and ≥1 pediatric ophthalmologist had the highest median household income ($78,388.67). Compared with counties with ≥1 pediatric ophthalmologist, counties with no pediatric ophthalmologist showed a lower median household income, in both the presence of ≥1 pediatric optometrist or no pediatric optometrist (P <.001).

The distribution of pediatric optometrists and ophthalmologists by median household income revealed a higher household income among counties with pediatric ophthalmologists and no pediatric optometrist ($76,126.87 vs. $68,681.77; 95% CI, 2,519.51–12,370.69; P = .003). Population demographics related to education level also showed counties with pediatric ophthalmologists had a higher mean population with bachelor’s degrees than counties without pediatric optometrists (P <.001).

Overall, counties with neither pediatric optometrists nor ophthalmologists had the lowest mean household income (difference, –$10,967.74; P <.001) and mean population with bachelor’s degrees (difference, –161,902; P <.001), compared with counties with practitioners.

Despite these disparities in access to pediatric eye care, with a range of potentially related factors, Cavuoto and colleagues indicated there has been limited analysis into the differences in pediatric visual acuity outcomes, based on population demographics across the US.

“Further investigation is necessary to determine if differences exist in pediatric visual acuity outcomes based on demographic characteristics such as socioeconomic status and distance to practitioners,” they wrote.
References

1. _{Siegler NE, Walsh HL, Cavuoto KM. Access to Pediatric Eye Care by Practitioner Type, Geographic Distribution, and US Population Demographics. JAMA Ophthalmol. Published online April 11, 2024. doi:10.1001/jamaophthalmol.2024.0612}
2. _{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 Ophthalmol. 2023;141(3):242-249. doi:10.1001/jamaophthalmol.2022.6010}
3. _{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 Ophthalmol. 2023;141(3):249-250. doi:10.1001/jamaophthalmol.2022.6011}