How to avert an eye care crisis

An aging population, a commensurate demand for services for age-related eye conditions, and thinning ranks of ophthalmologists are conspiring to contribute to dire concerns over the public’s access to essential eye care in the future, says Richard Edlow, O.D., noted Eyeconomist author and industry lecturer.

We are looking at a looming crisis, Dr. Edlow says, unless access is addressed.

“We will have a crisis on our hands that’s completely avoidable,” Dr. Edlow says. “We’ve got patients who are going to require care, and they will not be able to find doctors to meet that demand.

“Who are they going to call for their chronic conditions (cataract, glaucoma, macular degeneration and diabetic retinopathy)?”

For one, doctors of optometry.

Solutions?

Dr. Edlow presents to optometrists, state leaders and AOA state executive directors, equipping them with the data for them to present to their state legislators and policymakers. In presentations in states around the country, he voices his real concerns based on research and offers solutions to the potential crisis.

1. Collaboration care optimization. That means ophthalmologists and optometrists working together, whether they are under the same roof or have a strong referral relationship at separate sites, Dr. Edlow says. Without more collaboration, Dr. Edlow suggests, patients can look forward to delays in getting appointments scheduled and receiving timely care. “If I were running the American Academy of Ophthalmology, after all of these studies and statistics that have come out in the past two years on the increasing demand for eye care services, the very first thing I’d do  would be to call the American Optometric Association and sit down and say, ‘Let’s come up with a solution. Let’s look at the public health concerns.’”
2. Leverage optometrists with complementary skills: Dr. Edlow points to the results of a 2024 study by economists, “Seeing is believing: The effect of optometrist scope of practice expansion,” to augment his argument that optometry is an answer to the care gap. In the study, researchers found that, at three junctures in time, when scope expanded for optometrists, eye health rose in the U.S. As it expanded state-by-state, vision impairment fell by 12%. This decline bodes well for greater scope expansion in the future: “These findings have important implications on ongoing policy debates on scope of practice expansions of optometrists and other health care practitioners to meet the rapidly growing demand for medical services given the limited supply of physicians.”
3. Expand scope: Doctors of optometry in 12 states now provide advanced laser procedures—safely. It’s incumbent on each state legislature to expand its scope of optometry or they will face an aging population who will not be able to get ready access to care, Dr. Edlow says. “Scope expansion is critical in those states without up-to-date privileges, again, to help mitigate the upcoming public health crisis,” he says.

Supply and demand

Dr. Edlow cites in his presentations research published in Ophthalmology regarding whether there was adequate supply of ophthalmologists to meet increasing demand for their services.

That report’s authors used two workforce forecasting models to project whether the number of ophthalmologists could meet increasing demand, using Health Resources and Services Administration and Health Workforce Simulation Model data.

• Under the status quo model, workforce supply was assumed to meet national demand as of 2020, yet FTEs steadily decreased by 2,650 FTE ophthalmologists by 2035 while projected total demand increased by 24% or 5,150 FTEs.
• Under the reduced barriers model, workforce supply was shown already inadequate to meet national demand in 2020, short by 1,920 FTEs (authors note a surplus of 330 FTEs in metro areas and a deficit of 2,250 FTEs in nonmetro areas). Assuming a steady decrease by 2,650 FTE ophthalmologists by 2035, projected total demand increases by 25% or 5,840 FTEs.

Said those authors: “For the status quo scenario, where it is assumed that starting supply is adequate to meet total demand, there is 100% adequacy in 2020. Adequacy decreases each year as the total projected demand outpaced projected supply.

“By 2035, the projected ophthalmology workforce adequacy is 70%,” they add. “Under scenarios where there are reduced barriers to ophthalmology care access, the projected ophthalmology workforce is only 64% adequate to meet the projected demand for ophthalmologic services in 2035.”

Percent adequacy is defined by the authors as “the relationship between the projected future demand.”

Save the date! 

If AOA state affiliates are interested in elevating advocacy in their states, save these dates for the AOA State Government Relations Center (SGRC) Regional Advocacy Meetings in 2025. 

• Aug 15-16 in Chicago, Illinois
• Oct. 24-25 in Phoenix, Arizona 

Registration will open soon, and additional details will come.