More than 93% of US counties lack a pediatric optometrist
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Key takeaways:
- More than 90% of counties lack a pediatric ophthalmologist and 93.5% lack a pediatric optometrist.
- Counties with neither specialist had the lowest mean household income and population with bachelor’s degrees.
Communities lacking pediatric eye care providers had lower mean household incomes and fewer people with bachelor’s degrees, highlighting the importance of improving access in underserved areas, according to a study in JAMA Ophthalmology.
“This research demonstrates both imminent need and opportunity for collaboration between the optometry and ophthalmology communities to increase access to pediatric eye care across the country,” Nora Siegler, BA, a medical student at the University of Miami Miller School of Medicine, told Healio.
In a cross-sectional study, Siegler and colleagues accessed four public databases in April 2023 to identify the addresses of 586 pediatric optometrists (48.5% men) and 1,060 pediatric ophthalmologists (55.7% men). Researchers used those locations, as well as data from the 2020 U.S. Census, to determine the geographic distribution of pediatric eye care practitioners and its association with population demographics and service coverage.
According to results, 6.5% of U.S. counties had at least one pediatric optometrist, while 9.7% had at least one pediatric ophthalmologist, with researchers noting substantial geographic overlap (OR = 12.7; P < .001). Of 2,834 counties without a pediatric ophthalmologist, 96.4% also lacked a pediatric optometrist. Overall, researchers reported that 90.2% of counties lacked a pediatric ophthalmologist — a finding that has remained unchanged since 2022 — and 93.5% of counties were without a pediatric optometrist.
Of 308 counties with at least one pediatric ophthalmologist, there was a mean one ophthalmologist per 54,706 individuals aged 19 years or younger, and of 203 counties with at least one pediatric optometrist, there was a mean one optometrist per 62,739 individuals aged 19 years and younger.
“It was a surprise that there were more pediatric optometrists on average than pediatric ophthalmologists among counties with providers, despite there being fewer overall pediatric optometrists than pediatric ophthalmologists,” Siegler said.
Results also showed that the mean household income of counties with pediatric ophthalmologists was significantly higher than that of counties with pediatric optometrists ($76,126.87 vs. $68,681.77; P = .003), a trend that continued when assessing mean population with bachelor’s degrees (79,016 vs. 23,076; P < .001).
Counties that had neither pediatric ophthalmologists nor optometrists had the lowest mean household income ($57,714.03 vs. 78,388.67; P < .001) and lowest mean population with bachelor’s degrees (5,113 vs. 167,015; P < .001).
“These findings suggest that pediatric optometrists may be serving lower resourced communities and regions with lower population density than pediatric ophthalmologists, but because there are shortages of both providers, there still exist massive deserts in access to pediatric eye care,” Siegler added.
“There is clearly a need for all pediatric eye practitioners among underserved populations,” study author Kara M. Cavuoto, MD, professor of clinical ophthalmology with a secondary appointment in pediatrics at the Miller School of Medicine, told Healio. “Pediatric optometrists play a crucial role in providing pediatric eye care to lower-resourced communities and regions with lower population density, as demonstrated by our data.
“This highlights the importance of increasing financial incentives for optometrists to see pediatric patients, increasing pediatric training among optometrists and increasing collaboration between optometrists and ophthalmologists to maximize coverage in areas with reduced access to care.”
Perspective
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Siegler and colleagues’ point is true: There is a shortage of pediatric eye care, especially in rural counties, which drives health inequity in a vulnerable population. Good vision and eye health are essential for optimal development in children, as vision problems can hinder learning ability, leading to reduced opportunity and overall quality of life.
However, the article greatly underestimates optometrists’ reach and role in pediatric eye care by only identifying pediatric optometrists listed on AOA and AAO websites and by assuming that optometrists who are not listed as “pediatric” do not see patients aged 0 to 19 years.
So, what can optometrists do to close the gap of health inequity? A large percentage of pediatric visual impairment is simply due to undetected and uncorrected refractive error and can be diagnosed and treated in a comprehensive eye exam performed by all optometrists, pediatric or not. To close the gap, optometrists must stay up-to-date and empathize with the climate and environment in which our young patients live: increasingly digital and myopic, causing a younger age of onset of refractive error and, therefore, requiring earlier treatment to set them up for success.
I urge all optometrists to not view the designation of “pediatric” as a boundary and to recognize our ability and responsibility to participate in our next generations’ eye care.
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