Overview of issues with provision of paediatric ophthalmology care
Reviewed by Fiona Rowe

Previous reports have summarised a consistent decline in paediatric ophthalmology over the past 20 years with significant differences in mean salary compensation for paediatric ophthalmologists vs. other ophthalmology subspecialties. Many subsidise income by other non-paediatric work or retire early. With the Covid-19 onset, many report clinical and surgery revenue losses of up to 100% with 10% declaring bankruptcy. Issues have been noted with Medicaid reimbursement and discrepancies in ophthalmology professional fees. Some US states had severe access issues to paediatric ophthalmology services. Perceptions among ophthalmology trainee residents were that paediatric ophthalmology is not prestigious. Practical solutions include hybrid fellowship training of paediatric ophthalmology and adult cataract surgery, hiring lobbyists, improving Medicaid reimbursements, use of OCT to monitor amblyopia as an added professional / technical fee, financial agreements with optical shops and with neonatal units, expanded use of paediatric optometry and orthoptists, early exposure to medical students and changing reimbursement codes particularly in relation to children and no-show cancellation fees.

What we learned about the economic and workforce issues in pediatric ophthalmology: access to eye care and possible solutions.
Lee KE, Sussberg JA, Nelson LB, Thuma TBT.
JOURNAL OF PEDIATRIC OPHTHALMOLOGY AND STRABISMUS
2023;60:323–9.