Optometry increasingly shoulders medical eye care as ophthalmology shrinks

As ophthalmology continues a workforce contraction, recent data confirms a shift in how Americans receive their eye care with optometry increasingly delivering medical eye care services. 

Just two years after a landmark Ophthalmology report predicted a workforce decline of 12% full-time equivalent (FTE) ophthalmologists by 2035, concurrent to a 24% increase in demand, current modeling data suggest about 17,000 FTE ophthalmologists in care settings. Factoring a net loss of 126 physicians annually, ophthalmology is projected to have the second-worst rate of workforce adequacy across 38 medical and surgical specialties. 

⏩ ‘Inadequate to meet demand:’ Report spotlights declining ophthalmology workforce 

At issue is overall increased demand for eye care services, largely driven by Americans’ aging population. In fact, the U.S. population has entered an inflection point where the share of 60-and-older adults is greater than ever before in history. And because of that, the prevalence for age-related eye diseases is expected to increase: 

• 2.5% annual increase in cataracts
• 2.3% annual increase in glaucoma
• 2.9% annual increase in macular degeneration
• 2% annual increase in dry eye disease
• 2.7% annual increase in diabetic retinopathy 

The Ophthalmology report emphasized the widening supply-demand gap, as well as noting the acute effects experienced by rural and underserved areas where ophthalmology’s workforce adequacy falls off dramatically. 

“The decline isn’t just a projection anymore; it’s our daily reality,” says Richard Edlow, O.D., the Eyeconomist author and former AOA Information & Data Committee chair of 15 years. “There is no question that the U.S. has a serious issue with the eye care workforce, but it won’t be solved by looking at ophthalmology as a standalone profession without recognizing optometry’s role in the solution.” 

In stark contrast to ophthalmology, optometry stands to net an additional 513 physicians annually at a time when Americans’ demand for both routine and medical eye examinations is ballooning, over 19% and 62% respectively, projected between 2021 and 2040. 

Such is the case; optometry’s footprint in medical eye care is expanding at a clip. Recent Medicare Fee-For-Service (FFS) data confirms this trend with: 

• 34.7% of all Medicare FFS eye examinations in 2023 were provided by optometrists, a steady increase from just 29.9% of exams in 2017.
• 42% of all Medicare FFS patients in 2021 were cared for by optometrists, an increase from just 35.7% in 2013. 

Filling the access gap 

Optometry already provides over a third of all medically necessary eye exams for Medicare FFS patients, about 8.5 million exams in 2021 alone. Fully utilizing optometry’s geographically dispersed workforce, as well as fully recognizing optometry’s advancing scope of practice, will allow the shrinking ophthalmology workforce to focus on complex cases, while leveraging optometry for routine and preventive medical eye care. 

"Optometrists are the primary—and often the only—providers in these underserved areas,” noted Rich Castillo, O.D., D.O., co-chair of the AOA’s Contemporary Practice Task Force, in reviewing the Ophthalmology workforce report. 

“Communities benefit by promoting interdisciplinary collaboration between all eye care providers, encouraging a team-based approach to eye care and leveraging optometric physicians’ expertise in primary eye care.” 

Case in point—cataract care. In Dr. Edlow’s annual Economic Overview of the Ophthalmic Industry report, he calls attention to demand for cataract surgeries relative to a declining ophthalmology workforce. In 2025, approximately 16,369 FTE ophthalmologists were available to provide about 5 million cataract surgeries. But by 2030, over 1,200 fewer ophthalmologists will be available to meet the demand for 6 million cataract surgeries. That’s not accounting for other age-related conditions, such as glaucoma, diabetic retinopathy or age-related macular degeneration.   

Dr. Edlow notes that the opportunity before optometry remains the same as ever—focus on delivering both medical eye care and routine vision care.  

“Medical eye examinations are growing much more rapidly than vision exams; we see it in the data,” Dr. Edlow shared at Optometry’s Meeting® 2025. “This is an incredible opportunity for optometry.”