Rural Patients Have Limited Access to Retina Specialists, Study Shows

To address racial disparities in ophthalmology among socioeconomically disadvantaged groups, authors suggest initiatives such as expanding insurance coverage, increasing the availability of low-cost or free eye care services, teleophthalmology services and providing transportation options for patients who live in underserved areas. Photo: Mark Dunbar, OD. Click image to enlarge. There have been studies on the social and demographic characteristics of patients undergoing retinal detachment (RD) repair, but they are somewhat limited. In a recent study, researchers examined trends in RD repair surgeries in the Medicare population in an effort to characterize the types of patients most at risk. They also examined the impact of retinal surgeon demographics and location of practice on RD repair and found significant racial, geographic and gender differences are observed within the Medicare patient population receiving RD repair surgeries, as well as significant geographic and gender disparities in the retinal surgery workforce. The findings were reported in Retina.A total of 230,802 RD repair surgeries were performed on Medicare beneficiaries from 2011 to 2021. Pars plana vitrectomy (PPV) was the most common procedure, while the proportion of scleral buckle surgeries steadily declined from 6.38% to 1.95%. Most patients undergoing RD repair were white and from urban areas.Patients with an increased likelihood of requiring complex RD repair were more likely to be non-white, female, below age 65 or over 75, have diabetes and live in neighborhoods with lower household incomes and higher ADI.Socioeconomic disadvantaged and non-white patients were more likely to have RD cases that were coded as complex. The authors explained it is likely that these cases were complicated by presence of proliferative vitreoretinopathy due to delays in diagnosis or combined rhegmatogenous and tractional RD cases from advanced proliferative diabetic retinopathy. “Barriers such as inability to take time off work for follow-up visits, difficulty with transportation, lack of education about the disease severity or prejudice from providers disproportionately affect patients from low-income neighborhoods and racial minoritized groups, which can prevent surveillance and result in delayed presentation leading to more complex presentation of cases,” they wrote in their paper.For patients aged 75 and up, delays in accessing care appear to lead to more complex pathology and could contribute to the added complexity of RD repair. In addition, findings from this study suggest that financial costs, transport limitations and socioeconomic status could adversely impact women who develop an RD.Most retinal surgeons were male (84%) and practiced in urban areas (95.3%), although the proportion of female retinal surgeons increased over time.A previous study found that the medical workforce has historically demonstrated unequal female representation. While the proportion of female retinal surgeons increased over the study period, they performed fewer annual RD repair surgeries on average (4.91) compared to male surgeons (8.1). “Differences in surgical volume between male and female ophthalmologists have been observed as early as in residency as well as fellowship, and based on our findings, seem to persist in practice,” the authors noted in their paper.Studies of other medical specialties have identified differences in how men and women practice medicine. “Female physicians are more likely to have patient-centered communication and may have better clinical outcomes,” the authors wrote in their paper. “It would be interesting to see whether these differences exist in ophthalmology. Further study is needed to identify factors that can help address the disparity between women and men, and the factors between men and women that optimize clinical outcomes in ophthalmology.”Lastly, around 20% of patients lived in rural areas, yet only 4.7% of retina surgeons practiced in a rural setting. This is consistent with a previous study who found low eyecare provider availability including that of retina specialists in counties with low population densities and a large population of rural residents. “Our data suggests that access to retina care is unfortunately unequitable, and rural patients have limited access to retina specialists,” the authors wrote in their paper. “Incentives for retina specialists who provide care to rural areas might help to redistribute the retina surgeon work force. For example, higher Medicare reimbursements in rural areas would encourage retina specialists to care for patients in rural areas.”Click here for the journal source. Zafar S, Homes D, Dun C, et al. Patient and surgeon disparities in retinal detachment repair surgery in the Medicare population from 2011-2021. Retina. March 16, 2026. [Epub ahead of print].  This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.