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Mallem K, Xia T, Berkenstock MK. A Geodemographic Analysis of Travel Time to Uveitis Specialists in the United States. Ocul Immunol Inflamm 2024; 32:1036-1040. [PMID: 37094090 DOI: 10.1080/09273948.2023.2202249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/25/2023] [Accepted: 04/09/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE Travel time to a patient's medical provider represents a significant component of access to care. We examined travel time to the nearest uveitis specialist for the American population and characterize its impact on access to uveitis care. DESIGN Observational studies using the American Community Survey and American Census Bureau population estimates. METHODS Addresses of fellowship-trained uveitis specialists were collected from the American Uveitis Society (AUS) and the Ocular Immunology and Uveitis Foundation (OIUF) websites and geocoded using ArcGIS Pro 2.9. Service areas were defined as all locations within a 60-min drive time from each specialist's location. Demographic and population data for total population, racial groups, household poverty levels, population in dependent groups (younger than 18, older than 65), and health insurance status were overlaid. Data were aggregated for census tracts within and outside service areas and compared using chi-square analysis. Main Outcome Measures: Differences in population demographics for people within and outside service area coverage. RESULTS 223 uveitis specialist addresses were geocoded into ArcGIS. Of specialist locations, 94% were found in urban areas. Of the total United States population, 63.3% were found to be within service areas. Of these, 55.9% were White and 14.7% were African American, whereas 70% of the people outside service areas were White and 10.1% were African American (p < 0.0001) (Table 1). Only 8.3% of the people within service area coverage had no health insurance compared with 9.5% outside service areas (p < 0.0001). Within coverage areas, 12.7% of the households had a total income below the federal poverty level versus 15.1% of the households outside service area coverage (p < 0.0001). Within service area coverage, 37.4% of the people were in a dependent age group compared with 40.4.% outside service area coverage (p < 0.0001). CONCLUSIONS Our analysis shows a significant travel burden to the nearest uveitis specialist for a large proportion of Americans. More providers are needed in rural areas, as patients there are more likely to live under the poverty line, be uninsured, or belong to a dependent age group.
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Affiliation(s)
- Krishna Mallem
- The Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
- The Wilmer Eye Institute, Division of Ocular Immunology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Terry Xia
- The Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Meghan K Berkenstock
- The Wilmer Eye Institute, Division of Ocular Immunology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Lighthizer N, Patel K, Cockrell D, Leung S, Harle DE, Varia J, Niyazmand H, Alam K. Establishment and review of educational programs to train optometrists in laser procedures and injections. Clin Exp Optom 2024:1-10. [PMID: 39048296 DOI: 10.1080/08164622.2024.2380075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 07/06/2024] [Accepted: 07/09/2024] [Indexed: 07/27/2024] Open
Abstract
Current scope of practice for optometrists in many countries include topical and oral medication with injectable and lasers being added more recently to scope in the United States (US), Canada, the United Kingdom (UK) and New Zealand (NZ). This expanded scope of optometric practice improves access to eyecare and is critical since an ageing population with a higher prevalence of vision disorders and higher healthcare costs looms. Expanded scope has been shown alongside strong safety records. This review paper aims to investigate the expansion of optometric scope of practice regarding lasers and injectables in the US, UK, Canada, Australia and NZ. The design and delivery of post-graduation educational programs, curriculum frameworks for advanced skills and the metrics of laser procedures performed by optometrists will be discussed. The State of Oklahoma in the US was first to authorise optometrists to use lasers and injectables in 1988. As of 2024, qualified optometrists in the UK, in twelve states in the US, and specialist optometrists in NZ perform laser procedures. However, lasers and injectables are not within the current scope of optometric practice in Australia and Canada. Training courses such as Northeastern State University Oklahoma College of Optometry Advanced Procedures Course and Laser Procedures Course have been successfully designed and implemented in the US to train graduate optometrists. The outcomes of over 146,403 laser procedures performed by optometrists across the US have shown only two negative outcomes, equating to 0.001%. These metrics outline the effectiveness of these procedures performed by optometrists and show strong support for future optometric scope expansion. Eye health professionals, relevant educational institutions, advocacy groups, and policymakers are called upon to work collaboratively to expand the optometric scope of practice globally.
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Affiliation(s)
- Nathan Lighthizer
- Northeastern State University Oklahoma College of Optometry, Tahlequah, OK, USA
| | - Komal Patel
- Northeastern State University Oklahoma College of Optometry, Tahlequah, OK, USA
| | | | - Sophia Leung
- Alberta Association of Optometrists, Edmonton, AB, USA
| | - Deacon E Harle
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
| | - Jay Varia
- Optometry Department, Moorfields Eye Hospital, London, UK
| | - Hamed Niyazmand
- Department of Optometry, University of Western Australia, Perth, Australia
| | - Khyber Alam
- Department of Optometry, University of Western Australia, Perth, Australia
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Hussain ZS, Muayad J, Harvey BJ, Al-Aswad LA, Fakoya AOJ, Yousefi S. Rates of Laser Trabeculoplasty by Ophthalmologists and Optometrists: A Comparative Analysis of the CMS Medicare Public Use File. Clin Ophthalmol 2024; 18:269-275. [PMID: 38312307 PMCID: PMC10838098 DOI: 10.2147/opth.s438052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/04/2023] [Indexed: 02/06/2024] Open
Abstract
Purpose To provide a comparative analysis of rates of laser trabeculoplasty (LTP) among eye care providers in the USA. Methods This retrospective cohort analysis utilized the Centers for Medicare and Medicaid Services (CMS) Public Use File (PUF), 2015-2018. We used CPT code 65855 to select eye care providers who performed LTP in three key US states (KY, LA, and OK). Primary outcomes were eye provider differences in provider count, service count, unique beneficiary count, and Medicare-allowed payments. Asymptotic two-sided chi-squared tests were executed. Statistical significance was achieved at p<0.05. Results The sum of Medicare-allowed payments for LTP in all three states in 2018 was roughly 26% lower than in 2015. The proportion of Medicare-allowed payments furnished by optometrists increased from 11.3% to 17.9% between 2015 and 2018 (p<0.001). Relative to ophthalmologists, we observed significant increases in optometric Medicare-allowed payments in KY, LA, OK, and the all-inclusive tri-state cohort (all p<0.001). Furthermore, significant optometric increases in number of providers performing LTP (p=0.007), number of unique Medicare beneficiaries seen (p<0.001), and number of LTP services billed (p<0.001) were observed relative to ophthalmologists. Conclusion The recent expansion of surgical authority by optometrists in key US states is creating a tangible impact on ophthalmologic and optometric practice patterns. The findings of this study may act as provision for policymakers in the context of continually evolving guidelines for optometric surgical expansion.
