A recent cross-sectional analysis has underscored the profound geographic and socioeconomic disparities in access to cornea-specialized ophthalmologic care across the United States. Published in AJO International, the study geocoded the locations of 1,665 cornea ophthalmologists across the country, revealing that 85.6 percent of US counties have no cornea specialist whatsoever. This stark finding raises critical concerns about the equity and reach of subspecialty eye care in the nation.
The researchers – based at the Department of Ophthalmology and Visual Science at Rutgers New Jersey Medical School – employed data from the American Academy of Ophthalmology (AAO) and the US Census Bureau, stratifying counties into those with and without at least one cornea ophthalmologist. Striking disparities emerged – counties that did have cornea specialists also had significantly higher median household incomes, greater educational attainment, higher health insurance coverage, and lower poverty rates.
Notably, the study aligns with earlier findings in pediatric and neuro-ophthalmology, which also demonstrated urban clustering and rural deficits in subspecialty coverage. States with the lowest per capita access to cornea specialists included North Dakota, Indiana, and Arkansas – regions often marked by larger geographic spread and infrastructural limitations.
Corneal diseases such as keratoconus, infectious keratitis, and corneal dystrophies often require timely, specialized management. The absence of local expertise may lead to diagnostic delays, suboptimal treatment, or increased burden on general ophthalmologists dealing with these diseases. Moreover, surgical interventions like DALK, DSAEK, or refractive procedures require not only technical proficiency but also follow-up care, further complicating access for patients in these underserved areas.
The authors propose solutions such as expanding residency training in underserved regions and leveraging teleophthalmology to bridge gaps in access. However, they also caution that provider presence alone is insufficient; to truly bridge these access gaps, future investigations must examine patient-level barriers such as travel constraints, financial hardship, and health literacy, they add.
