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A shrinking ophthalmology workforce and rising demand create a pivotal opportunity for optometry
By Richard Edlow, OD
May 18, 2026
In tracking a vast dataset of numbers—VisionWatch, Medicare Payment and Utilization, U.S. Census Bureau age projections and vision care workforce numbers—the picture becomes clearer. America is getting older, demand for eyecare is rising and the traditional supply of ophthalmologists is not growing to scale to meet it. That combination is not just a public health challenge; it’s a real opportunity for optometry—if met strategically.
First, ophthalmology is constrained and getting tighter. There is roughly one ophthalmologist for every 20,000 people. The workforce is already tight, and by 2038, the current shortage could more than triple, dropping adequacy to about 72%, according to the Health Resources and Services Administration workforce projections. My workforce projections indicate a net decrease in the supply of ophthalmologists from 2025 to 2035 of 126 PER year.
Add to the decreasing pipeline of new ophthalmology capacity, it becomes clear that the supply of ophthalmologists will be insufficient to absorb a rapidly growing volume of age-related eye disease and routine care needs. In short: Ophthalmology will need to focus increasingly on surgery and complex medical retina, leaving gaps in clinic-based medical and routine eyecare.
Demand: the aging population will drive millions more visits
My analysis of VisionWatch and Medicare utilization numbers, applied to census projections, generate estimates that between 2025 and 2030 demand will increase by roughly:
- 2 million routine eye exams per year, and
- 9 million medical eye exams per year (from 70M to 79M medical exams).
That’s an increase of about 11 million exams annually by 2030. Those are conservative, utilization-based projections.
WHAT THIS MEANS FOR OPTOMETRY
There are about 49,700 optometrists in the workforce today. If every one of them absorbed an equal share of the additional 11 million exams, that would translate to roughly 210 more exams per optometrist per year—about four more patient visits per week. Manageable, right?
But here’s the crucial nuance: Only about one-third of the optometric workforce is currently delivering medical eyecare at the level many communities will need. When you allocate the increased medical exam volume against that smaller group, the math changes dramatically. The same increase of 11 million exams becomes roughly 634 additional exams per medically active optometrist per year. That averages out to about 12 to 13 extra patients per week. For a busy clinician, that’s a meaningful workload increase and a potential bottleneck.
The opportunities are truly plentiful, particularly in areas where robust ophthalmology clinics are more scarce. Not only will practicing at a fuller scope help close some of the gaps, it creates an important revenue model for optometry practices.
Incorporate diagnostic testing
Add or increase diagnostic testing—OCTs, visual fields, imaging for glaucoma and retina, dry eye diagnostics and even aesthetics-related services.
Encourage more optometrists to deliver medical eyecare
Training, mentorship and practice models must emphasize clinic-based medical management and co-management. The greater the number of ODs who treat medical eye conditions, the burden eases for others.
Invest in efficiency-enhancing technology
AI-assisted image triage, automated OCT interpretation and robust voice recognition for documentation can increase per-clinician capacity without compromising care. Practices that adopt these technologies thoughtfully will handle higher volumes more sustainably.
Begin to scale diagnostic capacity now
The projected increase in medical exams implies many millions more diagnostic tests. Practices and groups need to plan for that equipment and staffing growth now.
Focus on workforce development and retention
New ODs coming into the workforce are highly trained in medical eyecare. For those practice owners who want to expand their co-management, dry eye, aesthetic or medical services, hiring associates who have the interest and skills can be a practice growth-driver.
DON’T MISS THE AGING EYE OPPORTUNITY
The opportunity is real, but it’s not automatic. You’ll need to be deliberate—adopt workflows, technologies and training that enable more medical care. Or partner with colleagues to expand capacity where it’s most needed.
With an estimated 67 million baby boomers in the U.S., the demand for more complex vision care services runs straight through optometry offices. With strategic, purposeful action—training more clinicians for medical practice, adopting efficiency technologies, and building diagnostic capacity—we can both improve access and grow a healthy, resilient profession.
Read more on senior patient care here.
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Richard Edlow, OD, is known in the industry as The Eyeconomist. Dr. Edlow is a founder of Catonsville Eye Group in Baltimore and is retired from clinical practice. To contact: rcedlow@gmail.com |
