Healthcare deserts—areas without adequate infrastructure or access to medical services—now exist in approximately 80 percent of U.S. counties and affect roughly one in three Americans, according to a 2025 report from GoodRx Health, an online health information resource. Since 2021, these regions have seen an expansion in pharmacy deserts, the report noted, while access to critical hospital services, such as trauma care and beds, has remained stagnant. With nearly 60 percent of counties facing more than one type of healthcare desert, these areas disproportionately impact low-income and uninsured populations, which further exacerbates existing health disparities. The GoodRx Health report flagged Wyoming (87 percent), Vermont (74 percent), Montana (70 percent), New Mexico (60 percent) and Alaska (56 percent) as states with an especially high share of the population living in some kind of healthcare-desert county.
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Healthcare deserts can also exist within the vision care sector. “A desert is the term I reserve for residents ‘beyond reach’ of an ECP, more than a 30-minute drive away, which is the established access standard,” said Ron Krefman, OD, FAAO, and CEO of focalCenter, a vision industry market research consultancy firm. “But proximity alone doesn’t mean availability, so at focalCenter we measure access [to eyecare] three ways, each by geography and built into a platform we call eyeSITES. An underserved market is the broad case: thin provider density—fewer than half the national rate of ECPs per 10,000 people. A desert adds the distance test just described—residents living beyond a 30-minute drive of care.”
An October 2025 report from Georgetown University, titled Beyond Supply: A New Framework for Identifying Healthcare Deserts in the United States, noted that although healthcare deserts are significantly more impoverished than other areas, they only represent 28.7 percent of census tracts where the median household income falls below 200 percent of the federal poverty line—the benchmark for Medicaid and insurance subsidy eligibility. This suggests that factors independent of economic standing also play a critical role in influencing healthcare access, health outcomes, and the designation of a region as a healthcare desert.
According to Dr. Krefman, nationally there are approximately 730 underserved counties—home to nearly 11 million people; about 265 desert counties where most residents sit beyond a 30-minute drive, some 4 million people; and close to 500 voids, which are counties with no ECP of their own and have sparse access to ophthalmologists. “Access is tightening, not easing—demand is outrunning supply and the ophthalmology workforce is growing far slower than need—and the cost is real: failure in early detection of ocular and systemic disease.”
Filling an Eyecare Void
In the optical sector, teleoptometry has emerged as a practical way to extend professional eyecare services into regions where providers are otherwise scarce. Teleoptometry, a form of telemedicine, can be defined as the delivery of optometric care—including eye health evaluations, vision screenings, and prescription services—using digital telecommunications and advanced diagnostic equipment. Tele-refraction, coupled with remote optometrist guidance, can address the optometry resource gap in underserved areas, according to the National Institutes of Health.
With an aging population, these service gaps are increasingly viewed as significant public health crises, often resulting in the late diagnosis of sight-threatening conditions such as diabetic retinopathy, macular degeneration and glaucoma. To combat this issue, several strategies have been suggested, including the deployment of mobile clinics and the expansion of the scope of practice for optometrists to further address these gaps in eyecare.
However, the most promising methods for reducing the healthcare access gap may lie in innovative care models like remote diagnostic screenings, virtual consultations, and teleoptometry, which serve as essential bridges to treatment. Artificial intelligence is stepping in to assist practitioners, enhancing diagnostic accuracy and allowing remote monitoring for conditions such as myopia and dry eye disease.
The American Academy of Optometry offers the Ocular Telehealth Special Interest Group (SIG) with the mission to gather and disseminate information regarding virtual eyecare and to promote innovative technology in telemedicine. Ocular Telehealth participants include individuals from academia, industry, government and healthcare with an interest in providing ocular care through telecommunications technology. The Ocular Telehealth SIG focuses on eye and ocular adnexa (supporting structures that surround and protect the eyeball) issues, using the eye as a window to the overall health status of patients.
“Telehealth can fundamentally change the access equation. Instead of requiring patients to travel 50 or 100 miles to see a specialist, we can bring vision screening and monitoring directly to community health centers, pharmacies, or even mobile units in their neighborhoods,” said Anney K. Joseph, OD, FAAO, a teleoptometry provider with the TECS (Technology-based Eye Care Services) program at the VISN 7 Clinical Resource Hub, part of the Atlanta Veterans Affairs Medical Center since 2020. She is also an executive board member of the American Academy of Optometry’s Ocular Telehealth Special Interest Group. “A trained technician captures high-resolution retinal images and visual acuity measurements, then a licensed eyecare provider can review them remotely and provide prescriptions and/or referrals.”
Dr. Joseph added, “With diabetic eye screenings, we can reach at-risk populations who might never make it to a traditional office visit. The key is designing the pathway correctly: clear protocols for when someone needs in-person care, structured referral processes, and making sure we’re not just screening people and leaving them in a diagnostic dead-end. The technology enables access, but the workflow design determines whether it actually improves outcomes.”
To fully appreciate how these digital tools can overcome geographical barriers, it is essential to understand the scope and capabilities of teleoptometry.
“The impact on population health is serious. People in these areas often go years without eye exams, possibly missing early detection of diabetic retinopathy, glaucoma, or macular degeneration—conditions that can cause irreversible vision loss if caught too late,” said Trennda Rittenbach, OD, who currently cares for veteran patients throughout the U.S. Department of Veterans Affairs via telemedicine. “Optometrists are on the front line in helping detect chronic medical conditions during an eye exam such as diabetes, hypertension, stroke, etc. Vision loss doesn’t just affect eyesight—it impacts independence, employment, mental health, and overall quality of life. In these desert areas where access is lacking or non-existent, opportunities for early detection may be missed contributing to poorer overall health outcomes.”
