U veitis is a leading cause of irreversible vision loss in the United States, with recent estimates indicating an incidence of 60.1 cases and a prevalence of 386.4 cases per 100,000 people each year, respectively. Uveitis accounts for approximately 10% to 15% of cases of total blindness and, in the US, is predominantly noninfectious in etiology, with causes ranging from systemic autoimmune conditions to idiopathic (or undifferentiated) inflammation. Uveitis care is complex and patients can benefit from access to an ophthalmologist with fellowship training in uveitis. Despite its high burden of blindness, the uveitis subspeciality is recognized to be facing a growing workforce shortage. ^, Between 2019 and 2024, there have been between 8 and 16 new fellowship trainees (including foreign trained medical graduates) who match into uveitis each year. On average, the uveitis fellowship position annual fill rate of 63.4% is lower than the 80% fill rate across all ophthalmology fellowships.

Previous work has shown that this trend is due to the complex and time-intensive nature of uveitis care, which requires more patient time, long term management, and multidisciplinary coordination for patients with chronic disease. In addition, perceptions that uveitis involves a lower volume of surgical procedures compared to other ophthalmology subspecialities, and consequently lower financial reimbursement relative to time spent, are factors that can make uveitis solo fellowship less appealing to new trainees. ^,,,

The limited availability of uveitis specialists has important implications for patient access to care, visual outcomes, and broader public health considerations. It is estimated that 94% of uveitis specialists are clustered in large metropolitan areas and tertiary care centers specialists, with a mean travel time of 45.8 minute and creating major access challenges for the 36.7% of Americans who live more than 60 minutes from a uveitis specialist. ^, Those living further from specialists are more likely to be uninsured, live below the federal poverty line, or belong to vulnerable populations facing additional barriers to care, and many must travel across state lines to access treatment. This can lead to treatment delays and worse vision outcomes. While some comprehensive or retina-trained ophthalmologists provide uveitis care, patients treated by fellowship-trained uveitis specialists experience clinically meaningful and sustained improvements in visual acuity. This advantage stems from uveitis specialists’ expertise with various immunosuppressive therapies, optimal dosing strategies, and monitoring for both laboratory and clinical side effects, as well as their ability to recognize when to escalate to alternative immunosuppressive agents or utilize local peri‑ or intraocular corticosteroid therapy.

Although workforce projections have been described for the general ophthalmology workforce and certain subspecialties facing shortages, no other studies have modeled the future supply of uveitis specialists. This study addresses this gap by using publicly available data to characterize the current state of the uveitis workforce and project its future supply in the United States through 2055. These projections aim to inform workforce planning efforts and improve future access to specialized uveitis care.

This study provides the first long-term projections of the uveitis subspecialty workforce in the United States and reveals a critical shortage that threatens patient access to specialized uveitis care. Currently, only 224 registered uveitis specialists practice in the United States, equivalent to 0.66 specialists per 1 million residents, with 11 states having no uveitis specialists at all. Given that most uveitis specialists also practice other ophthalmology subspecialities, the proportion of their clinical time devoted to uveitis care may be limited. As a result, population-adjusted workforce ratios likely overestimate true uveitis coverage. Our projections indicate that without intervention, the workforce shortage will worsen. A conservative scenario demonstrated that the workforce could decline by 35% to just 145 specialists by 2055. Even maintaining the current status-quo of 12 fellowship graduates annually would only modestly increase the workforce to 268 specialists (+20%) by 2055, which would barely keep pace with the expected population growth by this year. Only an optimistic scenario in which 20 annual uveitis fellowship entrants would lead to nearly doubling the workforce to 418 specialists by 2055 would there be increased access to a uveitis specialist by 2055. Since we do not know the ideal ratio of uveitis specialists to patients, it remains uncertain whether even the optimistic scenario would adequately meet the demands of the population. These findings, then, underscore the urgent need for strategic workforce planning to ensure timely and equitable access to uveitis specialty care.

The uneven distribution of uveitis specialists across the U.S. presents major access challenges to patients. Our findings illustrate these geographic inequities, with 11 states lacking any uveitis specialists and 32 states with a density fewer than 1 provider per 1 million residents. These access issues are most pronounced in the South and Midwest regions, placing a large strain on the existing workforce to meet the needs of a high number of patients. This aligns with previous work finding that the largest travel time and distances were for patients in these 2 regions. This is compounded by certain states that have a higher risk of losing uveitis specialists due to retirement in coming years. Not only is this an issue for patients from more rural areas who need to travel farther to receive treatment, the limited workforce capacity disproportionally affects vulnerable groups, including racial and ethnic minorities, ^, individuals with low health literacy, and those facing financial barriers due to the high cost of care who are all at a higher risk of uveitis complications.

The growing burden of uveitis and expanding population in the United States makes adequate uveitis subspeciality workforce capacity increasingly critical. Between 2013 and 2023, analysis of ICD codes across all age groups and anatomic subtypes showed that the incidence of uveitis increased from 44.5 to 60.1 cases per 100,000 people each year, while prevalence nearly doubled. The same study also reported a higher burden of low vision among uveitis patients in recent years, with anterior uveitis having the highest incidence by anatomic location. A population-based study in Minnesota, demonstrated a 1.6-fold increase in the incidence of uveitis over a 50-year period. Hospitalization for syphilis-related uveitis has also risen in recent years. One of the main causes of noninfectious uveitis is autoimmune disease and there is evidence showing a rising prevalence of autoimmune-related conditions in the general population. Noninfectious uveitis primarily affects females and individuals in their working or school years (20-50 years old), in whom complications such as glaucoma and cataracts can cause vision loss early in life. As a result, these patients are more likely to require long term, steroid-sparing immunosuppression and sustained care. Maintaining a steady workforce of uveitis specialists is therefore critical to meeting the long-term demands of the United States population.