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Affiliation(s)
- Zain S Hussain
- Department of Ophthalmology, Dean McGee Eye Institute, Oklahoma City, OK, USA
- Department of Ophthalmology, University of Medicine and Health Sciences, Basseterre, Saint Kitts and Nevis
| | - Jawad Muayad
- Department of Ophthalmology, Texas A&M School of Medicine, Houston, TX, USA
| | - Ben J Harvey
- Department of Ophthalmology, Dean McGee Eye Institute, Oklahoma City, OK, USA
| | - Lama A Al-Aswad
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Adegbenro O J Fakoya
- Department of Cellular Biology and Anatomy, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Siamak Yousefi
- Department of Ophthalmology, University of Tennessee Health Science Center Hamilton Eye Institute, Memphis, TN, USA
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Reilly GR, Xie Y, Scherer RW, Hawkins BS, Lanzkron SM, Scott AW. Terminology for Retinal Findings in Sickle Cell Disease Research: A Scoping Review. Ophthalmol Retina 2024; 8:81-87. [PMID: 37634744 PMCID: PMC10841206 DOI: 10.1016/j.oret.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 07/14/2023] [Accepted: 08/21/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE To review the current sickle cell disease (SCD) literature to assess how "retinopathy" has been defined and to identify ocular outcomes that have been measured and described. DESIGN A systematic scoping review of SCD literature was completed regarding ocular manifestations of SCD and vision outcomes across all medical specialties. SUBJECTS Participants with SCD and control patients were included in our data extraction. METHODS We reviewed English-language literature from 2000 to 2021 for eligible studies by searching PubMed, Google Scholar, Embase, and the Cochrane library using terms to encompass SCD and ocular findings. MAIN OUTCOME MEASURES Data collection included study information, patient characteristics, vision-related findings (inclusion criteria and/or study outcomes), and retinopathy characteristics (definition, when, how and by whom diagnosed). RESULTS We identified 4006 unique citations and 111 were included in the analysis. Ophthalmologists were senior authors of about half (59/111; 53.2%) of the articles; most articles were published between 2016 and 2021 (71/111; 70.0%). The studies had been conducted primarily in North America (54/111; 48.6%) or Europe (23/111; 20.7%); designs were cross-sectional (51/111; 45.9%), prospective cohort (28/111; 25.2%), retrospective cohort (27/111; 24.3%), and case-control (4/111; 3.6%). Among studies reporting any retinopathy, it was commonly defined as a combination of nonproliferative sickle cell retinopathy and proliferative sickle cell retinopathy (PSR; 52/87; 59.8%), infrequently as PSR only (6/87; 6.9%), or not defined at all (23/87; 26.4%). The Goldberg classification was used to grade retinopathy in almost half of the studies (41/87; 47.1%). Investigators reporting diagnostic methods used clinical fundus examination (56/111; 50.4%), OCT (24/111; 21.6%), fluorescein angiography (20/111; 18.0%), ultrawidefield fundus photographs (15/111; 13.5%), and OCT angiography (10/111; 9.0%), or did not report methods (28/111; 25.2%). CONCLUSIONS There are inconsistencies in documentation of methods and outcomes in studies of SCD ophthalmic findings. Particularly concerning is the lack of documentation of ophthalmic examination methods, qualifications of examiners, and clarity and specificity of sickle cell retinopathy definitions. With the increase in SCD treatment research and novel systemic therapies available, it is important to adopt clear and consistent descriptions and rigorous data collection and reporting of ophthalmic outcomes in SCD studies. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Grace R Reilly
- Drexel University College of Medicine, Philadelphia, Pennsylvania; Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yangyiran Xie
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Roberta W Scherer
- Retired, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Barbara S Hawkins
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sophie M Lanzkron
- Johns Hopkins University School of Medicine, Division of Hematology, Department of Medicine, Baltimore, Maryland
| | - Adrienne W Scott
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Shaffer J, Rajesh A, Stewart MW, Lee AY, Miller DD, Lee CS, Francis CE. Evaluating Access to Laser Eye Surgery by Driving Times Using Medicare Data and Geographical Mapping. JAMA Ophthalmol 2023; 141:776-783. [PMID: 37471084 PMCID: PMC10360006 DOI: 10.1001/jamaophthalmol.2023.3061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/22/2023] [Indexed: 07/21/2023]
Abstract
Importance Recently, several states have granted optometrists privileges to perform select laser procedures (laser peripheral iridotomy, selective laser trabeculoplasty, and YAG laser capsulotomy) with the aim of increasing access. However, whether these changes are associated with increased access to these procedures among each state's Medicare population has not been evaluated. Objective To compare patient access to laser surgery eye care by estimated travel time and 30-minute proximity to an optometrist or ophthalmologist. Design, Setting, and Participants This retrospective cohort database study used Medicare Part B claims data from 2016 through 2020 for patients accessing new patient or laser eye care (laser peripheral iridotomy, selective laser trabeculoplasty, YAG) from optometrists or ophthalmologists in Oklahoma, Kentucky, Louisiana, Arkansas, and Missouri. Analysis took place between December 2021 and March 2023. Main Outcome and Measures Percentage of each state's Medicare population within a 30-minute travel time (isochrone) of an optometrist or ophthalmologist based on US census block group population and estimated travel time from patient to health care professional. Results The analytic cohort consisted of 1 564 307 individual claims. Isochrones show that optometrists performing laser eye surgery cover a geographic area similar to that covered by ophthalmologists. Less than 5% of the population had only optometrists (no ophthalmologists) within a 30-minute drive in every state except for Oklahoma for YAG (301 470 [7.6%]) and selective laser trabeculoplasty (371 097 [9.4%]). Patients had a longer travel time to receive all laser procedures from optometrists than ophthalmologists in Kentucky: the shortest median (IQR) drive time for an optometrist-performed procedure was 49.0 (18.4-71.7) minutes for YAG, and the the longest median (IQR) drive time for an ophthalmologist-performed procedure was 22.8 (12.1-41.4) minutes, also for YAG. The median (IQR) driving time for YAG in Oklahoma was 26.6 (12.2-56.9) for optometrists vs 22.0 (11.2-40.8) minutes for ophthalmologists, and in Arkansas it was 90.0 (16.2-93.2) for optometrists vs 26.5 (11.8-51.6) minutes for ophthalmologists. In Louisiana, the longest median (IQR) travel time to receive laser procedures from optometrists was for YAG at 18.5 (7.6-32.6) minutes and the shortest drive to receive procedures from ophthalmologists was for YAG at 20.5 (11.7-39.7) minutes. Conclusions and Relevance Although this study did not assess impact on quality of care, expansion of laser eye surgery privileges to optometrists was not found to lead to shorter travel times to receive care or to a meaningful increase in the percentage of the population with nearby health care professionals.
