Expansion of Laser Eye Surgery Not Associated With Shorter Travel Times for Care

Shorter travel times for care and an increase in the percentage of the population that had nearby health care professionals was not found to be associated with the expansion of laser eye surgery privileges to optometrists, according to a study published in JAMA Ophthalmology.

Eye care in the United States is provided primarily through ophthalmologists and optometrists. Some states have expanded the scope of practice for optometrists to improve access to eye care. However, the data that exists for the relationship between expanding scope and improving access is minimal. This study aimed to evaluate whether increased access to laser eye surgery was associated with the improvement of access in states that allowed for optometrists to perform such a surgery.

Medicare Part B claims, the 2020 US Census, geographical data, road geometries, and historical traffic data were all combined to estimate access and travel times in Oklahoma, Kentucky, Louisiana, Arkansas, and Missouri from January 2016 to December of 2020. Optometrists and ophthalmologists who filed claims for Medicare Part B were included. Geographical data included ZIP codes and geographic coordinates. Geographical access of 30 minutes or less was calculated for each state.

There were 1,564,307 individuals who were included in the analytic cohort from the 5 states mentioned.

The greatest percentage of laser eye surgery was found in Oklahoma, with 33.2% of laser peripheral iridotomy (LPI), 25.7% of selective laser trabeculoplasty (SLT), and 37.1% of YAG procedures in the state. The lowest percentage of procedures in states that expanded optometric scope before 2016 was found in Louisiana.

Optometrists accounted for 31.7% of LPI, 49.1% of SLT, and 56.2% of health care professionals making claims for YAG in Oklahoma. Optometrists accounted for 15.5% of LPI, 26.5% of SLT, and 29.6% of YAG in Kentucky; less than 10% of LPI, 20.9% of SLT, and 23.2% of YAG in Louisiana; and less than 9% of health care professionals making claims for YAG in Arkansas.

It was found that a greater percentage of the population was exclusively in a 30-minute drive to an ophthalmologist compared with only an optometrist. A longer travel time was found in Kentucky to receive all laser procedures, with the shortest median (IQR) drive time for an optometrist being 49.0 (18.4-71.1) minutes for YAG and the longest median drive time for an ophthalmologist being 22.8 (12.1-41.4) minutes. The median driving time for YAG was 26.6 (12.2-56.9) minutes for optometrists vs 22.0 (11.2-40.8) minutes for ophthalmologists; the median driving time in Arkansas was 90.0 (16.2-93.2) minutes for optometrists and 26.5 (11.8-51.6) minutes for ophthalmologists.

A total of 65.1% (95% CI, 64.1%-65.3%) of patients traveled less than 30 minutes for ophthalmologists compared with 53.0% (95% CI, 52.2%-53.8%) for optometrists in Oklahoma; the percentage in Kentucky was 60.0% (95% CI, 59.7%-60.8%) for ophthalmologists compared with 37.0% (95% CI, 35.6%-37.8%) for optometrists. Similarly, the percentage of patients was 54.0% (95% CI, 53.0%-54.1%) for ophthalmologists and 33.0% (95% CI, 16.5%-50.2%) for optometrists in Arkansas. However, in Louisiana, there was a lower percentage of patients who traveled less than 30 minutes for YAG procedures when going to an ophthalmologist at 65.0% (95% CI, 64.5%-65.6%) compared with optometrists at 71.0% (95% CI, 69.1%-72.2%).

Some limitations of the study included not being able to assess the quality of care improvement, whether ease of appointments was improved, effect of physician availability, or if costs decreased without compromising the quality of care. Sociodemographic factors could not be analyzed.

The researchers concluded that there was “insufficient evidence to assert that optometric scope expansion increases geographic access and reduces driving times for laser procedures.”

Reference

Shaffer J, Rajesh A, Stewart MW, et al. Evaluating access to laser eye surgery by driving times using Medicare data and geographical mapping. JAMA Ophthalmol. Published online July 20, 2023. doi:10.1001/jamaophthalmol.2023.3061