Rebecca Russ Soares, MD, MPH
Vitreoretinal Surgery Fellow
Mid Atlantic Retina at Wills Eye Hospital
Congratulations to Dr. Soares from Wills Eye Hospital, who is the 2021 recipient of the Retina Society Fellowship Research Award. Dr. Soares has done impressive work examining risk factors for access to care for retinal diseases through various projects. We are excited to have Dr. Soares discuss her impactful work on the geographic access to retinopathy of prematurity (ROP) treatment with us, which she presented at the Retina Society Meeting in Chicago.
Can you tell our readers about your study?
As many readers know, the incidence and severity of ROP is rising in the United States. Nevertheless, when surveyed by Vartanian et al., one in 10 neonatal intensive care unit (NICU) directors report difficulty maintaining or retaining ROP services, with a large percentage citing lack of access to trained physicians.1 This increasing demand for ROP screening and treatment and concomitant shortage of ROP treating physicians represents one of the biggest public health challenges of ROP— the workforce crisis. To address, clinicians and public health experts have created new telemedicine infrastructures and innovated artificial intelligence. However, little is known about where in the United States these workforce shortages are the greatest. That’s where our study comes in. Our study aimed to establish the regional and local patterns of access to ROP treatment. Specifically, we wanted to determine the geographic and socioeconomic predictors of community proximity to NICUs treating ROP.
To examine geographic access to ROP treatment, we used geographic information systems, or GIS, analysis. There are many ways that GIS analysts evaluate access and availability of healthcare resources. We decided on travel time as the primary outcome. In order to this, we used sophisticated GIS software to calculate the travel time (based on real traffic patterns) between every census tract in the United States and the single nearest level III or IV NICU. We also built off of the Vartanian et al. study and evaluated travel time to the nearest NICU reporting ROP treatment. We then paired our data with large, publicly available datasets from the United States Census Bureau and the Centers for Disease Control and Infection, to better characterize the sociodemographic factors of each census tract community.
What did you find?
It is no surprise that we found that as compared to urban census tracts, rural census tracts have a significantly greater mean distance to travel to the nearest level III and IV NICU and NICU treating ROP. We also found that when stratified, both rural and urban census tracts had a greater mean distance to NICUs offering anti-VEGF therapy, as compared to laser. Most importantly, we performed a multivariable regression analysis which showed that rural, poorer, and more non-white census tracts had a significantly higher odds of travelling for more than one hour to reach a level III or IV NICU or a NICU offering ROP treatment. On the other hand, census tracts in counties with a higher prevalence of very low birthweight (VLBW) births had lower odds of travelling for more than an hour. When we display our data topographically, we find outliers—communities with a higher prevalence of high risk VLBW babies that are very distant from treating centers.
What does this mean for addressing the workforce shortage in ROP?
Our data suggests that some communities are at higher risk of greater travel burden. Using GIS, as we have done in this study, we can find communities for which we may want to focus efforts on physician recruitment or targeted implementation of telemedicine.
1. Vartanian RJ, Besirli CG, Barks JD, et al. Trends in the Screening and Treatment of Retinopathy of Prematurity. Pediatrics 2017;139