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Affiliation(s)
- Jamie Shaffer
- Department of Ophthalmology, University of Washington, Seattle
- Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
| | - Anand Rajesh
- Department of Ophthalmology, University of Washington, Seattle
- Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
| | | | - Aaron Y. Lee
- Department of Ophthalmology, University of Washington, Seattle
- Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
| | - Darby D. Miller
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida
| | - Cecilia S. Lee
- Department of Ophthalmology, University of Washington, Seattle
- Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
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Roy Choudhury A, Plemmons A. Effects of giving psychologists prescriptive authority: Evidence from a natural experiment in the United States. Health Policy 2023; 134:104846. [PMID: 37271047 DOI: 10.1016/j.healthpol.2023.104846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/25/2023] [Accepted: 05/31/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Suicide is the tenth leading cause of death in the U.S. Six states have granted psychologists prescriptive authority to address shortages in the provision of behavioral and mental health care services to increase provider access to pharmacological interventions using psychotropic medications. METHODS This study estimates the impact of expanding scope of practice for specifically trained psychologists to include pharmacological interventions on mortality by self-inflicted injury in the U.S. by using the implementation of prescriptive authority for psychologists in New Mexico and Louisiana as a natural experiment using a staggered different-in-difference estimation. Additional robustness tests are conducted to identify heterogenous treatment effects, observe sensitivity of our results for Medicaid expansion, and to compare other forms of mortality that should not have been affected by psychologist prescriptive authority. RESULTS Mortality resulting from self-inflicted injury decreased by 5 to 7 percentage points in New Mexico and Louisiana following prescriptive authority expansions for psychologists. The effect is statistically significant for males, white populations, individuals who are married or single, and for people between the ages of 35 and 55. CONCLUSIONS In the U.S., expanding scope of practice for specifically trained psychologists to include prescriptive authority may help address poor mental health care outcomes, such as suicides. Similar policy expansions may be useful for other countries where referral from a psychologist and prescription assignment from a psychiatrist are separated.
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Affiliation(s)
- Agnitra Roy Choudhury
- Department of Economics, College of Liberal Arts & Social Sciences, Auburn University at Montgomery, 7400 East Drive, Montgomery, AL 36117, United States.
| | - Alicia Plemmons
- Assistant Professor of Business in the Department of General Business at West Virginia University, 83 Beechurst Avenue, Morgantown, WV 26506, United States; Research Fellow, Knee Center for Occupational Licensing, United States
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Soares RR, Mokhashi N, Sharpe J, Zhang Q, Hinkle J, Patel SN, Ho AC, Yonekawa Y, Hsu J. Patient Accessibility to Eye Care in the United States. Ophthalmology 2023; 130:354-360. [PMID: 36427602 DOI: 10.1016/j.ophtha.2022.11.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 11/05/2022] [Accepted: 11/17/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The United States (US) federal government uses health provider shortage areas (HPSAs) to define patient accessibility to primary care physicians. It is unclear whether HPSAs can be applied to eye care providers (ECPs). Our study determined the applicability of federal HPSA designations to ECP availability in the US. DESIGN Cross-sectional study. PARTICIPANTS US general population and ophthalmologists/optometrists in the Medicare database. METHODS The primary care HPSA score, visual impairment prevalence, and ECP location were determined for each census tract or county using data from the US Department of Health and Human Services, the Centers for Disease Control and Prevention, and Centers for Medicare and Medicaid Services. MAIN OUTCOME MEASURES Association of HPSA with vision loss and ECP density was examined. The 2-step floating catchment area approach was used to newly define eye care shortage areas (patient accessibility score [PAS], higher being worse accessibility) for every county in the US, by weighting the 2-step FCA scores by prevalence of vision loss and ECP density. Multivariable logistic regression was used to identify sociodemographic variables associated with areas of ECP shortage. RESULTS Among 72 735 census tracts included, statistically significant but weak correlations of HPSA score with visual impairment (VI) (r = 0.38; P < 0.0001) and ECP density per county population (r = -0.18; P < 0.0001) were found. Only 54.0% of census tracts with < 25th percentile ECP density per county were HPSAs (P < 0.0001). Of census tracts > than 75th percentile for VI only 58.0% were HPSAs (P < 0.0001). Multivariable regression found a higher odds of ECP PAS ≥ 75th percentile (worse accessibility) in rural counties (adjusted odds ratio [aOR], 2.47; 95% confidence interval [CI], 1.93-3.67; P < 0.001) and counties with a greater prevalence of residents with less than a high school education (aOR, 1.21; 95% CI, 1.19-1.25; P < 0.001), residents ≥ 65 years of age (aOR, 1.10; 95% CI, 1.07-1.13; P < 0.001), and uninsured residents (aOR, 1.04; 95% CI, 1.01-1.06; P < 0.001). Counties with a greater proportion of men (aOR, 0.93; 95% CI, 0.89-0.967; P < 0.001) or White residents (aOR, 0.99; 95% CI, 0.98-0.99) had a lower odds of ECP PAS ≥ 75th percentile. CONCLUSIONS Current HPSAs only weakly correlate with ECP supply. We propose a new approach to identify counties with high need but limited access to eye care. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Rebecca Russ Soares
- Retina Service, Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania.
