Geographic Access to Retinal Care in the United States.

Abstract

To assess the geographic coverage of U.S. medical and surgical retina specialists and identify community-level sociodemographic factors associated with reduced access. For this population-based, cross-sectional study, fellowship-trained retina specialists were identified using professional society membership databases, private practice websites, academic department profiles, and Centers for Medicare and Medicaid Services data. Practice addresses were geocoded, and 15-, 30-, and 60-min drive-time service areas were generated. U.S. Census tracts enriched with 2019-2023 American Community Survey sociodemographic data were overlaid, with tract proximity defined by the shortest service area capturing the tract centroid. Multivariable logistic regression was used to identify tract-level sociodemographic characteristics associated with inadequate access to care (i.e., >60-min). Odds ratios (ORs) were scaled per 10-percentage point increase in each predictor. Approximately 5.0% of U.S. residents lived >60-min from the nearest retina specialist. After adjusting for urbanicity, higher odds of inadequate access were observed amongst tracts with higher proportions of Medicare-aged residents (OR 1.61 [95% confidence interval, 1.58-1.64]) and greater racial homogeneity (1.15 [1.14-1.16]). Higher proportions of college-educated residents were associated with reduced odds of inadequate access (0.89 [0.88-0.90]). Weaker associations were observed between inadequate access and higher proportions of uninsured (1.05 [1.02-1.08]) and Hispanic/Latino residents (1.08 [1.07-1.09]). No association was observed for proportion very low-income residents (1.00 [0.99-1.02]). Approximately 1 in 20 U.S. residents lived >60-min from a retina specialist, with several sociodemographic characteristics associated with reduced access. These findings highlight specific communities that may benefit most from targeted interventions.