Study underestimates doctors of optometry providing eye care to children

May 23, 2024
Doctors of optometry say they are underrepresented in a recent study, even though they provide the vast majority of eye care in the U.S.
Pediatric Eye Care Study

Doctors of optometry are disputing research findings on eye care for children.

In a study (“Access to Pediatric Eye Care by Practitioner Type, Geographic Distribution, and US Population Demographics") published online in JAMA Ophthalmology on April 11, researchers compare the numbers of optometrists and ophthalmologists who care for children “to investigate the geographic distribution of pediatric optometrists and pediatric ophthalmologists and correlate the geographic locations with population demographics in order to identify gaps in coverage and access to care.”

“Geographic disparities in pediatric eye care access, compounded by socioeconomic differences, underscore the urgency of augmenting practitioner support in underserved areas,” the researchers conclude.

Although the study raises the important issue of children’s access to eye care—a priority of the AOA—doctors of optometry took issue with (1) citing “pediatric optometry” as a specialty when all optometrists are trained in optometry school to provide care to patients of all ages and (2) the use of an online doctor search or locator tool as the source for its flawed figures.

Researchers reported that they used online databases to identify eye doctors who served children; filters were applied to detect specialties. In the study, they wrote that “there were more pediatric ophthalmologists (3.3 per million people) than pediatric optometrists (2.5 per million people) across all states. They concluded that the study demonstrated a “nationwide gap in pediatric eye care” especially among underserved communities.

Still, doctors of optometry observed some shortcomings in the research, which researchers acknowledged under the “limitations” section that might cause the numbers of optometrists and ophthalmologists to be skewed—either overrepresented or underrepresented.

According to the AOA, doctors of optometry practice in 77% of U.S. counties and county equivalents and ophthalmologists in 44%. That would indicate better access to care provided by doctors of optometry, compared to what the study indicates.

Says former AOA president, Andrea Thau, O.D., a longtime champion of children’s vision who practices in New York: “They grossly underestimate the number and distribution of optometrists who provide pediatric care. There are tens of thousands of optometrists who provide pediatric care, not the 586 that they state.”

Study trips up on designation

As a general rule, pediatric optometry is not a designation used in the field. That’s because doctors of optometry don’t recognize specialties in the strictest sense.

“The primary document does not acknowledge that all optometrists, who have graduated from optometry school in the U.S., have had didactic and clinical experience in examining children,” says Glen Steele, O.D., professor emeritus at Southern College of Optometry and another stalwart for children’s eye and vision care. “As optometry does not recognize specialties, an optometric practitioner does not generally have the ability to identify as a pediatric optometrist, so the (study’s) numbers do not show the true number of optometrists skilled in examining children and providing those examinations.”

Dr. Thau adds, “Unlike ophthalmology, all optometrists, even those without residency training in pediatrics, or board certification or diplomate status specifically in pediatrics and vision development, are qualified to provide care to children. Optometrists’ training, both didactic and clinical, includes training in the care of all ages. Optometrists must complete rigorous training, graduate from an accredited optometric graduate program and pass national board examinations and state licensing examinations, which include proof of mastery of care of all ages.”

Many doctors of optometry are family practitioners—seeing patients of every age with all kinds of conditions, says Shane Foster, president of the Ohio Optometric Foundation, which recently received a state grant to support children in need of eye care there.

“Optometrists in rural communities, where specialty care is scarce, consider themselves family practice or primary eye care providers and see a wide range of patients,” Dr. Foster says. “In fact, in some states (such as Ohio), it may be against the state practice act to identify yourself as a ‘specialist’ of any kind.

“Primary care optometrists are well-equipped to handle most pediatric eye conditions and are capable of referring more complex cases to pediatric optometrists or ophthalmologists, when necessary,” he says.

Doctors of optometry spend four years, after undergraduate studies, focusing on learning the skills and knowledge to provide eye care to people of all ages, agrees Erica Shelton, O.D., M.S., an instructor at The Ohio State University College of Optometry.

Thus, Dr. Shelton says, doctors of optometry are considered the primary care provider for vision and eye health and are commonly located across communities.

“Infants and children are particularly vulnerable to certain eye conditions, and optometric education includes dedicated time in-classroom and in-clinic, focusing on learning about and treating pediatric vision conditions,” she says. “In addition to pediatric eye care training during school, some optometrists, with an aptitude for pediatric patient care, complete advanced training through a pediatric eye care residency, after they complete optometry school.”

Doctor searches don’t tell the whole story

The AOA Find a Doctor tool does allow users to refine their online searches with questions about what city and state they live in and the distance to the doctor. And under fields for “special emphasis” and “offers no-cost infant assessments,” searches can be further refined by users.

“The study is only as good as the data sources being used,” he says. “Using these databases would only identify optometrists and ophthalmologists who are members of the respective organizations and who have fully and accurately completed their online profiles.”

AOA: championing children’s eye care

The AOA has had a long-running commitment to children’s eye and vision care.

Most recently, the AOA supported new federal legislation—The Early Detection of Vision Impairments in Children Act—which was introduced May 14 and would establish grants for states to implement strategies for early detection of vision concerns. In addition, AOA and CooperVision announced the launch of the Myopia Collective to advance a new standard of care for children with myopia.

Three years ago, hundreds of doctors, optometry students, paraoptometrics and policymakers attended the AOA’s Emergency Children’s Vision Summit to help develop a path forward as the nation emerged from the depths of the COVID-19 pandemic. COVID-19 contributed to the rise in cases of myopia, as children spent more time indoors often on their digital devices for school and amusement. The summit triggered an ongoing conversation by optometry on myopia and its management. In 2023, the AOA organized a webinar series for doctors of optometry who were new to myopia management.

Dr. Steele says the study does highlight concerns long elevated by the AOA.

“There are kids who are not getting pediatric care from any practitioner—of any kind,” he says. “This is due to access—due to a combination of issues with transportation and availability. At present, community health centers are only a partial solution. There should be more, and they should be fully staffed with optometrists skilled in all ages of patients, not just pediatric patients.”

Adds Dr. Foster: “As the demand for eye care grows, and the availability of ophthalmologists declines, optometrists will become even more crucial to access to eye care, not only for pediatric patients, but for their parents and grandparents as well.”

Resources for practices

View the AOA's Educate Your Community resources for doctors of optometry.

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