<?xml version="1.0" encoding="UTF-8"?>
<!DOCTYPE root>
<article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:ali="http://www.niso.org/schemas/ali/1.0/" article-type="other" dtd-version="1.2" xml:lang="en"><front><journal-meta><journal-id journal-id-type="publisher-id">Sociology of Medicine</journal-id><journal-title-group><journal-title xml:lang="en">Sociology of Medicine</journal-title><trans-title-group xml:lang="ru"><trans-title>Социология медицины</trans-title></trans-title-group></journal-title-group><issn publication-format="print">1728-2810</issn><issn publication-format="electronic">2413-2942</issn><publisher><publisher-name xml:lang="en">Eco-Vector</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">693252</article-id><article-id pub-id-type="doi">10.17816/socm693252</article-id><article-categories><subj-group subj-group-type="toc-heading" xml:lang="en"><subject>Reviews</subject></subj-group><subj-group subj-group-type="toc-heading" xml:lang="ru"><subject>Научные обзоры</subject></subj-group><subj-group subj-group-type="article-type"><subject></subject></subj-group></article-categories><title-group><article-title xml:lang="en">Modern System of Ophthalmic Care in the USA: Organizational Structure, Financing, and Accessibility Problems</article-title><trans-title-group xml:lang="ru"><trans-title>Современная система офтальмологической помощи в США: организационная структура, финансирование и проблемы доступности</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-9080-3170</contrib-id><contrib-id contrib-id-type="spin">8540-2420</contrib-id><name-alternatives><name xml:lang="en"><surname>Arzhimatova</surname><given-names>Gulzhiyan Sh</given-names></name><name xml:lang="ru"><surname>Аржиматова</surname><given-names>Гульжиян Шевкетовна</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>MD, PhD</p></bio><bio xml:lang="ru"><p>канд. мед. наук</p></bio><email>okb7@mail.ru</email><xref ref-type="aff" rid="aff1"/><xref ref-type="aff" rid="aff2"/></contrib></contrib-group><aff-alternatives id="aff1"><aff><institution xml:lang="en">Moscow Multidisciplinary Research and Clinical Center named after S.P. Botkin</institution></aff><aff><institution xml:lang="ru">Московский многопрофильный научно-клинический центр имени С.П. Боткина</institution></aff></aff-alternatives><aff-alternatives id="aff2"><aff><institution xml:lang="en">Russian Medical Academy of Continuous Professional Education</institution></aff><aff><institution xml:lang="ru">Российская медицинская академия непрерывного профессионального образования</institution></aff></aff-alternatives><pub-date date-type="preprint" iso-8601-date="2026-06-15" publication-format="electronic"><day>15</day><month>06</month><year>2026</year></pub-date><volume>25</volume><issue>1</issue><issue-title xml:lang="ru"/><history><date date-type="received" iso-8601-date="2025-10-15"><day>15</day><month>10</month><year>2025</year></date><date date-type="accepted" iso-8601-date="2026-05-11"><day>11</day><month>05</month><year>2026</year></date></history><permissions><copyright-statement xml:lang="en">Copyright ©; , Eco-Vector</copyright-statement><copyright-statement xml:lang="ru">Copyright ©; , Эко-Вектор</copyright-statement><copyright-holder xml:lang="en">Eco-Vector</copyright-holder><copyright-holder xml:lang="ru">Эко-Вектор</copyright-holder><license><ali:license_ref xmlns:ali="http://www.niso.org/schemas/ali/1.0/">https://eco-vector.com/for_authors.php#07</ali:license_ref></license></permissions><self-uri xlink:href="https://rjsocmed.com/1728-2810/article/view/693252">https://rjsocmed.com/1728-2810/article/view/693252</self-uri><abstract xml:lang="en"><p><bold>Ophthalmic care in the United States holds a leading position globally in terms of technical equipment and the implementation of innovations. However, this system is characterized by profound contradictions that lead to persistent inequalities in access to care. Based on data from the OECD, the American Academy of Ophthalmology (AAO), and the Centers for Medicare &amp; Medicaid Services (CMS), the article provides an analysis of the organization, financing, and accessibility of services. Key barriers are identified: financial, logistical, cognitive, and communication-related, which particularly acutely affect vulnerable population groups. To overcome them, systemic reforms are proposed: the development of telemedicine, insurance coverage reform, and targeted personnel policies.