| | - Nikita Mokhashi
- Department of Ophthalmology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - James Sharpe
- Biostatistics Consulting Core, Vickie and Jack Farber Vision Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Qiang Zhang
- Biostatistics Consulting Core, Vickie and Jack Farber Vision Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - John Hinkle
- Retina Service, Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Samir N Patel
- Retina Service, Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Allen C Ho
- Retina Service, Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Yoshihiro Yonekawa
- Retina Service, Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jason Hsu
- Retina Service, Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
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Kolomeyer NN, Gupta D, Rhodes LA, Maltzman JS, Skuta GL, Tsai JC, Turalba AV, Stein JD, Emerick G. Glaucoma Surgery and Lasers Should Be Performed by Surgeons. Ophthalmol Glaucoma 2022; 5:557-561. [PMID: 36195289 DOI: 10.1016/j.ogla.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
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Brill D, Luo S, Sridhar J, Williams BK. Private equity in ophthalmology: lessons from other specialties. Curr Opin Ophthalmol 2022; 33:352-361. [PMID: 35916564 DOI: 10.1097/icu.0000000000000876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW In the absence of long-term data of the effects of private equity in ophthalmology, this article reviews the role of private equity in other medical specialties as a guide to the future for ophthalmology. RECENT FINDINGS Across an array of medical specialties, including anesthesiology, dermatology, emergency medicine, ophthalmology/optometry, radiology, and urology, medical practices are being consolidated into a few larger platform groups. Although there has been a short-term financial success for both private equity firms and senior medical practice partners, there exists broad skepticism from peer-reviewed publications and the national media. SUMMARY Although the impact of private equity on ophthalmology is largely speculative, ophthalmology may follow some of the trends observed in other medical specialties. These trends include increased volume of services, increased profits, improved payer mix, increased payment per patient visit, increased use of midlevel practitioners, decreased physician autonomy, and decreased physician salaries.
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Affiliation(s)
- Daniel Brill
- Department of Ophthalmology, University of Cincinnati College of Medicine
- Cincinnati Eye Institute, Cincinnati, Ohio, USA
| | - Shiming Luo
- Department of Ophthalmology, University of Cincinnati College of Medicine
| | - Jayanth Sridhar
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Basil K Williams
- Department of Ophthalmology, University of Cincinnati College of Medicine
- Cincinnati Eye Institute, Cincinnati, Ohio, USA
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Soares RR. The evolving field of Big Data: understanding geographic information systems analysis and its transformative potential in ophthalmic research. Curr Opin Ophthalmol 2022; 33:188-194. [PMID: 35220329 DOI: 10.1097/icu.0000000000000839] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review to is to highlight alternative uses of Big Data in the pursuit of ophthalmologic public health. In particular, we highlight geographic information systems (GIS) analysis as a type of Big Data, summarize various GIS methods, and enumerate sources of geographic data. RECENT FINDINGS The recent implementation of the IRIS Registry Data, has expanded our real-world knowledge of ophthalmology in the United States. Such innovations in Big Data allow us to better define ophthalmic diseases, treatments, and outcomes for underserved individuals and subpopulations. One underutilized source of Big Data entails use of geographic information to evaluate geographic heterogeneity and access across the United States. SUMMARY GIS and Big Data allow for refined epidemiologic estimates of eye disease for specific communities. In particular, how GIS can enable researchers to examine disparities in access to ophthalmic care is reviewed. GIS best practices and some data sources for GIS in ophthalmology are also summarized.
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Affiliation(s)
- Rebecca Russ Soares
- Retina Service, Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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11
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Berkowitz ST, Liu Y, Chen Q, Patel S. Correlation Between Ophthalmology Market Saturation and Medicare Utilization Rates. Am J Ophthalmol 2021; 229:137-144. [PMID: 33910054 DOI: 10.1016/j.ajo.2021.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE To characterize usage of ophthalmologic services by Medicare Fee-For-Service (FFS) beneficiaries relative to geography-specific market saturation, demographics, and contextual factors DESIGN: Cross-sectional study METHODS: Data sets from Centers for Medicare & Medicaid Services, US Census Bureau, US Department of Agriculture, and Housing and Urban Development, were used to calculate county- and state-level ophthalmologic service usage, market saturation, and demographic characteristics. Negative binomial regression models were used to evaluate the association between results and demographic or population-specific variables. RESULTS Ophthalmologic service usage ranged from 58.2% to 15.2%, whereas saturation ranged from 21,763 to 91.4 FFS beneficiaries per registered ophthalmologist. Usage was significantly associated with demographic characteristics in each geography: lower proportion of African American (P = .009), Hispanic (P < .001), and other race beneficiaries (P < .001), relative to white beneficiaries; a higher proportion of female (P < .001) relative to male; a higher proportion of adults having completed an associate degree or some college (P = .001), or holding a bachelor's degree or higher (P < .001), relative to a high school diploma; a lower proportion of adults in each geography experiencing poverty (P = .009), geographies with lower Multidimensional Deprivation Index (P < .001); a higher urban-influence code (P < .001). There was no significant correlation between the usage of ophthalmologic services and the geographic market saturation of ophthalmologists (Spearman rho, -0.030, P = .227). CONCLUSIONS AND RELEVANCE Ophthalmologic service usage is significantly influenced by population demographics; however, increased provider density alone appears insufficient to promote the usage of eye care services.
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Affiliation(s)
| | - Yuhan Liu
- Department of Biostatistics, Vanderbilt University
| | - Qingxia Chen
- Department of Biostatistics, Vanderbilt University; Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shriji Patel
- Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, Tennessee, USA..
