Access to Pediatric Eye Care by Practitioner Type, Geographic Distribution, and US Population Demographics

Abstract

Importance: Investigating disparities in service coverage of pediatric optometrists and pediatric ophthalmologists in relation to patient demographics will illuminate vulnerable populations and inform future interventions.

Objective: To characterize the geographic distribution of pediatric eye care practitioners and analyze its association with population demographics.

Design, setting, and participants: In this cross-sectional study, 4 public databases were used to identify the addresses of pediatric optometrists and pediatric ophthalmologists in the US in April 2023. Addresses were geocoded, and population demographic data were collected. Pediatric optometrists and pediatric ophthalmologists listed in the public databases, as well as respondents to the 2020 US census, were included in this study. Data were analyzed from April to July 2023.

Exposures: Public databases and US census data of eye practitioners and their practice locations.

Main outcomes and measures: Geographic distribution of pediatric optometrists and pediatric ophthalmologists as listed in public databases and correlations between service coverage and US population demographics.

Results: A total of 586 pediatric optometrists (302 female [51.5%]) and 1060 pediatric ophthalmologists (590 male [55.7%]) were identified. Among US counties, 203 (6.5%) had at least 1 pediatric optometrist, and 308 (9.7%) had at least 1 pediatric ophthalmologist, showing substantial geographic overlap (odds ratio, 12.7; 95% CI, 9.4-17.4; P < .001). In the 2834 counties without pediatric ophthalmologists, 2731 (96.4%) lacked pediatric optometrists. There were more pediatric ophthalmologists per million people (3.3) compared with pediatric optometrists per million people (2.5) across all states (difference, 0.8; 95% CI, 0-1.9; P = .047). Among counties with practitioners, the median (IQR) number of pediatric optometrists per million people was 7.8 (0.4-245.0), surpassing the median (IQR) number of pediatric ophthalmologists per million people, 5.5 (1.0-117.0). Counties with pediatric ophthalmologists had higher mean (SD) household incomes than counties with pediatric optometrists ($76 126.87 [$21 879.23] vs $68 681.77 [$18 336.40]; difference, -$7445.10; 95% CI, $2519.51-$12 370.69; P = .003) and higher mean (SD) population with bachelor's degrees than counties with pediatric optometrists (79 016 [82 503] vs 23 076 [44 025]; difference, -55 940; 95% CI, -73 035 to -38 845; P < .001), whereas counties with neither specialist type had the lowest mean (SD) household income ($57 714.03 [$2731.00] vs $78 388.67 [$18 499.21]; difference, -$20 675.00; 95% CI, -$21 550.90 to -$19 799.10; P < .001) and mean (SD) population with bachelor's degrees (5113 [12 875] vs 167 015 [216 486]; difference, -161 902; 95% CI, -170 388.9 to -153 415.1; P < .001) compared with counties with practitioners.

Conclusions and relevance: Geographic disparities in pediatric eye care access, compounded by socioeconomic differences, underscore the urgency of augmenting practitioner support in underserved areas.

Figure 1.. Geographic Distributions of Pediatric Optometrists (PT) and Pediatric Ophthalmologists (PO) per Population Younger Than 19 Years by County

CONANP indicates Comisión Nacional de Áreas Naturales Protegidas; EPA, Environmental Protection Agency; FAO, Food and Agriculture Organization; HERE, HERE Map Data; NOAA, National Oceanic and Atmospheric Administration; USGS, United States Geological Survey.

Figure 2.. Distributions of Pediatric Optometrists (PT) and Pediatric Ophthalmologists (PO) by Median Household Income by County

CONANP indicates Comisión Nacional de Áreas Naturales Protegidas; EPA, Environmental Protection Agency; FAO, Food and Agriculture Organization; HERE, HERE Map Data; NOAA, National Oceanic and Atmospheric Administration; USGS, United States Geological Survey.