</bold></p></abstract><trans-abstract xml:lang="ru"><p>Офтальмологическая помощь в США является одной из самых технологически оснащенных и инновационных в мире. В то же время система отличается глубокими внутренними противоречиями, которые приводят к устойчивому неравенству в возможностях получения помощи. На основе данных ОЭСР, Американской академии офтальмологии (ААО) и Центров услуг Medicare и Medicaid (CMS) в статье проводится анализ организации, финансирования и доступности услуг. Выявляются ключевые барьеры: финансовые, логистические, когнитивные и коммуникационные, которые особенно остро затрагивают уязвимые группы населения. Для их преодоления предлагаются системные реформы: развитие телемедицины, реформа системы страхования и целевая подготовка кадров.</p></trans-abstract><funding-group/></article-meta></front><body></body><back><ref-list><ref id="B1"><label>1.</label><mixed-citation>Verana Health. 2023 IRIS® Registry Report. Available at: https://info.veranahealth.com/iris-registry-report-2023.</mixed-citation></ref><ref id="B2"><label>2.</label><mixed-citation>Atta S, Zaheer HA, Clinger O, Liu PJ, Waxman EL, McGinnis-Thomas D, Sahel J-A, Williams AM. Characteristics Associated with Barriers to Eye Care: A Cross-Sectional Survey at a Free Vision Screening Event. Ophthalmic Research. 2022;66(1):170-178. doi:10.1159/000526875.</mixed-citation></ref><ref id="B3"><label>3.</label><mixed-citation>Berkowitz ST, Finn AP, Parikh R, Kuriyan AE, Patel S. Ophthalmology Workforce Projections in the United States, 2020 to 2035. Ophthalmology. 2024;131(2):133-139. doi:10.1016/j.ophtha.2023.09.018.</mixed-citation></ref><ref id="B4"><label>4.</label><mixed-citation>Centers for Medicare &amp; Medicaid Services (CMS). Doctors and Clinicians National File (Provider Data Catalog). Available at: https://www.cms.gov</mixed-citation></ref><ref id="B5"><label>5.</label><mixed-citation>Schehlein EM, Im LT, Robin AL, Onukwugha E, Saeedi OJ. Nonmedical Out-of-Pocket Patient and Companion Expenditures Associated With Glaucoma Care. J Glaucoma. 2017;26(4):343-348. doi:10.1097/IJG.0000000000000619.</mixed-citation></ref><ref id="B6"><label>6.</label><mixed-citation>Cicinelli MV, Marmamula S, Khanna RC. Comprehensive eye care—Issues, challenges, and way forward. Indian J Ophthalmol. 2020;68(2):316-323. doi:10.4103/ijo.IJO_17_19.</mixed-citation></ref><ref id="B7"><label>7.</label><mixed-citation>Cox C, Wager E, McGough M, Rakshit S. How does health spending in the U.S. compare to other countries? Peterson-KFF Health System Tracker. 2025-04-09. Available at: https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/</mixed-citation></ref><ref id="B8"><label>8.</label><mixed-citation>Elam AR, Tseng VL, Rodriguez TM, Mike EV, Warren AK, Coleman AL; AAO Taskforce on Disparities in Eye Care. Disparities in Vision Health and Eye Care. Ophthalmology. 2022;129(10):e89-e113. doi:10.1016/j.ophtha.2022.07.010.</mixed-citation></ref><ref id="B9"><label>9.</label><mixed-citation>Franco JJ, Pineda R 2nd. Geographic Access to Eye Care in the United States. Ophthalmology. 2025;132(1):119-121. doi:10.1016/j.ophtha.2024.07.032.</mixed-citation></ref><ref id="B10"><label>10.</label><mixed-citation>Friedman DS, Hahn SR, Quigley HA, et al. Doctor-patient communication in glaucoma care: analysis of videotaped encounters in community-based office practice. Ophthalmology. 2009;116(12):2277-2285.e1-3. doi:10.1016/j.ophtha.2009.04.052.</mixed-citation></ref><ref id="B11"><label>11.</label><mixed-citation>Gilson A, Chen Q, Adelman RA. Ophthalmic care may not align with patient need: An analysis on state-wide patient needs and provider density between 2008 and 2022. Int J Med Inform. 2024;185:105411. doi:10.1016/j.ijmedinf.2024.105411.</mixed-citation></ref><ref id="B12"><label>12.