Eye care workforce density by provider type in urban and rural counties in the United States, 2010 to 2021

PURPOSE: Healthcare provider geographic density patterns have been shown to play a role in healthcare disparities in the United States. This study examines these patterns specifically in ophthalmology and optometry across urban and rural communities. METHODS: A cross-sectional study evaluating the Area Health Resource File was conducted according to the National Center for Health Statistics' Urban-Rural Classification Scheme. Ophthalmologist and optometrist density per 100 000 persons in each county was assessed annually, and a Chow test was conducted to evaluate the urban-rural distribution trend. RESULTS: 3218 counties (472 large metropolitan, 763 small/medium metropolitan, and 1983 rural) were evaluated from 2010 to 2021. In this timeframe, it was found that urban counties had greater provider density than rural counties for both ophthalmology and optometry. Additionally, ophthalmologist density per 100 000 persons decreased from 2010 to 2021, while optometrist density increased in all county types. Counties with zero practicing nonfederal ophthalmologists ("dead zones") increased modestly from 60.7% in 2010, to 62.7% in 2021, disproportionately concentrated in rural counties. CONCLUSIONS: Geographic disparities in eye care access persist and may be widening, particularly in rural communities where ophthalmologist shortages are most pronounced. Although optometrist availability has increased, growing "dead zones" for specialty eye care raise concern for populations already at higher risk for vision-threatening disease, highlighting the need for targeted workforce and policy interventions.