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Michael Huvard, David Sanders, Chris Andrews, Manjool Shah, Joshua D Stein; The Extent to Which Medicare Beneficiaries Receive Eye Care Services Exclusively By Ophthalmologists or Optometrists – A Comparison of All 50 States. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1616.
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© ARVO (1962-2015); The Authors (2016-present)
Sight-threatening ocular diseases such as glaucoma, macular degeneration, diabetic retinopathy, and cataract are more prevalent with older age. These conditions often require laser or surgical interventions which, in most states, can only be performed by ophthalmologists. It is unclear whether older Americans are routinely receiving eye care services by ophthalmologists or optometrists and how this varies from state to state.
Using a health care claims database capturing a national 20% sample of all enrollees in Medicare, we identified enrollees who received ophthalmic care during the 2008-2012. For each enrollee, we determined whether they received exclusive eye care by an ophthalmologist, exclusive care by an optometrist, or ≥ 1 records of eye care by each provider type. For all 50 states, we calculated the ratio of patients who received ophthalmic care exclusively by ophthalmologists versus exclusively by optometrists.
Among the 7,893,648 eligible Medicare enrollees, 2,632,738 (33.4%) persons received ophthalmic care exclusively by an ophthalmologist, 1,287,861 (16.3%) by an optometrist, and 1,344,887 (17.0%) by both eye provider types. In 9 of 50 states (18%) a greater proportion of older Americans were under the exclusive care of optometrists compared to ophthalmologists and in 41 states (82%) a greater proportion were under exclusive care by ophthalmologists. Nationally, the ratio of older Americans under the exclusive care of ophthalmologists versus optometrists was 2.04 to 1. The states with the lowest ratio of patients under the exclusive care of ophthalmologists versus optometrists were New York (0.24 to 1), South Dakota (0.49 to 1), and Kansas (0.59 to 1) and those with the highest ratio of patients under the exclusive care of ophthalmologists to optometrists were New Mexico (3.9 to 1), Maryland (4.8 to 1), and Delaware (16.0 to 1).
Although licensed optometrists practicing in the US greatly outnumber ophthalmologists, in most US states, a greater proportion of older Americans are receiving exclusive eye care by ophthalmologists compared to optometrists.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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