</label><mixed-citation>Goyal A, Richards C, Patel V, et al. The Vision Detroit Project: Visual Burden, Barriers, and Access to Eye Care in an Urban Setting. Ophthalmic Epidemiol. 2022;29(1):13-24. doi:10.1080/09286586.2021.1884264.</mixed-citation></ref><ref id="B13"><label>13.</label><mixed-citation>Green N, Miller F, Khanna D. Barriers to Eye Care for Adults in the United States and Solutions for It: A Literature Review. Cureus. 2024;16(4):e59071. doi:10.7759/cureus.59071.</mixed-citation></ref><ref id="B14"><label>14.</label><mixed-citation>OECD. Health at a Glance 2023: OECD Indicators. Paris: OECD Publishing; 2023. doi:10.1787/7a7afb35-en.</mixed-citation></ref><ref id="B15"><label>15.</label><mixed-citation>Cox C, Ortaliza J, Wager E, Amin K. Health Policy 101: Health Care Costs and Affordability. KFF; 2025-10-08. Available at: https://www.kff.org/health-costs/health-policy-101-health-care-costs-and-affordability/</mixed-citation></ref><ref id="B16"><label>16.</label><mixed-citation>Lee CS, Blazes M, Lorch A, Pershing S, Hyman L, Ho AC, Haller J, Miller JW, Chew EY, Lum F, Lee AY. American Academy of Ophthalmology IRIS® Registry and the IRIS Registry Analytic Center Consortium. Ophthalmology Science. 2022;2(1):100112. doi:10.1016/j.xops.2022.100112.</mixed-citation></ref><ref id="B17"><label>17.</label><mixed-citation>Tseng VL, Dhaliwal G, Coleman AL, et al. Disparities in Glaucoma Surgery: A Review of Current Evidence and Directions for Future Research. Transl Vis Sci Technol. 2023;12(6):8. doi:10.1167/tvst.12.6.8.</mixed-citation></ref><ref id="B18"><label>18.</label><mixed-citation>Misleading Study Overstates Ophthalmology Access, Undercounts ODs. Review of Optometry. 2024-08-14. Available at: https://www.reviewofoptometry.com/article/misleading-study-overstates-ophthalmology-access-undercounts-ods</mixed-citation></ref><ref id="B19"><label>19.</label><mixed-citation>Rakshit S, McGough M, Cotter L, Claxton G. How does cost affect access to healthcare? Peterson-KFF Health System Tracker. 2025-04-07. Available at: https://www.healthsystemtracker.org/chart-collection/cost-affect-access-care/</mixed-citation></ref><ref id="B20"><label>20.</label><mixed-citation>Ravilla T, Courtright P, Yee Melgar JF, Green D. Affordability and Financing for Eye Care. In: Khanna RC, Rao GN, Marmamula S, eds. Innovative Approaches in the Delivery of Primary and Secondary Eye Care. Cham: Springer; 2019:69-86. doi:10.1007/978-3-319-98014-0_6.</mixed-citation></ref><ref id="B21"><label>21.</label><mixed-citation>Yiu G, Gulati S, Higgins V, Coak E, Mascia D, Kim E, Spicer G, Tabano D. Factors Involved in Anti-VEGF Treatment Decisions for Neovascular Age-Related Macular Degeneration: Insights from Real-World Clinical Practice. Clin Ophthalmol. 2024;18:1679-1690. doi:10.2147/OPTH.S461846.</mixed-citation></ref><ref id="B22"><label>22.</label><mixed-citation>Zhao D, Guallar E, Bowie JV, et al. Improving Follow-up and Reducing Barriers for Eye Screenings in Communities: The SToP Glaucoma Study. Am J Ophthalmol. 2018;188:19-28. doi:10.1016/j.ajo.2018.01.008.</mixed-citation></ref><ref id="B23"><label>23.</label><mixed-citation>MACPAC. Evaluating the Effects of Medicaid Payment Changes on Access to Physician Services. January 2025. Available at: https://www.macpac.gov/wp-content/uploads/2025/01/Evaluating-the-Effects-of-Medicaid-Payment-Changes-on-Access-to-Physician-Services.pdf</mixed-citation></ref><ref id="B24"><label>24.</label><mixed-citation>LASIK.com. How Much Does LASIK Cost in 2025? Updated 2025-10-13. Available at: https://www.lasik.com/how-much-does-lasik-cost/</mixed-citation></ref><ref id="B25"><label>25.</label><mixed-citation>Economist Impact. Vision for change: Meeting the growing demand for eye care. 2022. Available at: https://impact.economist.com/projects/vision-for-change/</mixed-citation></ref><ref id="B26"><label>26.</label><mixed-citation>Shneor E, Isaacson M, Gordon-Shaag A. The number of optometrists is inversely correlated with blindness in OECD countries. Ophthalmic Physiol Opt. 2021;41(1):198-201. doi:10.1111/opo.12746.</mixed-citation></ref><ref id="B27"><label>27.</label><mixed-citation>Resnikoff S, Lansingh VC, Washburn L, et al. Estimated number of ophthalmologists worldwide (International Council of Ophthalmology update): will we meet the needs? Br J Ophthalmol. 