Geospatial access to neuro-ophthalmologists in Canada: a regional analysis.

BACKGROUND: There is an undersupply of neuro-ophthalmologists in North America compared to care demand, which may be further compounded by barriers to care access, such as geography, education, and socioeconomic status. In this study, we sought to analyze the national distribution of neuro-ophthalmologists in Canada and evaluate factors associated with impeded care access. METHODS: A list of all neuro-ophthalmologists in Canada was compiled using the North American Neuro-Ophthalmology Society directory, Canadian Neuro-ophthalmology Group directory, and additional input from the authors. Canadian Census data from 2021 was collected at the level of aggregated dissemination areas (ADAs). The 3-step floating catchment area (3SFCA) method was used to assess accessibility to neuro-ophthalmologists across ADAs. Logistic regression models were created using the accessibility score to determine factors that impact accessibility. RESULTS: Of the 5 433 ADAs in Canada, 1 817 (33%) are located further than 100 km from the nearest neuro-ophthalmologist. The mean distance to a neuro-ophthalmologist was 155.0 km, while the median was 33.0 km. The overall 3SFCA-adjusted rate of accessibility in Canada was 0.015 neuro-ophthalmologists per 100,000 people. Regression analysis found rural residency (odds ratio [OR] = 0.56; p < 0.001) to be the most significant factor associated with reduced access to neuro-ophthalmological care, while areas with higher Indigenous population percentages were associated with reduced access to care (OR = 0.36; p < 0.001). CONCLUSIONS: There are disparities in access to neuro-ophthalmologists across Canada. Rural residence and an increased Indigenous population were found to be significant factors associated with reduced access to neuro-ophthalmological care. Further research should investigate strategies to mitigate these discrepancies.