2026-05-15 アメリカ国立衛生研究所（NIH）
＜関連情報＞
- https://www.nih.gov/news-events/news-releases/nih-supported-project-expands-access-care-children-amblyopia
- https://jamanetwork.com/journals/jamaophthalmology/article-abstract/2848367
- https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2817279
- https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2800630
ウェブベースの弱視診断支援ツール Web-Based Amblyopia Decision Support Tool
Allison I. Summers, OD, MCR; Stanley W. Hatch, OD, MPH; Sarah R. Hatt, DBO;et al
JAMA Ophthalmology Published:May 7, 2026
DOI:10.1001/jamaophthalmol.2026.1095
Abstract
Importance Amblyopia is the leading cause of monocular decreased best-corrected vision in children. Early detection and intervention are key for optimal treatment outcomes; however, limited access to pediatric eye specialists may hinder timely care and affect visual outcomes. Given the shortage of specialty-trained eye care professionals in the US, there is need to support comprehensive eye care professionals who are willing to examine and treat children with amblyopia.
Objective A panel from the Pediatric Eye Disease Investigator Group synthesized relevant literature and incorporated consensus opinion where direct evidence was lacking to create the Amblyopia Navigator Decision-Support Instrument, a free, web-based amblyopia decision support tool for eye care professionals.
Evidence Review The decisions related to optimal diagnostic measures, pass/refer criteria, and management recommendations were informed by 147 publications. In areas where direct evidence was lacking, guidance was supplemented with clinical trial protocols or existing professional guidelines. When data were conflicting or unavailable, recommendations were established through committee consensus. A single reviewer independently performed standardized (though not systematic) literature reviews to avoid missing pertinent recent publications.
Findings Presented are the process used, supporting evidence, and recommendations for testing methods, refractive correction, amblyopia treatment options, treatment adjustments, and monitoring schedules.
Conclusions and Relevance Because amblyopia is common and typically responds well to treatment, decision support tools that optimize its management could increase access to pediatric eye care by facilitating earlier detection, enabling broader participation of primary eye care professionals, and ultimately improving visual outcomes. Through this work and the development of the forthcoming free, web-based application version, Amblyopia Navigator Decision-Support Instrument, the Pediatric Eye Disease Investigator Group has created decision support tools designed to assist optometrists and ophthalmologists in the care of children aged 3 to 17 years with amblyopia.
小児眼科医療へのアクセス状況：医療従事者の種類、地理的分布、および米国人口統計に基づく分析 Access to Pediatric Eye Care by Practitioner Type, Geographic Distribution, and US Population Demographics
Nora E. Siegler, BA; Hannah L. Walsh, BS; Kara M. Cavuoto, MD
JAMA Ophthalmology Published:April 11, 2024
DOI:10.1001/jamaophthalmol.2024.0612
CONANP indicates Comisión Nacional de Áreas Naturales Protegidas; EPA, Environmental Protection Agency; FAO, Food and Agriculture Organization; HERE, HERE Map Data; NOAA, National Oceanic and Atmospheric Administration; USGS, United States Geological Survey.
Key Points
Question What is the association between geographic distribution of pediatric eye care practitioners and US population demographics in 2023?
Findings This cross-sectional study, including 586 pediatric optometrists and 1060 pediatric ophthalmologists, revealed that the geographic distribution of pediatric optometrists and pediatric ophthalmologists overlapped substantially. Regions lacking pediatric optometrists and pediatric ophthalmologists were associated with low socioeconomic status.
Meaning Disparities in pediatric eye care access were associated with socioeconomic status; these results support pursuing evidence-based efforts to increase practitioner reimbursement and recruitment in underserved areas, which may enhance pediatric eye care access.
Abstract
Importance Investigating disparities in service coverage of pediatric optometrists and pediatric ophthalmologists in relation to patient demographics will illuminate vulnerable populations and inform future interventions.
Objective To characterize the geographic distribution of pediatric eye care practitioners and analyze its association with population demographics.
Design, Setting, and Participants In this cross-sectional study, 4 public databases were used to identify the addresses of pediatric optometrists and pediatric ophthalmologists in the US in April 2023. Addresses were geocoded, and population demographic data were collected. Pediatric optometrists and pediatric ophthalmologists listed in the public databases, as well as respondents to the 2020 US census, were included in this study. Data were analyzed from April to July 2023.
Exposures Public databases and US census data of eye practitioners and their practice locations.
Main Outcomes and Measures Geographic distribution of pediatric optometrists and pediatric ophthalmologists as listed in public databases and correlations between service coverage and US population demographics.