2019;104(4):588-592 (Epub ahead of print 2019). doi:10.1136/bjophthalmol-2019-314336.</mixed-citation></ref><ref id="B28"><label>28.</label><mixed-citation>World Health Organization. Out-of-pocket expenditure (OOP) per capita in US$. Global Health Observatory. Available at: https://www.who.int/data/gho/data/indicators/indicator-details/GHO/out-of-pocket-expenditure-(oop)-per-capita-in-us</mixed-citation></ref><ref id="B29"><label>29.</label><mixed-citation>C.D. Howe Institute. Zhang T. Troubling Diagnosis: Comparing Canada’s Healthcare with Its International Peers (Commentary No. 673). January 2025. Available at: https://cdhowe.org/publication/troubling-diagnosis-comparing-canadas-healthcare-with-international-peers/</mixed-citation></ref><ref id="B30"><label>30.</label><mixed-citation>Healthwatch England. Cost of living remains barrier to health for the most vulnerable. 2024-03-18. Available at: https://www.healthwatch.co.uk/blog/2024-03-18/cost-living-remains-barrier-health-most-vulnerable</mixed-citation></ref><ref id="B31"><label>31.</label><mixed-citation>Peterson-KFF Health System Tracker. Health spending in the U.S. compared to peer countries — per capita spending 2023. 2025-04-09. Available at: https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/</mixed-citation></ref><ref id="B32"><label>32.</label><mixed-citation>Economist Impact. Vision for change (executive summary online). Available at: https://impact.economist.com/projects/vision-for-change/</mixed-citation></ref><ref id="B33"><label>33.</label><mixed-citation>American Academy of Ophthalmology (AAO). Latest Research From the World’s Largest Eye Disease Data Registry. News release, 2022-09-30. Available at: https://www.aao.org/newsroom/news-releases/detail/latest-research-largest-eye-disease-data-registry</mixed-citation></ref><ref id="B34"><label>34.</label><mixed-citation>Green N, Miller F, Khanna D. Cureus. 2024;16(4):e59071. doi:10.7759/cureus.59071.</mixed-citation></ref><ref id="B35"><label>35.</label><mixed-citation>FODO – The Association for Eye Care Providers. FODO member update – 5 May (news item referencing primary eye-care strategy principles). 2023-05-05. Available at: https://www.fodo.com/news-and-views/more/29465/page/4/fodo-member-update-5-may/</mixed-citation></ref><ref id="B36"><label>36.</label><mixed-citation>AAO. IRIS® Registry – About. Available at: https://www.aao.org/iris-registry</mixed-citation></ref><ref id="B37"><label>37.</label><mixed-citation>DRCR Retina Network. General Information. Available at: https://public.jaeb.org/drcrnet/view/General_Info</mixed-citation></ref><ref id="B38"><label>38.</label><mixed-citation>National Eye Institute (NIH). About NEI. Available at: https://www.nei.nih.gov/</mixed-citation></ref><ref id="B39"><label>39.</label><mixed-citation>Gesundheitsmarkt.de. Anzahl und Statistik der Praxen für Augenheilkunde. 2025-06-16. Available at: https://www.gesundheitsmarkt.de/anzahl-statistik-praxen-augenheilkunde-augenarzt-facharzt-praxis-augen-mvz/</mixed-citation></ref><ref id="B40"><label>40.</label><mixed-citation>KFF. 2024 Employer Health Benefits Survey. 2024-10-09. Available at: https://www.kff.org/health-costs/2024-employer-health-benefits-survey/</mixed-citation></ref><ref id="B41"><label>41.</label><mixed-citation>Nguyen AH, Stinnett SS, Challa P, et al. Observational Outcomes of Initial Trabeculectomy With Mitomycin C in Patients of African Descent vs European Descent. JAMA Ophthalmol. 2018;136(6): (PMC6583864). doi:10.1001/jamaophthalmol.2018.1225.</mixed-citation></ref><ref id="B42"><label>42.</label><mixed-citation>Kernohan A, et al. Cost-effectiveness of primary surgical versus primary medical treatment for advanced glaucoma. Br J Ophthalmol. 2023;107(10):1452-1459. doi:10.1136/bjo-2022-322375.</mixed-citation></ref><ref id="B43"><label>43.</label><mixed-citation>Bello SU, et al. Direct non-medical and indirect costs of glaucoma care in a tertiary hospital. Health Econ Rev. 2024;14(1): (online). doi:10.1186/s12982-024-00349-w..</mixed-citation></ref></ref-list></back></article>