Driven by technological progress, retail providers are also doing their part to bridge healthcare service gaps that traditional clinical settings often cannot reach by deploying wellness kiosks. These innovations utilize hybrid care models and integrated applications, allowing doctors to consult with patients, conduct assessments, and make diagnoses from a distance. Furthermore, these systems facilitate remote condition monitoring and the electronic prescribing of medication, serving as a digital complement to traditional face-to-face medical encounters.
According to The Business Research Company’s Global Tele-Optometry Platform Devices Market Report 2026, the size of the teleoptometry platform devices market has grown exponentially in recent years. The report projects that the market will increase from $1.80 billion in 2025 to $2.18 billion in 2026 at a compound annual growth rate (CAGR) of 20.8 percent. The growth can be attributed to increasing adoption of telemedicine services, growing prevalence of vision disorders, rising demand for remote eyecare, expansion of healthcare digital infrastructure, and increasing awareness of preventive eye health. However, despite this rapid market growth, the integration of these services faces significant hurdles.
Barriers to Adoption
While adoption of teleoptometry to provide eyecare services in these “healthcare deserts” does appear to be growing, barriers to adoption remain, including technological deficits, regulatory and reimbursement issues, and digital literacy among patients, particularly in older patients.
Expanding the reach of teleoptometry requires addressing several critical areas, according to Jennifer Bulmann, OD, chair of the American Academy of Optometry’s Ocular Telehealth Special Interest Group. Building on the earlier clinical workflow concepts identified by Dr. Joseph, Dr. Bulmann argues that to truly improve national health outcomes, the profession must design intentional care pathways focused on patient access at both the operational and policy levels.
Dr. Bulmann outlined what she sees as the essential requirements for expanding the reach of teleoptometry. First, regulatory frameworks must evolve to allow for task-shifting, where trained technicians perform standardized tests under supervision, and for interstate licensure to enable optometrists to provide care across state lines while maintaining safety standards. Second, she noted, reimbursement models need to improve, as current coverage is often inadequate for asynchronous “store-and-forward” care, a virtual healthcare method where patients or providers securely transmit recorded medical data, which is a critical method for reaching rural communities. In addition, stakeholders must advocate for policies that enhance the interoperability of electronic health records and support programs designed specifically for uninsured and Medicaid-eligible populations.
“We need to advocate for our patients at the policy level,” Dr. Bulmann said. “Examples are: better interoperability of electronic health records thereby improving care coordination; and supporting community-based programs specifically targeting Medicaid and uninsured populations. Thinking beyond our traditional office-based model and designing intentional care pathways that prioritize access and outcomes for patients will improve our overall health as a nation.”
ODs can help teleoptometry extend its reach in several ways, including meeting people where they are: in part-time and satellite offices, mobile clinics, by providing regular visits to counties with no ECP of their own, and partnerships with community health centers, schools, and family-medicine practices—plus loan forgiveness and mentoring that steer new graduates toward small towns and rural areas, according to Dr. Krefman. “All of it depends on knowing where the gaps actually are, which is what we built eyeSITES to show: a tool that ranks every U.S. market by how hard care is to reach, how thin the local supply of ECPs is, and how much consumer demand sits there—so a doctor weighing a second office, or a group planning to expand, aims at real unmet need.”
Provider and Patient Adoption
Provider adoption of telehealth is on the rise, but consumer embrace of teleoptometry is progressing more gradually. Data from The Vision Council’s 2023 inSight Report indicates that this slower pace is primarily due to a lack of consumer awareness and apprehension regarding reduced direct engagement with eyecare professionals. The report further reveals a clear divide in future intent: while nearly one-third of adults who have not yet utilized eyecare telehealth express interest in doing so, almost half of that same group remain hesitant and uninterested in adopting these services.
Research published in the Annals of Family Medicine, a peer-reviewed open-access medical journal dedicated to primary care, found that patient willingness to use telehealth is driven by several key factors, including convenience, efficiency, and communication, alongside considerations for privacy and comfort.
“Awareness varies significantly by demographic. Younger patients and those already comfortable with technology tend to embrace virtual options,” said Dr. Joseph. “Older patients or those with limited digital literacy often need more education and support. However, once they experience how convenient it is and they avoid a two-hour roundtrip for routine eyecare, they become advocates.”
A recent literature review in Telemedicine and e-Health, titled “The Role of Optometry in the Delivery of Eye Care via Telehealth,” concluded, “The application of teleoptometry to deliver eyecare is rapidly emerging, and appears to be a viable adjunct to the delivery of in-person optometry services.” In the same journal, a separate study found that while the majority of U.S. eyecare providers were not using virtual healthcare before the COVID-19 pandemic, just months into the U.S. outbreak, 77.4 percent were using virtual healthcare in their daily practice.
“The bigger challenge is communicating what telehealth can and can’t do,” said Dr. Joseph. “We are careful to explain that a remote screening doesn’t replace a comprehensive in-person eye exam. Certain symptoms such as sudden vision loss, flashes, floaters, or severe pain require immediate in-person care. Setting appropriate expectations is crucial for patient safety and trust. Our patients are screened with a specific set of questions before being seen in our telehealth clinics. We steer those who have the above symptoms (flashes, floaters, severe eye pain, double vision for example) from being seen in a screening telehealth setting and into face-to-face eyecare.”
