In this important study, Dr. Cecilia Lee, Dr. Aaron Lee, and their co-authors used census and mapping data to quantify how far Medicare patients travel to access eye care in the contiguous United States. This type of information about medically underserved geographic areas is essential for improving access to care. The authors note that the issue of rural access to care has been cited as a reason for increasing the number of eye care providers in the United States. Some providers also use access to care as an argument for increasing optometrists' responsibilities and scope of practice.
The authors used a large amount of data to determine the driving routes and times to the nearest optometrist and ophthalmologist for 3.79x107 people older than 65 years, representing each state in the contiguous United States. In addition, addresses for 17,071 ophthalmologists and 25,508 optometrists were geocoded from the 2012 Medicare Provider Utilization and Payment Data. They found that ninety percent of the Medicare population lived within 13.66 minutes of an optometrist and 25.21 minutes of an ophthalmologist. They analyzed each region of the United States to determine the difference in travel time to reach an optometrist versus an ophthalmologist, and the region with the least difference was the Mideast (only 2.10 minutes for 75% of the population). The 2 regions with the highest differences were the Plains and the Rocky Mountains, with travel time differences of 16.84 and 10.23 minutes, respectively, between reaching the nearest optometrist versus nearest ophthalmologist.
The authors used a unique method to create driving routes from each census block group to the nearest eye care provider, providing a more sensitive method of assessment than previous access to care studies, and conclude that an estimated 90% of the US Medicare population live within 15 minutes' driving time of an optometrist and half an hour of an ophthalmologist. In addition, in the case that a patient is seen by an optometrist and needs an elevated level of care, 90% of optometrists practice within 20 minutes of an ophthalmologist. These findings have implications for the future planning of adequate eye care delivery in the United States.
Lee CS, Morris A, Van Gelder RN, Lee AY. Evaluating Access to Eye Care in the Contiguous United States by Calculated Driving Time in the United States Medicare Population. Ophthalmology. 2016 Dec;123(12):2456-2461. doi: 10.1016/j.ophtha.2016.08.015. Epub 2016 Sep 12. PubMed PMID: 27633646; PubMed Central PMCID: PMC5608548.