What About the Children?

In his article for the AAO, Daniel Christian Terveen voiced his concerns about the national shortage of pediatric ophthalmologists in the US. In South Dakota alone, Terveen reports that there is only one pediatric ophthalmologist who provides all of the retinopathy of prematurity (ROP) care and – as a result – has a several month clinical and surgical wait time (1). Owing to lower reimbursement rates, the difficulty of performing eye examinations in children, and a lack of mentorship, only 81 percent of all fellowships were filled in 2021 in the US – a statistic that looks set to deteriorate (1).

To appropriately address how the needs of important services, such as healthcare, have changed in the last 15 years since the last pediatric ophthalmology service analysis in 2007, researchers from The University of Miami Miller School of Medicine assessed the number and location of pediatric ophthalmologists in the US in relation to US population demographic characteristics (2).

US counties were split into two groups for statistical analysis: the first had at least one practicing pediatric ophthalmologist, the second group had zero.

A total of 1056 POs were identified in the study, with men (611) slightly outnumbering women. The four states with the most pediatric ophthalmologists were California, New York, Florida, and Texas – also the four most populous states. Counties that had one or more pediatric ophthalmologists had a higher median household income compared with the 90 percent of counties that were found to have zero pediatric ophthalmologists. Notably, the proportion of families in each county without internet service, people younger than 19 without health insurance, and households without vehicle access were all greater in counties with zero pediatric ophthalmologists compared with counties with one or more.

In short, pediatric ophthalmologic care  access correlates with lower socioeconomic status, and the authors note that, since a similar study was conducted in 2007, the disparity has only increased.

“Increasing exposure to pediatric ophthalmology during ophthalmology residency and even at earlier stages in training, such as medical school and college, may help increase awareness of the subspecialty,” says Kara M Cavuoto – one of the analytical researchers. “Also important is the dedication of resources to the development of pediatric ophthalmology programs in underserved areas with incentives for those to continue their practice in those areas after training. Improved compensation and financial incentives would greatly assist in attracting new pediatric ophthalmologists and maintain the number of pediatric ophthalmologists in practice.”