March 2012
Volume 53, Issue 14
ARVO Annual Meeting Abstract  |   March 2012
Older Adult Access to Vision Rehabilitation Care in the U.S
Author Affiliations & Notes
  • Lori L. Grover
    Ophthalmology, Johns Hopkins Univ Wilmer Eye Inst, Baltimore, Maryland
  • Kevin D. Frick
    Health Policy and Management, Johns Hopkins Bloomberg Sch of Public Hlth, Baltimore, Maryland
  • Footnotes
    Commercial Relationships  Lori L. Grover, None; Kevin D. Frick, None
  • Footnotes
    Support  NEI EY017615
Investigative Ophthalmology & Visual Science March 2012, Vol.53, 4412. doi:
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      Lori L. Grover, Kevin D. Frick; Older Adult Access to Vision Rehabilitation Care in the U.S. Invest. Ophthalmol. Vis. Sci. 2012;53(14):4412.

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      © ARVO (1962-2015); The Authors (2016-present)

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Access to health care is a concept that includes geographic accessibility to health care providers and facilities. A key measure of access for patients with vision impairment (VI) involves eye care professionals who provide vision rehabilitation (VR) clinical care. In addition to a lack of accurate data on where VI patients and VR clinicians are geographically located, it is not known if access to appropriate VR care is a problem and if so, how this impacts patients with VI. The aim was to create an access measure for older adults with VI in the U.S.


Data were analyzed to assess a ratio of the older adult Medicare beneficiary population (those with health insurance who are 65 years and over) to available VR care providers defined as physicians by CMS (i.e. optometrists or ophthalmologists providing VR care) in the U.S. Data on VR clinicians were compiled from national and state professional eye care provider organizations (American Optometric Association, American Academy of Optometry, American Academy of Ophthalmology) and aggregated at the state level. Population data were drawn from the Behavioral Risk Factor Surveillance System (BRFSS) from 2005-2010. This measure represents the number of older adults with VI per VR physician and allows for a state-level assessment of potential access to VR care by the targeted VI population.


A national VR clinician census was identified (n=616) and stratified by state. Self-reported VI population data from the BRFSS VI module in 18 states were counted; providers within those states were identified (n=238). Access for older adults to VR care varied across states, and identified clinicians within these states were primarily optometrists as compared to ophthalmologists (overall provider ratio of 21:1). NY, OH and TX had the highest provider numbers and population access; NM, WV, WY and AR the lowest. Access rates were used to develop a choropleth map demonstrating proportional state values.


The relationship between clinician access and improved health outcomes is well documented. However, this measure has several limitations. VR clinicians are aggregated by state and may see patient populations from out of state; this may over- or underestimate patient access to VR care as access is not restricted by state boundaries. There are no standards to compare to as what constitutes ‘adequate’ access. Higher access does not ensure VR uptake of VR care or account for potential barriers to care that may arise. This access measure will continue to assist investigation in the areas of patient and provider factors impacting care, realized VR care access, and quality of care measures.

Keywords: clinical (human) or epidemiologic studies: health care delivery/economics/manpower • aging • low vision 

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