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Zhong J, Wang W, Wang H, Huang J, Li T, Chen J, Chen W, Yuan J, Chen W. Distribution and determinants of hospital efficiency and relative productivity in county-level hospitals in rural China: an observational study. BMJ Open 2021; 11:e042326. [PMID: 34215595 PMCID: PMC8256740 DOI: 10.1136/bmjopen-2020-042326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Cataract surgery is very important to prevent blindness, but its productivity and efficiency in China are unknown. Our study aimed to evaluate the geographical distribution of cataract surgeons and prospectively identify the factors associated with the increased productivity in cataract surgery and efficiency in outpatient ophthalmic services in rural Chinese hospitals. METHODS Data were prospectively collated from various hospital datasets and the census registered by the geographical unit county. Prior to mapping, the geographical location data of counties were cross-linked with the equivalent ophthalmologist and service output data to create categories and map multiple data attributes. Descriptive statistical analyses were performed to characterise the data stratified by county. Linear regression analyses were used to explore the factors associated with the increased productivity/efficiency. RESULTS The ophthalmologists, surgical productivity of ophthalmologists and outpatient efficacy of ophthalmologists significantly varied across counties. During the period between 2016 and 2018, the median (IQR) change in surgical productivity of and outpatient efficacy of ophthalmologists were 31.627 (-3.33 to 29.94) and 118.08 (-132.30 to 740.89). In the simple regression analysis for predictors of a high productivity change, only the increased number of phaco machine had statistical significance (p=0.003). In addition, only the gross domestic product per capita in 2016 was associated with an increased improvement in efficiency of outpatient services (p=0.008). CONCLUSIONS This study demonstrated that the ophthalmologist productivity and the efficiency of outpatient services were unequally geographically distributed, and their predictors were identified. Further studies to elucidate the extent of the problem and improve the health service delivery models are required.
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Affiliation(s)
- Jing Zhong
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Wei Wang
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Hongxi Wang
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Jingjing Huang
- Glaucoma, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Tao Li
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Jingjing Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wan Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jin Yuan
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Weirong Chen
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
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Wang Y, Yu M, Hu B, Jin X, Li Y, Zhang X, Zhang Y, Gong D, Wu C, Zhang B, Yang J, Li B, Yuan M, Mo B, Wei Q, Zhao J, Ding D, Yang J, Li X, Yu W, Chen Y. Deep learning-based detection and stage grading for optimising diagnosis of diabetic retinopathy. Diabetes Metab Res Rev 2021; 37:e3445. [PMID: 33713564 DOI: 10.1002/dmrr.3445] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 02/19/2021] [Accepted: 02/23/2021] [Indexed: 11/07/2022]
Abstract
AIMS To establish an automated method for identifying referable diabetic retinopathy (DR), defined as moderate nonproliferative DR and above, using deep learning-based lesion detection and stage grading. MATERIALS AND METHODS A set of 12,252 eligible fundus images of diabetic patients were manually annotated by 45 licenced ophthalmologists and were randomly split into training, validation, and internal test sets (ratio of 7:1:2). Another set of 565 eligible consecutive clinical fundus images was established as an external test set. For automated referable DR identification, four deep learning models were programmed based on whether two factors were included: DR-related lesions and DR stages. Sensitivity, specificity and the area under the receiver operating characteristic curve (AUC) were reported for referable DR identification, while precision and recall were reported for lesion detection. RESULTS Adding lesion information to the five-stage grading model improved the AUC (0.943 vs. 0.938), sensitivity (90.6% vs. 90.5%) and specificity (80.7% vs. 78.5%) of the model for identifying referable DR in the internal test set. Adding stage information to the lesion-based model increased the AUC (0.943 vs. 0.936) and sensitivity (90.6% vs. 76.7%) of the model for identifying referable DR in the internal test set. Similar trends were also seen in the external test set. DR lesion types with high precision results were preretinal haemorrhage, hard exudate, vitreous haemorrhage, neovascularisation, cotton wool spots and fibrous proliferation. CONCLUSIONS The herein described automated model employed DR lesions and stage information to identify referable DR and displayed better diagnostic value than models built without this information.
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Affiliation(s)
- Yuelin Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Lab of Ocular Fundus Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Miao Yu
- Department of Endocrinology, Key Laboratory of Endocrinology, National Health Commission, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Bojie Hu
- Department of Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Xuemin Jin
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yibin Li
- Department of Ophthalmology, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiao Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Lab of Ocular Fundus Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Yongpeng Zhang
- Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Di Gong
- Department of Ophthalmology, China-Japan Friendship Hospital, Beijing, China
| | - Chan Wu
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Lab of Ocular Fundus Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Bilei Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Lab of Ocular Fundus Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Jingyuan Yang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Lab of Ocular Fundus Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Bing Li
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Lab of Ocular Fundus Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Mingzhen Yuan
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Lab of Ocular Fundus Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Bin Mo
- Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qijie Wei
- Vistel AI Lab, Visionary Intelligence Ltd., Beijing, China
| | - Jianchun Zhao
- Vistel AI Lab, Visionary Intelligence Ltd., Beijing, China
| | - Dayong Ding
- Vistel AI Lab, Visionary Intelligence Ltd., Beijing, China
| | - Jingyun Yang
- Department of Neurological Sciences, Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Xirong Li
- Key Lab of Data Engineering and Knowledge Engineering, Renmin University of China, Beijing, China
| | - Weihong Yu
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Lab of Ocular Fundus Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Lab of Ocular Fundus Disease, Chinese Academy of Medical Sciences, Beijing, China
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Vu DM, Stoler J, Rothman AL, Chang TC. A Service Coverage Analysis of Primary Congenital Glaucoma Care Across the United States. Am J Ophthalmol 2021; 224:112-119. [PMID: 33340505 PMCID: PMC10619983 DOI: 10.1016/j.ajo.2020.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/03/2020] [Accepted: 12/07/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE To assess the number of infants at risk of delayed primary congenital glaucoma (PCG) evaluation due to long travel times to specialists. DESIGN Cross-sectional geospatial service coverage analysis. METHODS All American Glaucoma Society (AGS) and American Association for Pediatric Ophthalmology and Strabismus (AAPOS) provider locations were geocoded using each organization's member directory. Sixty-minute drive time regions to providers were generated using ArcGIS Pro (Esri). The geographic intersection of AGS and AAPOS service areas was computed because patients typically require visits to both types of specialists. American Community Survey data were then overlaid to estimate the number of infants within and beyond the AGS/AAPOS service areas. RESULTS One thousand twenty-nine AGS and 1,040 AAPOS provider locations were geocoded. The analysis yielded 944,047 infants age 0-1 year (23.6%) who live beyond the AGS/AAPOS service areas. Therefore, approximately 14-94 new PCG cases/year may be at risk of delayed diagnosis as a result of living in a potential service desert. Compared with children living within the AGS/AAPOS service areas, children aged <6 years in these potential service deserts were more likely to live in households earning below the US federal poverty level, lack health insurance, and live in a single-parent home. These communities are disproportionately likely to experience other rural health disparities and are more prevalent across the Great Plains. CONCLUSION Service coverage analysis is a useful tool for identifying underserved regions for PCG referrals and evaluation. These data may assist in targeting screening programs in low access areas for pediatric glaucoma care.
