Geographic Analysis of Access to Glaucoma Care by Provider Type and Population Demographics

To characterize the geographic distribution of glaucoma eye care providers in the United States and identify disparities in access to glaucoma care.

Using four public databases, the names and addresses of ophthalmic and optometric glaucoma eye care providers were identified. Each provider was geocoded into a United States county using ArcGIS Pro (Esri). Population demographics were recorded for each county using data from the 2018-2022 American Community Survey. Analysis of variance was used to compare socioeconomic indices between counties with and without glaucoma eye care providers in SPSS Statistics (IBM Corp.).

A total of 2183 ophthalmologists and 622 optometrists were identified. The states with the most glaucoma-specializing ophthalmologists per one million people were Connecticut (11.37), Maryland (10.85), and Massachusetts (10.24). About 2471 (78.61%) counties had no glaucoma eye care providers, 278 (8.84%) only had ophthalmologists, 176 (5.60%) only had optometrists, and 218 (6.94%) had both provider types. When comparing counties with both ophthalmologists and optometrists to counties with no glaucoma eye care providers, counties with both provider types had higher median income ($82,712.12 vs. $60,368.73, p < 0.001), higher educational attainment (38.54% vs. 21.02%, p < 0.001), higher health insurance coverage (90.89% vs. 89.17%, p < 0.001), and lower poverty (11.28% vs. 14.25%, p < 0.001).

The unbalanced distribution of glaucoma eye care providers in the United States suggests that some regions may suffer from relatively poor access to care. This disparity is compounded by increased socioeconomic depravity in counties lacking glaucoma eye care providers.