Several outside reviewers of this solicited editorial considered “managed care,” which I had failed to mention, a major barrier to eye care services. From a global perspective, the vast majority of people with whom we share this planet would be delighted to have eye care services that could be “managed.”
“Access” of any type requires trained, qualified providers operating at sufficient efficiency to meet a population's eye care needs. It also requires that patients live close enough to reach these providers, can afford their care, and recognize the value of seeking their services. These complex requisites naturally favor the rich and well-educated. By contrast, the underserved are almost always poor; live in remote, undesirable locations; or are ignorant of the value of intervention (“Once your hair grows white, your eyes grow white”).