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Affiliation(s)
- Daniel M Vu
- Bascom Palmer Eye Institute, University of Miami Health System, Miami, Florida, USA.
| | - Justin Stoler
- Department of Geography and Regional Studies, University of Miami, Coral Gables, Florida, USA; Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Adam L Rothman
- Bascom Palmer Eye Institute, University of Miami Health System, Miami, Florida, USA
| | - Ta Chen Chang
- Bascom Palmer Eye Institute, University of Miami Health System, Miami, Florida, USA
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15
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Tang V, Symons RCA, Guest D, McKendrick AM. An overview of optometrists' diabetic retinopathy practice patterns - a cross-sectional survey. Ophthalmic Physiol Opt 2021; 41:885-895. [PMID: 33682935 DOI: 10.1111/opo.12798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/21/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Contemporary eye care increasingly recommends the use of advanced retinal imaging technology. Anecdotal evidence suggests that this equipment is widely available in primary eye care settings; however, knowledge regarding how optometrists use this equipment in the context of diabetic retinopathy (DR) is limited. This study aimed to obtain a current overview of optometrists' clinical practice behaviours in the detection, screening, diagnosis and management of patients with diabetes. METHODS A cross-sectional survey was designed to evaluate optometrists' self-reported clinical practice patterns and perceptions, as well as the availability and impact of retinal imaging equipment specific to DR and diabetic macular oedema (DMO) on optometrists' clinical practice. The survey invited participation from all optometrists practising in Australia. RESULTS One hundred and sixty-seven optometrists participated. Optometrists' self-reported confidence in assessing DR and DMO was high. Optometrists' referral patterns considered the severity of DR and DMO before initiating referral to secondary ophthalmology care. Nearly all optometrists (98.8%) indicated that they had some form of retinal imaging equipment available to them in clinical practice. An optical coherence tomography (OCT) device was available to 75.5% of optometrists. A significant association between having an OCT device in the practice and higher self-reported confidence levels in the assessment of DMO was found. CONCLUSIONS Many optometrists are well equipped with sophisticated retinal imaging technology for the provision of high-quality eye care. Enhancing optometric training and education programmes can maximise the community benefit of access to this equipment and improve delivery of eye care in the community.
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Affiliation(s)
- Vanessa Tang
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Robert C Andrew Symons
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Daryl Guest
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Allison M McKendrick
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia
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Rothman AL, Stoler JB, Vu DM, Chang TC. A Geodemographic Service Coverage Analysis of Travel Time to Glaucoma Specialists in Florida. J Glaucoma 2020; 29:1147-1151. [PMID: 33264165 DOI: 10.1097/ijg.0000000000001648] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PRECIS Approximately 1 in 9 Florida residents over the age of 65 years (438,642 people) live more than an hour away from a glaucoma specialist, which represents a significant barrier to care. PURPOSE To describe access to glaucoma care for Florida's elderly population using travel time to American Glaucoma Society (AGS) member offices. METHODS For this cross-sectional service coverage analysis, a list of AGS member locations was extracted from the AGS website, and addresses were geocoded using ArcGIS Online. Driving time regions were created using the service area tool in ArcGIS Pro 2.4 and overlaid with 2010 United States Census and 2016 American Community Survey data for all Florida residents age 65 or older. RESULTS Fifty-eight AGS member providers with 65 locations were identified and geocoded. There were 3,797,625 individuals aged over 65 years in Florida, of which 1,153,320 (30.4%) lived within 15 minutes of driving time from an AGS provider's office, 2,586,825 (68.1%) within 30 minutes, 3,358,983 (88.4%) within 60 minutes, and 3,491,815 (91.9%) within 120 minutes. The areas with the lowest access include rural areas near Lake Okeechobee and the Florida Panhandle. The population living beyond a 60-minute drive was more likely to be White, non-Hispanic and older, but less likely to be living below the federal poverty level or receiving public assistance than the population living within a 60-minute drive. CONCLUSIONS There is a significant travel burden for the elderly community of Florida to reach AGS providers. Additional studies could help identify other social barriers to accessing glaucoma providers in Florida and beyond in an effort to improve patient compliance and, ultimately, vision outcomes.
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Affiliation(s)
- Adam L Rothman
- Bascom Palmer Eye Institute, University of Miami Health System
| | - Justin B Stoler
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami
- Department of Geography and Regional Studies, University of Miami, Coral Gables, FL
| | - Daniel M Vu
- Bascom Palmer Eye Institute, University of Miami Health System
| | - Ta C Chang
- Bascom Palmer Eye Institute, University of Miami Health System
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Eye Care Provider Availability for the Medicare Population in U.S. States That Have Expanded Optometrist Scope of Practice. Optom Vis Sci 2020; 97:929-935. [PMID: 33110024 DOI: 10.1097/opx.0000000000001599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE Estimating a broader set of measures of local eye care provider availability than used in prior research offers information that is useful for policy decisions related to access to eye care. PURPOSE The purpose of this study was to examine whether policy-relevant information was gained when measures of local eye care provider availability in addition to the estimated travel time (ETT) to the closest provider were estimated for the population 65 years or older in Kentucky, New Mexico, and Oklahoma. These states have expanded surgical scope of practice for optometrists. METHODS This study used block group-level population data from the 2010 U.S. Decennial Census and eye care provider office address information from the 2016 Medicare Provider Utilization and Payment Data. Geographic information system analysis was used to calculate ETTs between individuals and eye care providers. Expanded measures of availability included the difference in ETT to an individual's second closest and closest ophthalmologist, the difference in ETT to an individual's closest ophthalmologist and closest optometrist, and whether only one ophthalmologist at the closest office accepted Medicare. Descriptive statistics were calculated for each state and by urbanicity. RESULTS Of the population 65 years or older in each state, between 10.8 (Kentucky) and 16.6% (Oklahoma) had a one-way ETT to the second closest ophthalmologist >15 minutes longer than to the closest ophthalmologist, between 21.1 (Kentucky) and 27.6% (Oklahoma) had a one-way ETT to the closest ophthalmologist >15 minutes longer than to the closest optometrist, and between 56.4 (Kentucky) and 70.0% (Oklahoma) had only one ophthalmologist at the closest office who accepted Medicare. Findings differed substantially by urbanicity. CONCLUSIONS Using a portfolio of travel time-based measures enhances the understanding of local eye care provider availability.
