Modern system of ophthalmic care in the USA: organizational structure, funding, and access barriers

Ophthalmic care in the United States is among the most technologically advanced and innovation-driven areas of modern medicine. The country's high level of clinical equipment and infrastructure, rapid adoption of surgical, pharmacological, and digital technologies, development of specialized centers, and implementation of large-scale clinical registries give US ophthalmology substantial scientific and practical potential. At the same time, this system has marked internal contradictions: high healthcare expenditures and rapid technological progress do not necessarily translate into equitable access to medical care across different population groups.

This review aimed to analyze the organizational structure, financing mechanisms, and key barriers affecting access to ophthalmic care in the United States. We analyzed data from the Organisation for Economic Co-operation and Development, the Centers for Medicare & Medicaid Services, the American Academy of Ophthalmology, the National Eye Institute, the IRIS® Registry, and scientific publications addressing workforce capacity, insurance limitations, geographic disparities, and social indicators for assessing eye health.

The review demonstrates that the main barriers to access are associated with the high cost of medical services, limitations of insurance coverage, uneven distribution of specialists, logistical difficulties, low health literacy, and communication barriers. The most vulnerable groups include low-income patients, individuals without comprehensive insurance coverage, residents of rural and remote areas, older adults, and racial and ethnic minorities. Potential directions for reform include expanding insurance coverage, developing telemedicine and mobile ophthalmic services, improving price transparency, training healthcare professionals for underserved regions, implementing culturally adapted educational programs, and using clinical registries to monitor quality of care and identify disparities.

These findings may be useful for developing strategies aimed at improving access to ophthalmic care and preventing systemic imbalances in healthcare.