Geographic Disparities in Ophthalmologist Access Persist

A new county-level analysis of eyecare workforce distribution in the United States suggests that geographic disparities in access to ophthalmology persist and may be widening, especially in rural communities, even as optometrist availability continues to grow. The study found that ophthalmologist density declined slightly from 2010 to 2021, while optometrist density increased across all county types.Researchers from Weill Cornell Medical College in New York used the Area Health Resource File to examine nonfederal ophthalmologists and optometrists across all US counties from 2010 through 2021. A total of 3,218 counties were included in the analysis and classified into large metropolitan (n=472), small or medium metropolitan (n=763) and rural groups (n=1,983). The team assessed annual provider density per 100,000 population and used a Chow test to determine whether trends differed by county type. Their findings were published last week in Graefe's Archive for Clinical and Experimental Ophthalmology. These graphs from the study show OD and OMD density across rural, small/medium and large metropolitan counties by provider type from 2010 to 2021. Solid lines represent means. Shaded regions indicate 95% confidence intervals. Although optometrist availability has increased, the growing number of “dead zones” with zero practicing nonfederal ophthalmologists underscores the important role ODs can play in improving access, especially in rural communities that already face a higher risk for vision-threatening disease. Researchers emphasize the need for targeted workforce and policy initiatives, expanded scope where appropriate and stronger referral and teleophthalmology partnerships. Photo: Shah J, et al. Graefes Arch Clin Exp Ophthalmol. July 2, 2026. Click image to enlarge.  The results showed that urban counties consistently had greater provider density than rural counties for both specialties. Median ophthalmologist density per 100,000 people was 2.5 in large metropolitan counties and 2.6 in small or medium metropolitan counties, compared with 0.0 in rural counties. Median optometrist density was also higher in urban areas: 12.9 in large metropolitan counties and 12.3 in small or medium metropolitan counties vs. 10.2 in rural counties. From 2010 to 2021, ophthalmologist density decreased in 36.0% of large metropolitan counties, 37.8% of small or medium metropolitan counties and 16.0% of rural counties. Optometrist density declined in 14.8%, 20.8% and 18.7% of those county groups, respectively. Overall, however, optometrist density rose by a mean of 2.3 per 100,000 people while ophthalmologist density fell by 0.09 per 100,000 population, on average.The data highlight ongoing concern about ophthalmology access in rural counties, as these regions were far more likely than metropolitan counties to have no practicing nonfederal ophthalmologist at all. Such counties, referred to as “dead zones,” increased modestly from 60.7% in 2010 to 62.7% in 2021 and were disproportionately concentrated in rural areas.“Although provider density does not directly measure levels of care provided to patients,” the researchers wrote in their paper, “the coexistence of low rural ophthalmologist availability and increasing optometry density suggests that optometrists are depended upon for triage and treatment of patients in underserved regions.” Because of this, the authors argue that ophthalmologists should strengthen rural referral networks and expand teleophthalmology services to make specialty care more accessible for patients who need it. Additionally, they pointed out that optometry’s expanding scope of practice could improve access to essential procedures such as laser capsulotomy and intravitreal anti-VEGF injections.“Further investigation is needed into determinants and predictors of workforce density and evaluation of eyecare access,” the authors concluded.Click here for the journal source. Shah J, Ahmed H, Weiss MB, et al. Eye care workforce density by provider type in urban and rural counties in the United States, 2010 to 2021. Graefes Arch Clin Exp Ophthalmol. July 2, 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.