Abstract
Purpose :
There are known geographic disparities in the density of eye care providers, which may result in differential access to eye care. However, little is known about how the density of eye care providers impacts access to cataract surgery. The purpose of this study was to determine the association between eye care provider density and the proportion of Medicare beneficiaries receiving cataract surgery in the US.
Methods :
This was a cross-sectional study of eye care providers serving Medicare beneficiaries in 2019. The American Community Survey Summary File and Medicare Physician & Other Practitioners dataset were utilized to identify the number of eye care providers, ophthalmology clinic visits, and cataract surgeries performed per 5-digit zip code. Linear regressions were used to examine associations between provider density and surgical volume.
Results :
In 2019, 15,266 cataract surgeons performed 1,848,887 cataract surgeries for 1,181,595 Medicare beneficiaries. The mean number of cataract surgeons and optometrists per 100,000 beneficiaries was 8.4 and 58.3 respectively. The average number of cataract surgeries performed per surgeon was 250.5. Greater cataract surgeon (β, 270.8; 95% CI, 257.0 to 284.6) and optometrist density (β, 15.2; 95% CI, 11.2 to 19.2) were significantly associated with a greater number of cataract surgeries performed per 100,000 beneficiaries (P<0.001). Greater cataract surgeon density was not associated with the number of surgeries performed per surgeon, but was associated with a greater number of surgeries performed per 1,000 clinic visits (β, 2.9; 95% CI, 0.3 to 5.4; P=0.02). Optometrist density was associated with a greater number of surgeries per surgeon (β, 0.9; 95% CI, 0.6 to 1.2) as well as surgeries per 1,000 clinic visits (β, 2.1; 95% CI, 1.2 to 3.0).
Conclusions :
In 2019, greater cataract surgeon density was associated with a greater proportion of Medicare beneficiaries receiving cataract surgery, but was not associated with the number of surgeries performed per surgeon. More cataract surgeries were performed per clinical encounter in areas with a higher density of cataract surgeons. Optometrist density was correlated with a modest but significant increase in cataract surgeries performed per surgeon and per clinical encounter. Differences in the geographic distribution of eye care providers may result in disparities in access to cataract surgery.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.