Uveitis continues to be a major driver of vision loss in the United States, accounting for up to 15% of blindness and requiring long-term, highly specialized care. But while the burden of disease is growing, the number of physicians trained to manage it may be heading in the opposite direction.
A new workforce projection study published in the American Journal of Ophthalmology models what the field could look like over the next three decades. The findings suggest a widening gap between patient needs and specialist availability, with potential consequences for access, outcomes, and health equity.
Some background: Why uveitis care is already stretched thin.
Uveitis is not a quick-visit condition. It often involves chronic inflammation, systemic disease links and long-term immunosuppressive treatment, all of which demand time and subspecialty expertise.
Despite that, the U.S. currently has just over 200 uveitis specialists, and they are heavily clustered in major metro areas. Many states have none at all, forcing patients to travel long distances for care.
- At the same time, fellowship interest has lagged behind other ophthalmology subspecialties, partly due to lower procedural volume and reimbursement challenges.
How researchers projected the future workforce.
To understand where things are headed, researchers built simulation models using real-world workforce data, fellowship match trends, and physician retirement patterns.
They used Monte Carlo simulations to test different scenarios, ranging from low trainee entry to more optimistic growth. These models accounted for factors like age, mortality, retirement and variability in fellowship participation over time.
- The goal: To estimate how many specialists would remain in practice through 2055 under different conditions.
Study participants: Who is currently in the uveitis workforce?
The analysis identified 224 practicing uveitis specialists in the US, based on the American Uveitis Society database.
Most are mid-career, with a median of 12 years in practice, but the workforce is unevenly distributed. Entire states lack a single specialist, while others have fewer than one per million residents.
- This uneven distribution already creates access challenges, particularly for patients in rural or underserved areas.
What we learned: A shrinking workforce is the most likely outcome.
Under the most conservative scenario, the number of uveitis specialists is projected to drop by about one-third by 2055, falling to roughly 145 physicians nationwide.
- Even maintaining current training levels, which is around 12 new fellows per year, would only result in modest growth that barely keeps pace with population increases.
The only scenario that meaningfully improves access is one where fellowship participation rises to about 20 new trainees annually, which could nearly double the workforce over time.
Here's why the pipeline is struggling to keep up.
Several factors are driving the shortage. Uveitis care is time-intensive, often requiring longer visits and complex coordination, but reimbursement does not always reflect that workload.
Burnout is also a concern, with many specialists reporting high stress levels and limited support staff.
- On top of that, many uveitis specialists split their time across other subspecialties, meaning the actual availability of dedicated care is even more limited than the raw numbers suggest.
Geographic gaps could make access worse.
The study highlights major disparities in where specialists are located.
Eleven states currently have no uveitis specialists, and many others have extremely low provider density. Patients in these areas often face long travel times, delayed care and increased risk of complications.
As older physicians retire, these gaps could widen further, especially in regions already at risk of workforce attrition.
What do the experts say could help close the gap?
The authors point to several potential solutions aimed at strengthening the workforce pipeline.
These include hybrid fellowship models that allow dual subspecialty training, expanded mentorship opportunities and policy efforts to improve reimbursement and reduce administrative burden.
- Emerging tools like artificial intelligence may also help improve efficiency in uveitis clinics, potentially easing some of the strain on providers.
Anything else?
Because the projections rely on registry data and modeled assumptions, they may not reflect every practicing specialist or future changes in training patterns.
The study also does not define the ideal number of specialists needed, making it difficult to determine how large the gap between supply and demand will ultimately be.
What this means for patient care moving forward.
The trajectory is clear: Without intervention, the uveitis workforce is unlikely to keep up with patient needs. Expanding training alone may not be enough.
Addressing structural challenges within the field—like workload, reimbursement and geographic distribution—will likely be just as important to maintaining access to care in the long term.