Potential Disparities in Access to Adult Strabismus Care

Importance Adult strabismus impacts quality of life through diplopia, eye strain, and psychological burden. Access to care may be limited by various factors, yet disparities in adult strabismus care have not been examined nationally. Objective To evaluate potential disparities in access to adult strabismus care across the US by practice type, insurance status, and county-level socioeconomic characteristics. Design, Setting, and Participants This national secret shopper study used standardized telephone calls to US pediatric ophthalmology practices identified through the American Association for Pediatric Ophthalmology and Strabismus and the American Academy of Ophthalmology that simulated appointment scheduling for an adult patients with strabismus. Of 1064 practices contacted, 1060 were included after excluding 4 clinics with disconnected phone numbers. These data were analyzed from August 2025 to September 2026. Exposure Practice type (academic vs other), insurance type (Medicaid vs commercial insurance), and county-level characteristics, including race and ethnicity majority, median household income, Area Deprivation Index (ADI), and Social Vulnerability Index (SVI). Main Outcome and Measures Appointment success (ability to schedule appointment during call) and appointment wait time (days between call date and earliest available appointment). Results Overall, 23.8% (252 of 1060) of practices offered an appointment under at least 1 insurance scenario. Patients using Medicaid had a lower appointment success rate than those with commercial insurance (161 of 648 [24.8%] vs 91 of 194 [46.9%]; difference, −22.1 percentage points; 95% CI, −29.8 to −14.3; P < .001). In multivariable regression, other practice types (adjusted odds ratio [aOR], 1.82; 95% CI, 1.28-2.58; P = .001) and commercial insurance (aOR, 2.36; 95% CI, 1.67-3.33; P = .001) had higher appointment success, while majority racial and ethnic minority counties (aOR, 0.66; 95% CI, 0.45-0.97; P = .04) and lower median household income counties (aOR, 0.64; 95% CI, 0.44-0.93; P = .02) had lower odds. Among practices offering appointments, academic centers had longer wait times than other practices (mean [SD], 95.1 [59.3] days vs 57.0 [54.1] days; 38.1 days difference; 95% CI, 21.2-55.1; P < .001), as did lower-income counties (mean [SD], 78.6 [68.1] days vs 61.3 [52.6] days; −17.4 days difference; 95% CI, −33.3 to −1.4; P = .03). Conclusions and Relevance This national secret shopper study identified potential disparities in adult strabismus care access. Commercial insurance and other practice types had higher appointment success, while majority racial and ethnic minority and lower-income counties had reduced access and longer wait times. These findings highlight a potential unmet likely benefit of adult strabismus practitioners and support targeted policy interventions to improve equitable access to care.