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State Advocacy

The AOA supports the optometric community by providing information, guidance and advice in both the state legislative and political arena.

Clouds for advocacy

Doctors of optometry deliver an essential component of patients' overall health and provide more than two-thirds of primary eye health care in America. More than 99% of the U.S. population lives in counties with a doctor of optometry. In more than 5,800 communities nationwide, doctors of optometry are the only primary eye and vision care providers.

Through our state legislative efforts we aim to:

  • Serve as both a political and legislative resource for state associations around the country.
  • Monitor state laws and regulations relating to the practice of optometry.
  • Monitor the impact of federal laws and regulations on the states state laws and regulations.
  • Maintain a database of state laws and regulations, as well as other comparative and analytical optometrist legislative and regulatory databases.

The American Optometric Association (AOA) is dedicated to ensuring doctors of optometry can practice to the highest level of medical eye care and patients have access to the primary eye health care they provide across the country. To enhance that access, the AOA is taking assertive steps to support states in expanding optometry's scope of practice and ensuring doctors can practice to the full extent of their education and training.

Eye and vision care access nationwide

At a time when patients are facing a potential lack of access to primary care, doctors of optometry are uniquely positioned to serve as frontline providers in primary eye care for the vast majority of U.S. patients.

Research conducted by the AOA shows 46,521 doctors of optometry are providing patient care in the United States. [1]As of February 2018, doctors of optometry practiced in more than 10,176 communities and counties that account for 99% of the U.S. population. [2]Thirty-nine percent of U.S. counties or county-equivalents (representing 8% of the U.S. population or 24.9 million individuals) have access to an doctor of optometry but not an ophthalmologist. [3]Ninety-one percent of the population is living in a county with access to both types of eye doctors.

In a letter [4]to the lawmakers in the state of Washington, the Federal Trade Commission (FTC) cited a 2015 article by Diane M. Gibson published in Preventative Medicinestating that 24% of U.S. counties had no doctor of optometry or ophthalmologist. However, the AOA Health Policy Institute (HPI), using accurate and updated data, found only 12% of counties or county-equivalents in the U.S. (accounting for 1% of the U.S. population or 3 million individuals) do not have eye doctors.

Gibson's article used 2011 data from The Area Health Resources File (AHRF) to determine the number and practice location for both doctors of optometry and ophthalmologists. [5]The source of ophthalmology data in the AHRF was the American Medical Association's (AMA) Physician Masterfile. The source of optometrist data in the AHRF was the Centers for Medicare and Medicaid Services National Provider Identification (NPI) File and not that of the AOA's Data Management System nor data from the State Boards of Optometry License Files. Doctors of optometry in the NPI data file were listed with one office address only. AOA data show that roughly 15% of practicing doctors of optometry work in more than one location. When considering access to eye care based on the number of eye doctors in a county, policymakers should be aware of the limitations of some data that may lead to inaccurate assumptions.

The AOA HPI performed a new analysis using more complete data, including data on practicing doctors of optometry obtained from the AOA Master Optometry List. This data includes multiple practice location zip codes for current licensed, practicing doctors of optometry in the U.S. Data for ophthalmology were obtained using the AMA Physician Masterfile and include the primary practice zip code for each ophthalmologist. Zipcodes from the optometrist data for all known practice locations and for the primary ophthalmologist locations were matched to U.S. Census Bureau data to determine counties in which there were eye care providers. The number of practice locations for both doctors of optometry and ophthalmologists might be incomplete and access to eye care providers may be higher than estimated in this brief.

Only 17 counties, distributed across 10 states, have populations greater than 20,000 with no doctor of optometry or ophthalmology. Only 5 counties within 4 states have populations greater 25,000 and no eye care provider (See Table 1). When considering access to eye care based on the number of eye doctors in a county, policymakers should use these more accurate and updated data.

State County name County population Percent of County populations deemed rural
TX Starr 60,968 23.7%
FL Suwannee 41,551 83.2%
TX Jasper 35,710 78.2%
GA Harris 32,024 96.7%
KY Harlan 29.278 54.2%

Credit: Health Policy Institute (HPI)/American Optometric Association (AOA)

Among the 10 largest counties in the U.S., all but one (Kings County, New York) have 20 or more eye care providers per 100,000 population.

Sixty percent of U.S. counties or county-equivalents (1,883 counties or equivalents) have more than 50% of the total population represented by rural population. [1]Eighteen percent of these counties or county-equivalents (accounting for 675,610 rural population or 1% of the total rural population in the U.S.) have no eye care provider. Doctors of optometry are practicing in the remaining 82% of counties or county-equivalents where a majority of the population is rural. Ophthalmologists are practicing in 31% of these counties or county-equivalents. Geographic access to eye care is not an issue for the overwhelming majority of the U.S. population, including the rural population. Doctors of optometry are currently practicing in counties and county-equivalents that comprise 99% of the total population in both urban and rural areas.

Contact the AOA State Government Relations Center (SGRC) for state-specific access maps for optometry/ophthalmology practice locations

[1] American Optometric Association (AOA) Professional Optometrist Data. St. Louis, Missouri. February 22, 2018.[2] U.S. Census Bureau. 2010 ZCTA to County Relationship File. Accessed March 1, 2018.[3] American Medical Association (AMA) Masterfile Physician Professional Data 2016. Chicago, Illinois. Available from: Medical Marketing Services, Inc. October 2017.[4]www.ftc.gov/system/files/documents/advocacy_documents/ftc-staff-comment-washington-state-rep-paul-graves-regarding-ssb-5411/hb-1473/proposed_advocacy_comment_-_wa_eye_care_final_2-9-18.pdf[5] Gibson, D.M. (2015) The geographic distribution of eye care providers in the United States: Implications for a national strategy to improve vision health, 73 PREVENTIVE MEDICINE. 30.[6] Gibson, D.M. (2015) The geographic distribution of eye care providers in the United States: Implications for a national strategy to improve vision health, 73 PREVENTIVE MEDICINE. 30.

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