A workforce shortage is projected across ophthalmology where a rising demand and declining supply are projected to create a 30% workforce inadequacy by 2035, the second-worst rate among 38 medical and surgical subspecialties. The uveitis workforce faces more acute strain due to several factors. First, the management of chronic, complex disease is highly time intensive and reimbursed poorly compared to procedural work in ophthalmology, making it a less financially incentivizing specialty. Second, fewer than one-third of specialists report access to ancillary personnel such as nurses or physician assistants, which increases provider workload. Uveitis specialists also spend longer with each patient and must have specialized knowledge in coordinating immunomodulatory therapies, which reflects the complexity of care and need for multidisciplinary management which requires more time and effort. It has been reported that 41% of uveitis specialists feel varying degrees of burnout, another 49.5% reported being stressed but not burned out, and burnout levels were associated with feelings of inadequate compensation, a regional shortage of uveitis specialists, and inadequate support staff. These factors threaten ophthalmologist sustainability and have direct implications for patients’ visual health. It has been shown that early referral to a uveitis specialist improves visual acuity outcomes, supporting the need for the development of guard rails and support structures that will allow for growth and stability in the uveitis workforce.

These challenges may make the specialty less appealing to potential trainees, jeopardizing the future workforce of uveitis specialists. Between 2019 and 2024 the number of participating uveitis fellowship programs grew from 11 to 18 and fellowship positions has grown from 15 to 22. Yet, the uveitis fellowship fill rate has averaged 64% over the past 5 years, which is below the average ophthalmology fellowship fill rate of 80% and suggests less interest relative to available training opportunity in the field of uveitis. Notably, out of the total matched ophthalmology fellowship applicants in 2024, 26% were international graduates (including Canada) who may not stay in the United States to contribute to the uveitis workforce after training.

Several efforts are aimed at strengthening the workforce pipeline. The concern that uveitis specialists cannot do surgery aims to be addressed by hybrid fellowship models which allow trainees to dually complete training in surgical retina, cornea or related areas. The increasing use of local therapies is positioned to help with financial reimbursement. In addition, the creation of professional groups like the “Young Uveitis Specialists” within the AUS, aims to provides greater mentorship resources and guidance to those in their first 10 years of practice. Additionally, the Understanding Viewpoints and Expectations in Applicants (UVEA) task force, has been established by the AUS to address the workforce shortage by seeking to increase the number of uveitis fellowship applicants. Furthermore, the American Academy of Ophthalmology is lobbying to increase Medicaid reimbursement rates for ophthalmology. Emerging tools like artificial intelligence and machine learning, which have a unique potential in ophthalmology, may contribute to reducing the administrative burden and possibly increase efficiency in a uveitis clinic. Given that uveitis is associated with significant medical costs, work loss and worse health, addressing workforce gaps is both an important public health and economic consideration.

This study is not without limitations. The workforce estimates were based on the American Uveitis Society (AUS) roster, which may not capture all practicing uveitis specialists. Using this source we identified 224 active uveitis specialists as of May 2025, compared with 208 reported in earlier studies and 223 in a 2023 analysis using both the AUS and Ocular Immunology and Uveitis Foundation websites. A 2025 analysis using 3 different databases identified 447 self-reported uveitis specialists, of whom 265 had completed a uveitis-specific fellowship. These discrepancies may be due to differences in data sources and inclusion criteria and more registered physicians in recent years. For this analysis, we restricted inclusion to U.S. based specialists and manually verified practice locations by internet search for individuals without a listed address to ensure inclusion of AUS registrants who may have been missed by automated filtering. However, we did not verify retirement or mortality at the time of analysis. The model assumes continued fellowship entry patterns and retention of international medical graduates who complete uveitis fellowship in the U.S. workforce. Our conservative scenario could help approximate a scenario with reduced IMG participation in the workforce. Our estimates do not account for full-time equivalent (FTE) status, which could significantly affect the current and future workforce capacity. Many ophthalmologists manage uveitis patients as part of a surgical retina, cornea or medical retina practice, with a prior survey finding that 19% practiced uveitis exclusively and another analysis finding that 62.6% have training in medical and/or surgical retina. ^, Several assumptions in modeling also introduce variability. The fixed entry age is speculative and subject to the limitations of HRSA and AMA demographic data, but there are a myriad of training pathways and international medical graduates or those who had completed multiple fellowships may contribute to variability. To address this, we retrospectively implemented an age structure based on a normal distribution, although this may not fully reflect actual ages. The stochastic model has a high level of compounding variability, which limited the interpretability of results. The current workforce data limited by the veracity of AUS directory and may not be the most up to date and reflect recent provider relocations. The density-corrected population projections are limited by the 2023 U.S. Census data, which does not account for individuals that do not participate. Finally, these supply projects should be contextualized with uveitis provider demand, which was outside the scope of this current study.