COUNTY-LEVEL ANALYSIS OF EYE EXAM ACCESS AND UTILIZATION IN THE UNITED STATES

ABSTRACT

Purpose

The eye exam is a critical tool for the prevention, screening, and diagnosis of ocular and systemic conditions. In this study, we characterize county-level variation in eye exam access and utilization for Medicare patients in the United States.

Methods

This nationwide study uses the Medicare Physician & Other Practitioners – by Provider and Service dataset. We included all ophthalmologists and optometrists who performed eye exams on Medicare beneficiaries within a United States county in 2019. For every county where exams were performed, we calculated the number of practicing vision testing providers, percentage of providers classified as ophthalmologists, and the number of exams per 100 Medicare beneficiaries. Multiple linear regression was used to characterize associations between these variables and county characteristics, including measures of poverty, education, and income.

Results

In 2019, 28937,540 eye exams were performed by 46,000 providers in 2,291 U.S. counties. In the median county, 34.9 eye exams were provided per 100 Medicare beneficiaries. The average county had 20.1 exam providers, 16.5% of whom were ophthalmologists. There were a median 6.6 eye exam providers for every 10,000 Medicare beneficiaries in the average county. The average provider performed 517.8 exams. Regression showed counties with lower median household incomes, higher poverty rates, or fewer high-school graduates had fewer eye exam providers per 10,000 Medicare beneficiaries and fewer eye exams performed per 100 Medicare beneficiaries.

Conclusions

We find significant county-level variation in eye exam utilization and provider availability. This reflects broader, well-recognized trends in socioeconomic health disparities in the U.S.

KEYWORDS:

• Eye exam
• healthcare disparities
• provider access
• geographic inequity
• preventative care

Acknowledgments

All authors contributed to study conception, analyses, manuscript preparation and revision. All authors approved the manuscript before submission. Article contents have not been previously presented. No financial disclosures were reported by the authors of this paper.

Disclosure statement

No potential conflict of interest was reported by the authors.

Financial support

No financial disclosures were reported by authors of this paper.

Exclusivity statement

This manuscript has not been published anywhere previously and is not simultaneously being considered by any other publication.

Additional information

Funding

The author(s) reported that there is no funding associated with the work featured in this article.