Eyes on Transit: Disparities in Accessing Eye Care by Public Transportation in Virginia

PURPOSE: This study aimed to calculate geospatial accessibility to optometrist and ophthalmologist using public transportation in Virginia, and to measure the sociodemographic factors associated with accessibility. METHODS: We evaluated one-way public transit travel time and population-weighted accessibility score, defined as the number of eye care centers (optometry and ophthalmology) reachable within a one-hour walk or a two-hour transit commute, across seven regions in Virginia. Both objective and perceived ("feels-like") accessibility measures were calculated. Mann-Whitney U tests were used to compare accessibility between optometry and ophthalmology services, and spatial error models were used to examine socioeconomic factors associated with accessibility score. RESULTS: The mean of the weighted one-way transit time to an ECC in Virginia was 81 min. 62% of the trip was due to time spent outside the vehicle (e.g. walking to or waiting at stops). The mean of the weighted accessibility score for ECCs was 9.22. On average, the proportion of the population that could reach at least one ophthalmologist within an hour was 53% compared to 71% for an optometrist. Accessibility scores for all ECCs were associated with population density and racial diversity, but no relationship was seen with poverty. CONCLUSIONS: Eye care in Virginia is grossly inaccessible by public transportation. Compared to optometric care, there is limited access to ophthalmologic care. Tailored interventions accounting for local characteristics should be considered to address transit disparities.