Ophthalmology deserts leave rural patients driving 3+ hours for retinal exams

The US has roughly 19,000 practicing ophthalmologists, but they are concentrated in metropolitan areas, leaving entire regions of Appalachia, the Great Plains, and the rural South with zero ophthalmologists within a 90-mile radius. A diabetic patient in rural Mississippi who needs a dilated retinal exam every six months to prevent blindness must drive 3+ hours each way, take a full day off work, and arrange transportation because they cannot drive home with dilated pupils. Telemedicine retinal screening (using fundus cameras operated by trained technicians) could solve this but is reimbursed at only $15-25 per read by Medicare, making it economically unviable for practices to deploy remote screening stations. The shortage persists because ophthalmology residency slots have been federally capped since 1997, and the majority of graduates choose subspecialties (LASIK, cosmetic) in cities over general eye care in underserved areas.