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Feng PW, Ahluwalia A, Feng H, Adelman RA. National Trends in the United States Eye Care Workforce from 1995 to 2017. Am J Ophthalmol 2020; 218:128-135. [PMID: 32445703 DOI: 10.1016/j.ajo.2020.05.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/09/2020] [Accepted: 05/12/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe temporal and geographic trends in the US eye care workforce. DESIGN Cross-sectional study. METHODS We obtained data from the 2017 Area Health Resources File. The main outcomes were ophthalmologist and optometrist density, as defined as the number of providers per 100,000 individuals, the ratio of ophthalmologists ≥55 years of age to those <55 years of age, and county characteristics associated with the availability of an ophthalmologist. RESULTS From 1995 to 2017, the national ophthalmologist density decreased from 6.30 to 5.68 ophthalmologists per 100,000 individuals. Although rural counties experienced a mean annual increase in ophthalmologist density by 2.26%, they still had a lower mean ophthalmologist density (0.58/100,000 individuals) compared with nonmetropolitan (2.19/100,000 individuals) and metropolitan counties (6.29/100,000 individuals) in 2017. The ratio of older to younger ophthalmologists increased from 0.37 in 1995 to 0.82 in 2017, with the greatest ratio increase occurring in rural counties (0.29 to 1.90). The presence of an ophthalmologist was significantly associated with a greater proportion of individuals with a college degree and health insurance, and more developed health care infrastructure. From 1990 to 2017, the density of optometrists increased from 11.06 to 16.16 optometrists per 100,000 individuals. CONCLUSIONS Over the last 2 decades, the national density of ophthalmologists has decreased and the workforce has aged. In contrast, the density of optometrists has increased. Rural counties continue to have a disproportionately lower supply of eye care providers, although some growth has occurred. Given the rising ratio of optometrists to ophthalmologists, it is of interest for future work to determine how the optometrist workforce can best complement potential shortages of ophthalmologists.
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Affiliation(s)
- Paula W Feng
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | - Aneesha Ahluwalia
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | - Hao Feng
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut
| | - Ron A Adelman
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut.
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Miller DD, Stewart MW, Gagne JJ, Wagner AL, Lee AY. Differences in characteristics of Medicare patients treated by ophthalmologists and optometrists. PLoS One 2020; 15:e0227783. [PMID: 32925977 PMCID: PMC7489526 DOI: 10.1371/journal.pone.0227783] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 09/01/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose To quantify differences in the age, gender, race, and clinical complexity of Medicare beneficiaries treated by ophthalmologists and optometrists in each of the United States. Design Cross-sectional study based on publicly accessible Medicare payment and utilization data from 2012 through 2017. Methods For each ophthalmic and optometric provider, demographic information of treated Medicare beneficiaries was obtained from the Medicare Provider Utilization and Payment Data from the Centers for Medicare and Medicaid Services (CMS) for the years 2012 through 2017. Clinical complexity was defined using CMS Hierarchical Condition Category (HCC) coding. Results From 2012 through 2017, ophthalmologists in every state treated statistically significantly older beneficiaries, with the greatest difference (4.99 years in 2014) between provider groups seen in Rhode Island. In most states there was no gender difference among patients treated by the providers but in 46 states ophthalmologists saw a more racially diverse group of beneficiaries. HCC risk score analysis demonstrated that ophthalmologists in all 50 states saw more medically complex beneficiaries and the differences were statistically significant in 47 states throughout all six years. Conclusions Although there are regional variations in the characteristics of patients treated by ophthalmologists and optometrists, ophthalmologists throughout the United States manage older, more racially diverse, and more medically complex Medicare beneficiaries.
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Affiliation(s)
- Darby D. Miller
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, United States of America
- * E-mail:
| | - Michael W. Stewart
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, United States of America
| | - Joshua J. Gagne
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Alan L. Wagner
- Department of Ophthalmology, Eastern Virginia Medical School, Norfolk, VA, United States of America
| | - Aaron Y. Lee
- Department of Ophthalmology, University of Washington, Seattle, WA, United States of America
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20
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Omega-3 Fatty Acids and Eye Health: Opinions and Self-Reported Practice Behaviors of Optometrists in Australia and New Zealand. Nutrients 2020; 12:nu12041179. [PMID: 32331489 PMCID: PMC7230711 DOI: 10.3390/nu12041179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/16/2020] [Accepted: 04/16/2020] [Indexed: 12/20/2022] Open
Abstract
This study investigated optometrists’ attitudes and self-reported practice behaviors towards omega-3 fatty acids for eye health, and knowledge and understanding of their potential risks and benefits. An anonymous online survey was distributed to optometrists in Australia and New Zealand. Questions included practitioner demographics and practice modality; self-reported practices and recommendations relating to diet, nutritional supplements, and omega-3 fatty acids for age-related macular degeneration (AMD) and dry eye disease (DED); and practitioner knowledge about omega-3 fatty acids. Of 206 included surveys, most respondents (79%) indicated recommending for their patients to consume omega-3 fatty acids to improve their eye health. Sixty-eight percent of respondents indicated recommending omega-3-rich foods for AMD management, while 62% indicated recommending omega-3 supplements. Most respondents (78%) indicated recommending omega-3-rich foods or supplements for DED. For DED, recommended omega-3 supplement dosages were (median [inter-quartile range, IQR]) 2000 mg [1000–2750 mg] per day. The main sources of information reported by respondents to guide their clinical decision making were continuing education articles and conferences. In conclusion, optometrists routinely make clinical recommendations about diet and omega-3 fatty acids. Future education could target improving optometrists’ knowledge of differences in the evidence for whole-food versus supplement sources of omega-3 fatty acids in AMD. Further research is needed to address uncertainties in the evidence regarding optimal omega-3 dosage and formulation composition in DED.
