In a study published in JAMA Ophthalmology, researchers investigated the geographic distribution of pediatric eye care practitioners (ECPs) in the United States.
Give me some background first.
Early detection of eye diseases in children is crucial to ensuring their quality of vision, quality of life (QoL), social, and emotional development.
Further, early identification and treatment of disruptions in a patient’s vision in infancy or childhood can often prevent loss of sight.
Now, talk about the study.
Investigators sought to identify the geographic distribution of pediatric eye care providers compared to patient demographics in order to define populations lacking access to care.
Who was included in the study?
This cross-sectional study utilized four public databases to identify the practice locations of pediatric optometrists and ophthalmologists across the U.S. from April 2023 to July 2023.
The researchers geocoded all clinical practice addresses and collected population and demographic data.
The study included:
- Pediatric optometrists listed in the public databases
- Pediatric ophthalmologists listed in the public databases
- Respondents to the 2020 U.S. census
And the participant breakdown?
The study identified a total of 586 pediatric optometrists and 1060 pediatric ophthalmologists.
Of the pediatric optometrists 302 (51.5%) were female. Of the pediatric ophthalmologists, 590 (55.7%) were male.
Findings?
Among all U.S. counties, it was identified that:
- 203 (6.5%) had at least one pediatric optometrist (odds ratio, 12.7; 95% Confidence interval [CI], 9.4-17.4; P < .001)
- 308 (9.7%) had at least one pediatric ophthalmologist (odds ratio, 12.7; 95% CI, 9.4-17.4; P < .001)
Let’s focus on ophthalmologists.
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, -$7,445.10; 95% CI, $2519.51-$12 370.69; P = .003
- 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
And how did this compare to counties with neither pediatric ODs or MDs?
Compared to counties with practitioners, these counties had:
- The lowest mean (SD) household income
- $57,714.03 ($2,731.00) vs $78,388.67 ($18,499.21); difference, -$20,675.00; 95% CI, -$21,550.90 to -$19,799.10; P < .001
- The lowest mean (SD) population with bachelor's degrees
- 5,113 (12,875) vs 167,015 (216,486); difference, -161 902; 95% CI, -170 388.9 to -153 415.1; P < .001
Exactly how many counties were without pediatric ECPs?
Of the 2,834 counties without pediatric ophthalmologists, 2,731 (96.4%) also lacked pediatric optometrists.
These counties were reported to have:
- Lower than average median household income
- Smaller portion of the population with bachelor's degrees
- Lower home internet access
What states lacked the most access?
The following states had access to only one pediatric optometrist:
- Georgia
- Idaho
- New Mexico
- Rhode Island
- South Carolina
The following states only had access to two pediatric ophthalmologists:
- Vermont
- Wyoming
It was reported Washington, D.C. had zero pediatric optometrists.
And the states with the highest access?
The states with the highest access to pediatric optometrists were:
- Illinois (61)
- Ohio (34)
- Texas (33)
- California (32)
The states with significantly higher access to pediatric ophthalmologists were:
- California (115)
- New York (90)
- Florida (64)
- Texas (56)
- Massachusetts (52)
Limitations?
The researchers noted that, since this study utilized U.S. census data for demographics, the method resulted in the exclusion of several demographics—including undocumented immigrants and international patients—who would have not responded to the census from their data.
They added that their research may have overlooked discrepancies in access to pediatric eye care such as in regions that have a high concentration of census nonrespondents.
Expert opinion?
The researchers noted that this study highlighted the urgency of extending pediatric eye care access in the underserved areas identified in their data.
Take home.
Based on this data, there is a large portion of counties in the U.S. that lack access to pediatric eye care.
Thus, the study authors encourage further research to assess possible differences in visual acuity outcomes between the counties.