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Evaluating Access to Laser Eye Surgery by Driving Times Using Medicare Data and Geographical Mapping
Jamie Shaffer1,2, Anand Rajesh1,2, Michael W Stewart3
1Department of Ophthalmology, University of Washington, Seattle.
JAMA Ophthalmology
|July 20, 2023
Summary
Granting optometrists laser eye surgery privileges did not significantly increase patient access. Travel times to optometrists for these procedures were often longer than to ophthalmologists, with minimal population gains within a 30-minute radius.
Area of Science:
- Ophthalmology and Optometry
- Health Services Research
- Public Health Policy
Background:
- Several US states have expanded optometrists' scope of practice to include laser procedures like laser peripheral iridotomy, selective laser trabeculoplasty, and YAG laser capsulotomy.
- The primary goal of these legislative changes is to improve patient access to essential eye care services.
- The impact of these expanded privileges on patient access, specifically within the Medicare population, remains largely unevaluated.
Purpose of the Study:
- To evaluate patient access to laser eye surgery care by comparing estimated travel times and 30-minute proximity to optometrists versus ophthalmologists.
- To determine if expanded optometrist privileges have improved geographic accessibility for Medicare beneficiaries needing laser eye procedures.
Main Methods:
- Retrospective cohort database study utilizing Medicare Part B claims data from 2016-2020.
- Analysis included patients receiving laser eye care (laser peripheral iridotomy, selective laser trabeculoplasty, YAG laser capsulotomy) from optometrists or ophthalmologists in Oklahoma, Kentucky, Louisiana, Arkansas, and Missouri.
- Patient access was measured by the percentage of the Medicare population within a 30-minute travel time (isochrone) and median travel times.
Main Results:
- Optometrists performing laser eye surgery generally cover a geographic area comparable to ophthalmologists.
- Less than 5% of the population in most studied states had access exclusively through optometrists within a 30-minute drive.
- Patients experienced longer median travel times for laser procedures performed by optometrists compared to ophthalmologists in several states, including Kentucky and Arkansas.
Conclusions:
- The expansion of laser eye surgery privileges to optometrists did not demonstrably shorten patient travel times for these procedures.
- These legislative changes did not result in a significant increase in the Medicare population having nearby access to laser eye care professionals.
- Further research is needed to assess the impact on the quality of care and overall patient outcomes.
