Pediatric Ophthalmology and Strabismus of the Future

Abstract

I t is well publicized that the United States faces two major demographic changes over the next few decades: the increasing mean age of the population and the increasing overall size of the population (336 million estimated in 2020). The changes will have the greatest impact on health care services provided to the segment of the population over 60 years of age. This will substantially increase the demand for eye care services. Amid the clamor over the need for improved systems to provide quality treatment of age-related macular degeneration, glaucoma, and cataract, it is left unsaid that there will be an increase in the number of adults with strabismus seeking care, in part because they seek an improved quality of life. Substantially less has been written about the demands on the pediatric ophthalmic surgeon. The U.S. Census Bureau projects that between 2000 and 2020 the proportion of the population under 20 years of age will fall only slightly, from 28.5% to 27.4%. In discussions about the aging of the U.S. population, it is often forgotten that the population under 20 years is not shrinking but growing. The U.S. Census Bureau estimates growth to be nearly 10%, increasing from 80.5 million in 2000 to 88.9 million persons by 2020. How we will meet these escalating demands for adult strabismus and pediatric ophthalmology services deserves our immediate dialog and planning. This issue of the Journal of AAPOS contains three reports pertaining to supply and demand of pediatric ophthalmology and strabismus services. Estes and colleagues evaluated the current distribution of 749 pediatric ophthalmologists who were members of the American Association for Pediatric Ophthalmology (AAPOS) and 227 additional physicians who identified themselves as pediatric ophthalmologists in the American Academy of Ophthalmology (AAO) member database. They made two key observations. First, there is substantial regional variation in the U.S. population, with Metropolitan Statistical Areas (MSA) including from 17.8% to 42.6% in the 0 to 20 years age group. Users of the database should pay particular attention to adjusting the search findings to account for the proportion of the population less than 20 years of