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Source / Disclosures

Disclosures: The authors report no relevant financial disclosures.


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A higher number of eye care clinicians was associated with a lower prevalence of visual impairment, according to a cross-sectional study in California.

The Geographic distribution of ophthalmologists and optometrists in each of the 58 California counties and 542 medical service study areas (MSSAs) was evaluated. The number of ophthalmologists was obtained from the American Academy of Ophthalmology membership data using practice zip codes, and the number of optometrists was obtained from the Blue Book of Optometrists. Information on visual impairment was gathered from the 2014 to 2018 American Community Survey Questionnaires.

Based on 2014 to 2018 data, the total population of California 18 years or older was 30,068,581. In the same period of time, there were 2,378 ophthalmologists and 4,186 optometrists. Overall, there were 22.18 eye care clinicians per 100,000 population. Both ophthalmologists and optometrists were present in 288 MSSAs (53.1%), while nine MSSAs (1.7%) had ophthalmologists only, 121 (22.3%) had optometrists only and 124 (22.9%) had no eye care services.

The study found a significantly lower prevalence of visual impairment in counties and MSSAs with a higher number of eye care clinicians per 100,000 population, such as San Francisco County (39.24) and San Luis Obispo County (31.19). The mean prevalence of visual impairment was 2,365.07 per 100,000 population in MSSAs with both ophthalmologists and optometrists as compared with 3,170.53 per 100,000 population in MSSAs with optometrists only.

“Risk factors for low vision and visual impairment have been previously reported,” the authors wrote. However, “one potential risk factor that has not been well studied is the availability of eye care clinicians.”

Of note, the prevalence of visual impairment was also significantly associated with income below 150% of the federal poverty level, due to more limited access to care.

“Future studies specifically examining the association between poverty level and visual impairment would be of value, as poverty is explored in this study only as a potential confounding factor,” the authors wrote.

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