Results A total of 586 pediatric optometrists (302 female [51.5%]) and 1060 pediatric ophthalmologists (590 male [55.7%]) were identified. Among US counties, 203 (6.5%) had at least 1 pediatric optometrist, and 308 (9.7%) had at least 1 pediatric ophthalmologist, showing substantial geographic overlap (odds ratio, 12.7; 95% CI, 9.4-17.4; P < .001). In the 2834 counties without pediatric ophthalmologists, 2731 (96.4%) lacked pediatric optometrists. There were more pediatric ophthalmologists per million people (3.3) compared with pediatric optometrists per million people (2.5) across all states (difference, 0.8; 95% CI, 0-1.9; P = .047). Among counties with practitioners, the median (IQR) number of pediatric optometrists per million people was 7.8 (0.4-245.0), surpassing the median (IQR) number of pediatric ophthalmologists per million people, 5.5 (1.0-117.0). Counties with pediatric ophthalmologists had higher mean (SD) household incomes than counties with pediatric optometrists ($76 126.87 [$21 879.23] vs $68 681.77 [$18 336.40]; difference, −$7445.10; 95% CI, $2519.51-$12 370.69; P = .003) and higher mean (SD) population with bachelor’s degrees than counties with pediatric optometrists (79 016 [82 503] vs 23 076 [44 025]; difference, −55 940; 95% CI, −73 035 to −38 845; P < .001), whereas counties with neither specialist type had the lowest mean (SD) household income ($57 714.03 [$2731.00] vs $78 388.67 [$18 499.21]; difference, −$20 675.00; 95% CI, −$21 550.90 to −$19 799.10; P < .001) and mean (SD) population with bachelor’s degrees (5113 [12 875] vs 167 015 [216 486]; difference, −161 902; 95% CI, −170 388.9 to −153 415.1; P < .001) compared with counties with practitioners.
Conclusions and Relevance Geographic disparities in pediatric eye care access, compounded by socioeconomic differences, underscore the urgency of augmenting practitioner support in underserved areas.
2022年における小児眼科医療へのアクセス状況（地理的分布および米国人口統計学的特徴別） Access to Pediatric Ophthalmological Care by Geographic Distribution and US Population Demographic Characteristics in 2022
Hannah L. Walsh, BS; Abraham Parrish, MA, MILS; Lauren Hucko, BA;et al
JAMA Ophthalmology Published:January 26, 2023
DOI:10.1001/jamaophthalmol.2022.6010
The figure displays the geographic distribution of US pediatric ophthalmologists (PO) per population younger than 19 years. This image was created using ArcGIS Pro (Esri) with data from Garmin, Food and Agriculture Organization of the United Nations, National Oceanic and Atmospheric Administration, United States Geological Survey, Geographic Information Systems User Community, and OpenStreetMap.
Key Points
Question What is the current geographic distribution of pediatric ophthalmologists and how does this correspond to regional patient demographic characteristics?
Findings In this cross-sectional study of 1056 pediatric ophthalmologists, disparities in geographical access to pediatric ophthalmologists persisted in 2022, and the range of practitioner to million persons has increased since 2007. Disparities in practitioner distribution were associated with lower socioeconomic status.
Meaning Findings of this study suggest that disparities in access to pediatric ophthalmological care are associated with socioeconomic status; evidence-based measures and accurate publicly available information on locations of pediatric ophthalmologists are warranted to increase access to care.
Abstract
Importance The geographic distribution of pediatric ophthalmological care has not been reported on since 2007; understanding this distribution could shed light on potential avenues to increase access, which is a necessary first step in addressing the pediatric ophthalmological needs of underserved areas.
Objective To analyze the number and location (ie, geographic distribution) of pediatric ophthalmologists in relation to US population demographic characteristics.
Design, Setting, and Participants In this cross-sectional study, public databases from the American Academy of Ophthalmology and American Association for Pediatric Ophthalmology and Strabismus were used to identify pediatric ophthalmologists in the US as of March 2022.
Main Outcomes and Measures Geographic distribution of pediatric ophthalmologists listed in public databases and any association between pediatric ophthalmologist distribution and US population demographic characteristics. Addresses were geocoded using ArcGIS Pro (Esri).
Results A total of 1056 pediatric ophthalmologists (611 men [57.9%]) were identified. States with the most pediatric ophthalmologists were California (n = 116 [11.0%]), New York (n = 97 [9.2%]), Florida (n = 69 [6.5%]), and Texas (n = 62 [5.9%]), the 4 most populous states. A total of 2828 of 3142 counties (90.0%) and 4 of 50 states (8.0%) had 0 pediatric ophthalmologists. In 314 counties (10.0%) with 1 or more pediatric ophthalmologists, the mean (range) pediatric ophthalmologists per million persons was 7.7 (0.4-185.5). The range of practitioner to million persons has increased since 2007. Counties with 1 or more pediatric ophthalmologists had a higher median (SD) household income compared with counties with 0 pediatric ophthalmologists ($70 230.59 [$18 945.05] vs $53 263.62 [$12 786.07]; difference, −$16 966.97; 95% CI, −$18 544.57 to −$14 389.37; P < .001). Additionally, the proportion of families in each county without internet service (8.0% vs 4.7%; difference, 3.4%; 95% CI, 3.0%-3.7%; P < .001), the proportion of persons younger than 19 years without health insurance (5.7% vs 4.1%; difference, 1.6%; 95% CI, 1.1%-2.2%; P < .001), and the proportion of households without vehicle access (2.1% vs 1.8%; difference, 0.3%; 95% CI, 0.6%-5.2%; P = .001) were greater in counties with 0 compared with counties with 1 or more pediatric ophthalmologists.
Conclusion and Relevance This cross-sectional study found that disparities in access to pediatric ophthalmological care have increased over the past 15 years and are associated with lower socioeconomic status. As patients may rely on online sources to identify the nearest pediatric ophthalmologist, accurate publicly available databases are important.