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21
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Black JM, Jacobs RJ, Phillips JR, Acosta ML. The changing scope of Optometry in New Zealand: historical perspectives, current practice and research advances. J R Soc N Z 2019. [DOI: 10.1080/03036758.2019.1587476] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Joanna M. Black
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - Robert J. Jacobs
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - John R. Phillips
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - Monica L. Acosta
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
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22
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Geographical access to electroconvulsive therapy services in Texas. J Affect Disord 2019; 245:1135-1138. [PMID: 30699857 DOI: 10.1016/j.jad.2018.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/22/2018] [Accepted: 12/08/2018] [Indexed: 11/21/2022]
Abstract
AIMS Electroconvulsive Therapy (ECT) is a well-established and effective treatment in mood disorders but the use of ECT in Texas is much lower than the general average among the United States. Our goal is to explore the geographical accessibility of Electroconvulsive Services in Texas. METHODS 22 ECT Centers in Texas listed in State's 2016 annual ECT report were enrolled and georeferenced. We used Esri's StreetMap Premium Network release 1 network dataset to generate 1-hour drive time service areas for these ECTs. We estimated populations within these service areas based on US Census Tract level population-weighted centroids; generated from the 2015, American Community Survey (ACS) estimates at the US Census Block Group level. RESULTS About 75% (19,851,802 of 26,538,614) of Texas total population is within a 1-hour drive time to any ECT Services location. When focusing on population below the poverty level from 2015 Block Group level ACS data: 68% (3,046,141 of 4,472,451) are within a 1-hour drive time. CONCLUSIONS ECT services are geographically accessible in Texas. Other barriers may contribute to lower use of ECT.
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23
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Wright DM, O'Reilly D, Azuara-Blanco A, Hogg RE. Impact of car transport availability and drive time on eye examination uptake among adults aged ≥60 years: a record linkage study. Br J Ophthalmol 2018; 103:730-736. [PMID: 29970390 PMCID: PMC6582726 DOI: 10.1136/bjophthalmol-2018-312201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/18/2018] [Accepted: 06/15/2018] [Indexed: 11/04/2022]
Abstract
AIM To examine associations between uptake of free primary eye care, service availability (density of optometric practices) and service accessibility (household car access and drive time to nearest provider) after accounting for socioeconomic status and other individual, household and area factors. METHODS We constructed a cohort of 294 870 community-dwelling adults aged 60 years, drawing contextual information from the 2011 Northern Ireland Census. Minimum drive times to the nearest optometry practice (1-19 min) and number of practices were derived for 890 geographical areas. The primary outcome was attendance at one or more publicly funded eye examinations to which all cohort members were entitled between 2009 and 2014. We used multiple log-binomial regression to estimate associations between eye care uptake, car ownership and drive time. RESULTS Eye examination uptake was 60.0%. 23.7% of the cohort had no car access, and these individuals had lower uptake than car owners (unadjusted risk ratio (RR) of uptake=0.86 (0.86, 0.87)). Among non-car owners, uptake decreased with drive time (longest vs shortest: RR=0.92 (0.88, 0.97)) with the largest decrease at 4 min drive time (approximately 1.5 miles). This pattern was weaker among car owners. These associations were independent of service availability, which was not associated with uptake. CONCLUSION Both drive time and household car access were associated with eye care use, adjusting for individual, household and area factors. Policies to improve uptake should target those with no car access, especially those beyond walking distance from the nearest eye care provider.
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Affiliation(s)
- David M Wright
- Centre for Public Health, Queen's University Belfast, Belfast, UK .,Administrative Data Research Centre, Northern Ireland, UK
| | - Dermot O'Reilly
- Centre for Public Health, Queen's University Belfast, Belfast, UK.,Administrative Data Research Centre, Northern Ireland, UK
| | | | - Ruth E Hogg
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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Luo H, Shrestha S, Zhang X, Saaddine J, Zeng X, Reeder T. Trends in Eye Injuries and Associated Medical Costs among Children in the United States, 2002-2014. Ophthalmic Epidemiol 2018; 25:280-287. [PMID: 29473762 DOI: 10.1080/09286586.2018.1441425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To describe the trends in eye injuries and associated medical costs among children in the United States. METHODS Data were from the 2002-2014 Medical Expenditure Panel Survey (MEPS). Eye injuries in children aged <18 years were identified by the International Classification of Diseases-9 (ICD-9) codes. The trends of cumulative incidence of eye injury, total costs, and average costs were estimated from 2002-2014 MEPS data. All costs were adjusted to 2014 US dollars. Analyses accounted for the complex stratified multistage survey design of the MEPS. We used MarketScan data (2010-2013) to validate outpatient cost estimates. RESULTS The 3-year average cumulative incidence of eye injuries declined from 0.56% in 2002-2004 to 0.31% in 2012-2014 (Trend p < 0.001). The average annual total costs decreased from $193 million during 2002-2004 to $66 million during 2012-2014 (p < 0.001). CONCLUSION The MEPS data showed that among children aged <18 years, the incidence of eye injuries and associated financial burden substantially declined during 2002-2014, highlighting the progress in preventing children eye injuries. Continuing efforts are needed to further reduce the burden in this population.
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Affiliation(s)
- Huabin Luo
- a Department of Public Health, East Carolina University, Greenville , NC , USA
| | - Sundar Shrestha
- b Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion , Centers for Disease Control and Prevention (CDC) , Atlanta , GA , USA
| | - Xinzhi Zhang
- c Department of Health Services Administration , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Jinan Saaddine
- b Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion , Centers for Disease Control and Prevention (CDC) , Atlanta , GA , USA
| | - Xiaoming Zeng
- d Department of Health Services and Information Management , East Carolina University , Greenville , NC , USA
| | - Timothy Reeder
- e Department of Emergency Medicine, East Carolina University , Greenville , NC , USA
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