JMIR Publications

ABSTRACT

Background:

Rural United States (US) communities experience disproportionately high rates of visual disability yet have limited access to ophthalmologists. Teleophthalmology may help address these gaps, but its effectiveness depends on broadband availability. The relationship between broadband access and ophthalmologist density has not been well characterized.

Objective:

To quantify the association between household broadband access and county‑level ophthalmologist density and to identify sociodemographic predictors of limited broadband availability.

Methods:

We conducted an ecological study of all 3,141 US counties using 2019 data from the American Community Survey, Area Health Resources File, and National Center for Health Statistics. Broadband access was the primary exposure; ophthalmologist density per 100,000 residents was the outcome. We used simple and multiple linear regression adjusting for urbanicity, income, education, age, sex, race/ethnicity, unemployment, and insurance status. Sub-group analyses compared metropolitan and non-metropolitan counties. County-level heatmaps illustrated geographic patterns.

Results:

Median household broadband access was 56.6%, ranging from 72.2% in the most urban counties to 49.1% in the most rural. Each 10-percentage-point increase in broadband access was associated with 1.13 more ophthalmologists per 100,000 residents in unadjusted models and 0.86 more in adjusted models (p < 0.001). Associations persisted in both metropolitan (β = 0.129) and non-metropolitan (β = 0.047) counties. Regions with both low broadband access and low ophthalmologist density were concentrated in the South, Western Mountain region, and Alaska.

Conclusions:

Broadband access is strongly associated with ophthalmologist availability across U.S. counties, independent of sociodemographic factors. Areas lacking ophthalmologists also tend to lack broadband infrastructure, creating compounded barriers to both in-person and teleophthalmic care. Efforts to expand broadband may support more equitable access to vision services in underserved regions.